ABSTRACT
CONTEXT: Induction of labor is always a challenge to many an obstetrician more so when the cervix is unfavorable. OBJECTIVES: To determine the efficacy and safety ofmisoprostol in cervical ripening and labour induction. MATERIALS AND METHOD: Aprospective study spanning 2 years and involving 151 patients admitted for cervical ripening and induction of labor at Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria. 50 microgram (mcg) ofmisoprostol was inserted vaginally every 4 hours until cervix became favorable or onset of labor. RESULTS: Main indications for induction of labour were prolonged pregnancy and hypertensive diseases of pregnancy. An average of 2 insertions of 50 mcg tablet was used to achieve cervical ripening in 107 patients (71%) and 80% (120) had spontaneous labor within 10 hours of insertion. The mean insertion-labor interval was 7.86 hours (SD +/- 2.5). The average duration of labour was 9.36 hours (SD +/- 2.9). Vaginal delivery was achieved in 96% of the patients. Uterine hyperstimulation occurred in 9 patients but there was no case of uterine rupture. CONCLUSION: Misoprostol was effective and safe in cervical ripening and induction of labor with a vaginal delivery rate of 96%. It should be an essential drug in obstetric practice especially in low resource settings.
Subject(s)
Abortifacient Agents, Nonsteroidal/therapeutic use , Cervical Ripening , Labor, Induced/methods , Misoprostol/therapeutic use , Abortifacient Agents, Nonsteroidal/adverse effects , Abortifacient Agents, Nonsteroidal/pharmacology , Adolescent , Adult , Delivery, Obstetric , Female , Gestational Age , Hospitals, Teaching/statistics & numerical data , Humans , Misoprostol/adverse effects , Misoprostol/pharmacology , Nigeria , Pregnancy , Prospective Studies , Risk Factors , Uterine RuptureABSTRACT
Spontaneous liver rupture is a rare complication of pre-eclampsia. A booked, 30-year old woman with pre-eclampsia and twin gestation developed severe abdominal pains 10 hours after a supervised, vaginal delivery. On examination she was in hypovolemic shock with abdominal distension from hemoperitoneum. Uterine rupture was suspected and she had a laparotomy after resuscitation. But at surgery the uterus was intact and instead liver rupture was found which was managed by omental packing after evacuating the clots. Postoperatively, the patient developed acute renal failure that responded well to treatment. The mother and her babies were discharged in good health after 15 days of multidisciplinary management.
