A comparative study of labour induction with intravaginal misoprostol verus intravenous oxytocin in premature rupture of membranes beyound 36 weeks gestation.

Background: The recommended strategies for a woman with PROM at term have changed considerably during the last several decades. PROM occurs in about 10% of patients beyond 36 weeks of gestation. IV oxytocin infusion has stood the test of time as labor inducing agent but associated with high perinatal and maternal morbidity. Misoprostol is gaining increasing interest as an alternative induction agent. Aims & Objective: (1) To study the efficacy and safety of labor induction with Intravaginal misoprostol and i.v. oxytocin in women with premature rupture of membranes beyond 36 weeks of gestation. (2) To evaluate & compare the efficacy between vaginally administered misoprostol with i.v. oxytocin. Material and Methods: A prospective randomized study was carried out where 200 women admitted to department of obstetrics & gynaecology, pravara rural hospital, PMT, Loni with PROM beyond 36 weeks of gestation were included where 100 each were included in two groups-Vaginal misoprostol group & oxytocin infusion group. Results: Nearly 58% of the cases of PROM were in the age group 21-25 yrs. No significant association was found between prevalence of PROM with parity. It was seen that lesser the pre induction bishop’s score, more was the time required for a patient to go into active labor. The induction-delivery interval was significantly higher in oxytocin group compared to misoprostol group. Conclusion: Misoprostol is a better inducing agent than oxytocin in low bishop’s score & unfavourable cervix. Misoprostol is an effective & safe agent for induction of labor in women with PROM.

A comparative study of maternal & neonatal outcome and patient satisfaction with intravaginal misoprostol versus intravenous oxytocin in patients with premature rupture of membranes beyond 36 weeks gestation.

Background: Premature rupture of membranes (PROM) occurs in about 10% of patients beyond 36 weeks of gestation. In this situation, labor induction with prostaglandins, has been proved to be beneficial and results in decreased chorioamnionitis, neonatal antibiotic therapy, neonatal intensive care (NICU) admission, and increased maternal satisfaction. Many techniques for induction of labor are available. This prospective randomized comparative study was thus taken up to compare the outcomes of misoprostol versus oxytocin with respect to the maternal and neonatal outcomes and patient satisfaction. Methods: A prospective randomized study was carried out where 200 women admitted to department of obstetrics & gynecology, Pravara Rural Hospital, PMT, Loni with PROM beyond 36 weeks of gestation were included where 100 each were included in two groups- vaginal misoprostol group & oxytocin infusion group. Results: Nearly 58% of the cases of PROM were in the age group 21-25 yrs. Vaginal deliveries were 42% in misoprostol group, where as 44% in oxytocin group; whereas LSCS were 7% in misoprostol group and 5% in oxytocin group. Maximum number of cases had APGAR score between 7-10 in both the groups. Patients with misoprostol induction were more satisfied as compared to patients with oxytocin induction. Conclusions: Labor induction with oxytocin infusion for PROM beyond 36 weeks in an unfavorable cervix is associated with longer duration of the second stage and a higher risk of cesarean delivery for failure to progress in comparison to those with transvaginal misoprostol. Patients with misoprostol induction were more satisfied as compared to patients with oxytocin induction.