Outcome of Induction of Labour Using 25 Misoprostol in North Central Nigeria: A 5 -Year REVIEW (original) (raw)
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Misoprostol for induction of labour: a survey of attitude and practice in southwestern Nigeria
Archives of Gynecology and Obstetrics, 2008
Background Although supported by research evidence, misoprostol for induction of labour remains contentious. Objective To assess perception and practice of obstetricians regarding use of misoprostol for labour induction. Methodology Cross-sectional questionnaire-based survey of Senior Registrars and Consultant Obstetricians in southwestern Nigeria. Results One hundred and six questionnaires were completed (52.8% Consultants; 47.2% Senior Registrars). Most respondents (96, 90.6%) employ misoprostol for induction in both live and dead fetuses with majority having personally prescribed misoprostol for cervical ripening or induction of labour (97.2 and 79.3%, respectively). Fetal tachycardia, hyperstimulation and ruptured uterus were the commonly reported complications. Twenty-six respondents (24.5%) reported being aware of maternal death in relation to misoprostol use. Only 52.9% of the respondents have protocols guiding misoprostol use in their hospitals. More than half of respondents administer misoprostol 50 μg or higher 6 hourly. Most (92, 87.6%) believe that research evidence backs use of misoprostol for the indication; 89.5% of respondents support use of misoprostol. Most respondents (90, 86.5%) disagree with the notion that misoprostol is too dangerous for induction; only 26 respondents (25.1%) considered oxytocin a better choice for induction; 93 respondents (88.6%) agreed that, given cautious use, misoprostol is safe for induction, while 86 respondents (81.9%) considered misoprostol a cost-effective intervention for labour induction in developing countries. Though senior registrars and younger consultants tended to report side effects more frequently than older consultants, they were more likely to support misoprostol for induction of labour than older consultants. This differences were however not statistically significant (P > 0.05). Conclusion Misoprostol is widely utilized by obstetricians for induction of labour in southwestern Nigeria. Fetal and maternal side effects are commonly experienced. We recommend urgent adoption of evidence-based guidelines in every unit using the drug to prevent complications.
Port Harcourt Medical Journal, 2011
Context: Wide spread use of misoprostol is increasingly commoner in our obstetrics and gynaecological practice, most especially for Induction of labour in spite of its serious associated risks of maternal and fetal complications Objective: To determine the use of Misoprostol for induction of labour among the Obstetricians in the West African sub region. Methodology and settings: During the October 2007 pre examination workshop of the West African College of Surgeons (FWACS), Faculty of Obstetrics and Gynaecology 42 examiners responded through structured questionnaires on the use of misoprostol for induction of labour (IOL) in their institutions of practice. Results: About 91 % admit using misoprostol for IOL with only half (50%) having written protocols for labour induction with misoprostol. Almost all (93%) prefer the vaginal route for the administration of misoprostol and about 74% do not use misoprostol for those with Caesarean section scar compared to only 19% who do. Misoprostol is used for cervical ripening and control of post partum haemorrhage among 24.4% and 50% of the Obstetricians respectively. The commonest complications encountered were Fetal distress, uterine rupture and uterine hyper tonus among 54.8%, 52.4% and 45.2% of the respondents. Conclusions: Misoprostol use was high with yet serious complication occurring among those using it for IOL. Despite the manufacturers and other regulatory agents warning against its use in pregnancy because of serious maternal and fetal complications, misoprostol use for IOL is widespread. A regulated use of this drug especially in pregnancy is advocated.
BMC Pregnancy and Childbirth
Background: Oral 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. Methods: As 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. Results: Of 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. Conclusion: The oral misoprostol regimen for IOL described in the present study is safe, effective and logistically feasible to administer in a resource-limited setting.
Misoprostol use for labor induction in developing countries: a prospective study in Guinea
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2005
Background: The purpose of this study was to assess the efficacy, side effects and cost of misoprostol regimens in various obstetrical situations frequently occurring in developing countries. Study design: One hundred and four parturient women with indications for labor induction received different regimens of misoprostol in the range of 50-800 mg according to their gestational age. Misoprostol was administered by the vaginal route, every 6 h without exceeding four doses. Results: All indications for labor induction concerned women with a gestational age of more than 30 weeks, except in the intrauterine death cases. The mean overall duration of labor was 7.8 h (AE4.6 h). The mean amount of misoprostol used was 226 mg (AE196 mg). The difference in the mean labor duration between the four indications for induction was statistically significant (P < 0.01). It was also significant for the mean total dose of misoprostol used. Total dose of misoprostol and Bishop score were inversely proportional. Two caesarean deliveries and two uterine ruptures were recorded, but no maternal deaths. The mean Apgar score was 8.0 (AE1) at 1 min and 9.5 (AE0.8) at 5 min. In our series, four fetal deaths occurred. The mean cost of misoprostol for labor induction was around US$ 1, with a range of s 0.05-4. Conclusions: The use of vaginal misoprostol appears to be relevant in developing countries in cases where labor induction is indicated. Nevertheless, the advantages of misoprostol (low cost, facility of storage) are counter-balanced by side-effects (C-section, uterine rupture) which can be harmful for the mother and also for the newborn.
