A COMPARATIVE STUDY BETWEEN THE USE OF INTRAVAGINAL MISOPROSTOL AND INTRAVENOUS OXYTOCIN FOR INDUCTION OF LABOUR AFTER PRE-LABOR RUPTURE OF MEMBRANES AT TERM
Gona Aziz Rahem a
a Sulaimaniyah Maternity Teaching Hospital, Kurdistan Region, Iraq.
Submitted: 1/1/2019; Accepted: 1/12/2020; Published: 21/12/2020
DOI Link: https://doi.org/10.17656/jsmc.10266
Misoprostol is a prostaglandin E1 analogue medication, has been shown to be effective and safe for induction of labor in women with pre-labour rupture of membranes at term.
The aim of this study is to compare efficacy and acceptability of intravaginal misoprostol with intravenous oxytocin for induction of labor after pre-labour rupture of membranes at term.
Patients and Methods
This study was conducted as prospective randomized trial at the department of Obstetrics and Gynecology in Maternity teaching hospital and Rizgary hospital in Erbil, performed in 2010-2011. The study involved 100 pregnant women with uncomplicated pregnancies at term, with pre-labour rupture of membranes. The women were assigned to receive 50 Microgram of vaginalmisoprostol every 4 hours (50 patients) or oxytocin infusion (50 patients). The patients were selected randomly from the Labour room. The parameter studied were induction to delivery interval, rate of cesarean section, indications of cesarean section, neonatal outcomes, maternal complications and maternal satisfaction. The test that used for statistical analysis of variables was t-test.
The two groups were comparable with respect to maternal age, gestational age in weeks, parity and Bishop score. The time interval from induction to delivery was shorter in misoprostol group (7.77±0.88 hours), compared to oxytocin group (9.91±1.02 hours), which is statistically significant (p-value<0.001) and mean difference between them was (2.138 hours). Maternal satisfaction was more in misoprostol group (92%) compared to oxytocin group (62%) which is statistically significant (p-value<0.001). The rate of caesarean section was (18%) in oxytocin group & (12%) in misoprostol group (p-value=0.401) which is statistically insignificant, no difference of statistical importance seen with regard to indications of C/S, fetal distress, neonatal APGAR score <7, admission to neonatal intensive care unit, fetal weight and sex, and maternal adverse effects of the drugs.
In pre-labour rupture of membranes at term, it is effective, safe and economic to use misoprostol for induction of labour with low cervical Bishop score and is associated with shorter induction to delivery interval compared to oxytocin, with higher maternal satisfaction.
Pre-labour rupture of membranes at term; Induction of labour; Misoprostol; Oxytocin.
1-Tekoaking CNM MPH clinical management of premature rupture of membranes. JNM.1994.39.2.
2- Myles Taylor and Stuart Rundle, Pre labour rupture of membranes, an evidence-based text for the MRCOG, Third edition,2016. 338-344;373-380.
3- Jane E. Norman and Sarah J. Stock. Induction and Augmentation of Labour. Dewhurst’s text book of Obstetrics & Gynaecology, ninth edition,2018. 326-335.
4- Oliver C Ezechi M.B.B.S, Olabisi M Loto M.B.Ch.B, Paschal M Ezeobi M.B.B.S et al. Safety and efficacy of misoprostol in induction of labour in prelabour rupture of membrane in Nigerian women. IJRM. 2004, 117 : 449-452. 12.
5- American college of Obstet &gynec. Induction of labour. ACOG technical bulletin.Washington, D.C: ACOG, 1995.217
6- Harman JH,Kim A.Current trend in cervical ripening and labor induction. American family physician 1999;60 (2).
7- Grane J, St.John`s NF . Induction of labour at term. Monteral QC. SOGC Clinical practice guideline 200; 107.
8- Nooh A, Baghdadi S and Raouf S. Induction of labor; How close to the evidence-based guideline are we? O&GJ 2005; 25(5):451-454.
9- Takayanagi yet-al. Pervasive social deficits, but normal partutition, in oxytocin receptor-deficient mice. Proc Nath Acadsci USA.2005.102:16096-101
10- Ragunath M and McEwan AS. Induction of labor. Obstet. Gyn. Rep.M. 2008. 18(1); 1-6.
11- Laurence DR, Bennent PN, Brown MJ. Clinical pharmacology, Edinburgh, Churchill Livingstone, 8th edition. 1997 ;250.
12- Mary E Hannah-et al. Induction of labor compared with Expectant management for pre labor rupture of membranes at term. The new ENGLAND JOURNAL of medicine. 1996; 334(24):1615
13- Templeton A. Review of Labor Induction with Misoprostol: Route of Administration, Efficacy, Safety, and Potential Concerns In:Shannon CS, Winikoff B editors . Misoprostol. Population Council, 2004; 17-23.
14- Sak Oi S,Pak Ch .Prostaglandin for induction of second trimester trimination and intrauterine death .Best practice and research clinical Obstet. & Gyn. 2003;17 (5): 765-775 .
15- Al-Tikreeti R, Muhauder S, The Treatment of Incomplete and Missed Abortion with Oral Misoprostol (accepted for publication in Iraqi postgraduates) MJ 2005;4(4).
16-Motval. NJ. Cytotec (misoprostol) prescribing information. physicians desk references, 47th ed. Medical Economics Inc. 1993;2251-3.
17- Searle. Cytotec (misoprpstol) product information from the American Hospital formulary service. Skokie, IL; 1988 dec. 6.
18- PDR-Cytotec (misoprostol), package leaflet-Searle 2001. 1461.
19- Ozden S, Delikara MN,Avci A,Ficicio gluc. Intravaginal misoprostol vs. expectant management in premature rupture of membranes with low Bishop scores at term. IJ Gyn. & obstet.2002. 77. 115.
20- Lin, Monique G. MD; Nuthalapaty, Francis S. MD; Craver, Alissa R. et al.Misoprostol for labor induction in women with term premature rupture of membranes: A meta- analysis. Obstet. & gyn.2005. 106. 3. 593-601.
21- Wing DA. A benefit –risk assessment of misoprostol for ripening and labor induction. Drug safety 2002 ;25 (9): 665-676.
22- Sanchez-Ramos L; Chen AL; Kaunit ZAM et al Labour induction with intravaginal misoprostol in premature rupture of membranes: a randomized study. Obstet. Gyn.1997. 89:6, 909-12.
23- Kramer RL; Gilson GJ; Morrison DS et al. A randomized trial of misoprostol and oxytocin for induction of labour: safety and efficacy. Obstet. Gyn.1997.89:3. 387-91.
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