Induction of labor with oral misoprostol in nulliparous mothers of twins

Abstract

The efficacy and safety of oral misoprostol for labor induction of twins is unknown. We conducted a retrospective case-control study to evaluate the use of oral misoprostol in near term (> or =35 weeks) twin pregnancies in nulliparas. Eligible cases were given 100 mcg oral misoprostol, which was repeated after 6 h if labor did not start. Either a third dose or diluted oxytocin infusion were given in intractable cases. Diluted oxytocin infusion was used for augmentation. Controls were nulliparas delivered at > or =35 weeks by elective cesarean section. The two groups were comparable in most aspects, except for fetal malpresentation, which was the major reason for avoiding induction. Of the 69 patients in whom labor was induced, 53 (76.8%) had a vaginal birth, 3 (4.3%) had a combined twin delivery, and 13 (18.8%) had a cesarean during labor. The mean length of stay of the neonates was significantly shorter among study cases, without significant difference in the frequency of delayed discharges as an overall proxy for neonatal complications. Labor induction with oral misoprostol could be offered to patients in whom near term vaginal twin delivery is unequivocally permitted and wish to deliver by the vaginal route.

The effect of induction method in twin pregnancies: a secondary analysis for the twin birth study

“…In their retrospective study of 883 women with twins who underwent a trial of labor, other methods of induction were not assessed and information regarding neonatal mortality and morbidity was missing. As in our study, others have shown that both PG and oxytocin are safe induction agents in twin pregnancy and are not associated with higher rates of hyperstimulation or adverse neonatal or maternal outcomes compared to induction in singleton [3, 11, 12, 28]. …”

Induction of Labor versus Cesarean Delivery in Twin Pregnancies

“…35 weeks. 15 The authors used misoprostol and oxytocin as their primary induction agents. They found that among 69 patients in whom labor was induced, 53 (76.8%) had a vaginal birth, three (4.3%) had a combined VD-CD, and 13 (18.8%) had a CD.…”

“…Additionally, one case of a failed induction required a reoperation for an incisional hematoma. 15 Other studies examining induction of labor in twin pregnancies have compared induction to spontaneous labor. These studies did not find any differences in maternal or neonatal outcomes among women who had induction of labor compared with spontaneous labor.…”

Perfil clínico-epidemiológico das gestações gemelares com parto no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo no período de 2003 a 2006

“…Simões et al [127] Os autores concluem que o uso do misoprostol é seguro e pode ser oferecido para as pacientes que desejam parto vaginal [127] .…”

“…Nos demais casos, a indicação foi eletiva devido a complicações materno-fetais e, essa proporção não sofreu influência da corionicidade. Em estudo realizado por Gardner et al [5] , as principais Simões et al [127] relatam não haver riscos adicionais na indução do parto com misoprostol oral nas gestações gemelares, porém a casuística desse estudo é pequena e mais dados precisam ser aventados para que esses resultados sejam confirmados. Neste serviço, o plantonista pode decidir pela via de parto, por não haver consenso na literatura sobre a melhor via nas gestações gemelares em relação ao comprometimento fetal, e isso ocorreu em 16,9% dos casos [124] .…”