2021
Artificial induction of labor (AIL) is the set of techniques intended to induce childbirth in order to reduce maternal-fetal mortality. The aim of this paper was to study the maternal and fetal prognosis after the artificial induction of labor with misoprostol. It was a descriptive prospective study conducted from September 1, 2018 to February 28, 2019 at the maternity unit of the Referral Health Center (RHC) in commune I of Bamako. It was about any pregnant woman at term who had received misoprostol as part of the artificial induction of labor. 102 cases of artificial induction with misoprostol 200 μg were collected out of 3641 deliveries, or a frequency of 2.8%. The age group 28 - 32 years accounted for 56.86% with an average age of 28.8 years. Multiparous represented 54.90% of the number. The history of diabetes and hypertension involved 37.25% of the pregnant women. The main indication was premature rupture of membranes (PRM) (40.2%). Induction was performed between the 37th and...
Induction of Labor using Misoprostol in a Tertiary Hospital in the Southeast of Brazil
Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics, 2017
Purpose To assess cases of labor induction with vaginal 25-µg tablets of misoprostol and maternal outcomes in a tertiary hospital in southeastern Brazil. Methods This was a retrospective cohort study of 412 pregnant women with indication for labor induction. Labor induction was performed with vaginal 25-µg tablets of misoprostol in pregnant women with Bishop scores < 6. Stepwise regression analysis was used to identify the factors present at the beginning of induction that could be used as predictors of successful labor induction. Results A total of 69% of the pregnant women who underwent labor induction progressed to vaginal delivery, and 31% of the women progressed to cesarean section. One or two misoprostol tablets were used in 244 patients (59.2%). Of the 412 patients, 197 (47.8%) required oxytocin later on in the labor process, after induction with misoprostol. The stepwise regression analysis showed that only Bishop scores of 4 and 5 and previous vaginal delivery were indep...
Journal of Current and Advance Medical Research, 2020
Background: Misoprostol is very useful for induction of labour among the pregnant women. Objective: The purpose of the present study was to see the indication and complication of induction of labour by misoprostol among pregnancy women. Methodology: This single center clinical trial was carried out in the Department of Obstetrics and Gynaecology at a private hospital in Dhaka city, Bangladesh from September 2005 to February 2006 for a period of six months. Primi or second gravida patients with the gestational age between 37 weeks to 42 weeks in singleton pregnancy with cephalic presentation and not in labour were selected as study population. After proper selection of the cases, induction of labour was done by applying tablet misoprostol 50mcg in the posterior vaginal fornix. Complication of induction were recorded. Result: A total number of 60 patients were recruited for this study. 24 patients were between 23 to 26 years and 12 patients were between 27 to 30 years. Pre-eclampsia, ...
Postgraduate Medical Journal of Ghana
Background: Induction of labour is indicated when the risk associated with expectant management of labour is higher. The most common indication for labour induction is postdate pregnancy and induction for this indication has been shown to reduce perinatal death. Misoprostol is the most commonly used drug for labour induction at the Korle-Bu Teaching, the leading national referral centre in Ghana. Method: To assess the outcomes in Elective Induction of Labour using 50 μg of intravaginal misoprostol in postdate singleton live pregnancies at Korle-Bu Teaching Hospital. This was a prospective cohort study carried out to measure the rates of vaginal deliveries and factors affecting vaginal deliveries during labour induction. One hundred and sixteen pregnant women of at least 41 weeks gestation. Women were included and followed up from the first insertion of misoprostol to delivery.Results: Eighty-six patients (74.1%) had vaginal delivery and 30 (25.9%) were delivered by caesarean section...
2023
Objective: To compare the effectiveness and safety of 50μg of sublingual misoprostol administered six (6) hourly to that of 50μg of vaginal misoprostol administered four (4) hourly. Methodology: A non-blinded, randomized controlled trial conducted from Sept 1, 2014, to Nov 31, 2014, at a tertiary hospital in Ghana. Hundred and sixty women with medical or obstetric indications for labour induction were randomized into two groups. Results: The rate of vaginal delivery, caesarean section, uterine tachysystole and uterine hyperstimulation were similar in both groups. Sixty-three (78.8%) and 66 (82.5%) mothers in the vaginal and sublingual groups delivered vaginally. More (10.0%) mothers in the vagina group required emergency caesarean for foetal distress. Six (vaginal group) and 8 (sublingual group) of the mothers required emergency caesarean for cephalopelvic disproportion. Three mothers from each group had an emergency caesarean section due to failed labour induction. Almost the same number of mothers had uterine tachysystole in both groups. More (3.8%) mothers in the vaginal group had uterine hyperstimulation. Differences in the mean induction delivery interval and the need for oxytocin augmentation were not significant. No differences were found in the intrapartum passage of meconium, blood loss in the third stage of labour, 5-minute Apgar score <7, and neonatal intensive care unit admissions. Conclusion: The sublingual regimen was as effective and safe as the vaginal regimen in achieving vaginal delivery.