Safety and effectiveness of oral misoprostol for induction of labour in a resource-limited setting: a dose escalation study

Abstract

BackgroundOral misoprostol as an induction of labour (IOL) agent is rapidly gaining popularity in resource-limited settings because it is cheap, stable at ambient temperatures, and logistically easier to administer compared to dinoprostone and oxytocin. We aim to investigate the safety and effectiveness of a regimen of oral misoprostol in Papua New Guinean women undergoing IOL.MethodsAs part of a prospective dose escalation study conducted at Modilon Hospital in Papua New Guinea, women with a singleton pregnancy in cephalic presentation and an unfavourable cervix who gave written informed consent were administered oral misoprostol, commencing at 25mcg once every 2 h for 4 doses and increased to 50mcg once every 2 h for 8 doses within 24 h. The primary outcomes studied were i) the proportion of women delivering within 24 h of oral misoprostol administration, and ii) rates of maternal and perinatal severe adverse events.ResultsOf 6167 labour ward screened admissions, 209 women (3%) fulfilled the study inclusion criteria and underwent IOL. Overall, 74% (155/209 [95% confidence interval 67.6–79.9]) delivered within 24 h. Most women (90%; 188/209; 95% CI [84.9–93.5]) delivered vaginally with 86% (180/209) having a good outcome for both the mother and baby. Of the 10% (21/209) who failed IOL and underwent caesarean section, a significant proportion of their babies were admitted to special-care nursery compared to babies delivered vaginally (20/21 [95%] versus 8/188 [4%]; Fisher Exact test P < 0.001), but their perinatal mortality rate was not significantly higher (1/21 [5%] versus 2/188 [1%]; P = 0.30). The only maternal death was not study related and occurred in a patient with post-partum haemorrhage, 15 h post-delivery.ConclusionThe oral misoprostol regimen for IOL described in the present study is safe, effective and logistically feasible to administer in a resource-limited setting.

An observational study of 100 cases of 25μg oral misoprostol for induction of labour in term pregnancy

“…6 In this study out of 100 patients 35 required only one dose, 25 required 2 doses and 17 patients required 3 doses, 11 required 4 and 12 patients required 5 doses. In study by Nahar et al, it is showed that out of 60 patients 31(51.7%) patients needed only 1 dose of misoprostol and 24(40%) patients needed 2 doses and only 5(8.3%) patients needed 3 doses of Misoprostol.…”

“…In the study carried out by Marilyn Morris et al on "Safety and effectiveness of oral misoprostol for induction of labour in a resource-limited setting: a dose escalation study" at New Guinea, median age of pregnant women was 27 years. 6 A similar study carried out by Shazia Syed et al have taken 250 pregnant women in age group of 18 to 24 years, among which 47% (118) were primigravida. The mean age with standard deviation of the study population was 24.08±3.25 years with the range of 18 to 31 years in study of Aftabun Nahar et al 7 The most common indication for induction of labour in the present study was postdatism (58%) and PROM was 42%.…”

“…9 In study of Marilyn et al, mean induction delivery interval in patients with postdatism was 9 hours and patients with PROM was 6.4 hours. 6 In the study Shazia et al, The mean inductiondelivery interval was 11±2.7 hours. 8 In Varsha et al, mean induction to delivery interval was 14.16±3.45 hours.…”

“…Marilyn et al showed that the majority of babies (99%; 206/209) survived with a good outcome on discharge. 6 Varsha et al, 6.5% of patients had meconium-stained amniotic fluid, 3% of babies were admitted of which 33.33% were admitted for meconium aspiration syndrome and had good prognosis. Take-home baby rate was 100%.…”

“…In study of Marilyn Morris et al, majority of women underwent induction of labour for post-dates (56%; 117/209). 6 Forty-five (22%) had pre-labour rupture of membranes (PLROM), 28 (13%) had pre-eclampsia and 10 (5%) had suspected fetal compromise including intrauterine growth restriction. In study of Shazia Syed et al postdated women were 52%, PROM was 18.8% and PIH were 16.4%.…”