Pharmacologically and physiologically, prostaglandins have two
direct actions associated with labor: ripening of the cervix and a direct
oxytocic action and there fore have been widely used for induction of
labor in late pregnancy and as abortifacient agents in early pregnancy
(Hofmeyr and Gulmezoglu,. 2001 and Calder., 1999).
The use of natural prostaglandins has been limited by their
instability, high cost, rapid metabolism and high incidence of
gastrointestinal side effects (Egarter et al., 1990 & Calder 1999).
Misoprostol (cytotec ®), asynthetic PGE1 analogue, is as effective
as dinoprostone for pre induction cervical ripening and induction of labor
in patients with low bishop score misoprostol is inexpensive, safe and
simple to administer. (de Aquino and Ceatti., 2003, Gherman et al.,
2001, Birlain et., 2001 and Ozan et al., 2001).
The aim of this study is to find out if the use of misoprostol for
labor induction has any undesirable effects on the mother and the
neonate.
The study included 50 pregnant females with different indications
for labor induction women were enrolled into two groups, each
containing 25 women. In the misoprostol group, induction of labor was
by 50μg intravaginal misoprostol and in the non-misoprostol group,
induction of labor was by physician chosen combinations of stripping or
artificial rupture of membranes, enemas, castor oil and IV infusion
oxytocin.
Summary
95
The Bishop score were used to evaluate the cervical ripening,
cardiotocographic monitoring was used to evaluate the effects on uterine
contraction and fetal heart rate.
All cases were followed up till delivery. Induction-activation
interval, induction-delivery interval, mode of delivery, uterine contraction
abnormalities, fetal heart rate changes, fetal outcome: A pgar score,
umbilical card blood gases and maternal side effects were recorded and
evaluated.
Our results showed that; misoprostol was accompanied by
significantly shorter induction-activation and induction – delivery
intervals, but also accompanied by a higher incidence of hyperstimulation
syndrome.
Successful outcome was achieved in 22 cases (88%) in the
misoprostol group and in 20 cases (80%) in the non – misoprostol group.
Failure to achieve vaginal delivery in the misoprostol group was
due to operative interference for hyperstimulation syndrome while, the
failure to achieve vaginal delivery in the non-misoprostol group was due
to operative interference due to failure to progress in labor.
Neonatal outcomes were similar in both groups, no neonate met the
ACOG criteria for birth asphyxia. |
