A retrospective review of pregnancy outcome after misoprostol (prostaglandin E1) induction of labour

ABSTRACT

This retrospective study looked at the outcome of using 50-100 ug misoprostol once daily to indicate labour compared to the outcome of the over all patient population delivered during the same period (1994-1996). During that period 11,255 patients were delivered and 1037 (9.2 percent) were induced with misoprostol. Results showed a significantly lower mean Caesarean section rate 9.3 percent for the misoprostol group versus 13.3 percent for the overall population (p=0.002, Odds Ratio (OR) 0.67, 95 percent CI 0.53, 0.83). The abruption rates were not significantly different 0.8 percent for misoprostol versus 0.4 percent (p=0.09,OR 1.86, 95 percent CI 0.81, 4.09). There was more postpartum haemorrage in the misoprostol group 5.6 percent versus 3.5 percent (p=0.0006, OR 1.63, 95 percent CI 1.22, 2.19); a higher incidence of Apgar scores less than 6 at one minute 10.2 percent versus 7.9 percent (p=0.0093, OR 1.33, CI 1.06, 1.65) but not at five minutes 2.9 percent versus 2.4 percent (p=0.674, OR 1.09,CI 0.73, 1.61) and a higher perinatal mortality rate 55/1000 versus 16.1000 (p=0.00, OR 3.5, 95 percent CI 2.55, 4.80). The rate remained higher but not significantly so when a correction was made to eliminate the high number of intrauterine deaths induced with misoprostol 18/1000 (p=0.69, OR 1.11, 95 percent CI 0.66, 1.84). There were no cases of uterine rupture in either group. In conclusion, there was a significantly lower Caesarean section rate among patients who had once daily misoprostol induction of labour. Close monitoring of the foetus, in patients with misoprostol induction, is needed to detect foetal distress and prophylaxis against postpartum haemorrage is still mandatory. (AU)