Labor Induction by Vaginal Misoprostol in Grand Multiparous Women

Abstract

Grand multiparas who lived under conditions of poverty, who often are undernourished and anemic, are at particular risk of uterine rupture when labor is induced with oxytocin. This study examined the potential value of misoprostol, a synthetic prostaglandin E1 analog, when used vaginally to induce labor in women with at least five previous deliveries. The 165 participants included 134 with a live fetus and 31 who had experienced intrauterine fetal death. All had a single fetus, and no patient had previously had operative delivery. Membrane rupture was the most common indication for induction, followed by preeclampsia and intrauterine fetal death. No patient received oxytocin in addition to misoprostol. The women with a live fetus received a vaginal dose of 50 μg, while those with a dead fetus received 100 μg. Vaginal misoprostol was generally well tolerated. There were no uterine ruptures in this series. Two patients had placental retention, and three, postpartum bleeding. The cesarean section rate was 11 percent in women with an unripe cervix and only 1.4 percent when the cervix was ripe. The overall rate of 6 percent is about one third of the prevailing rate at the study site. The application-to-expulsion interval (AEI) averaged 10 hours in women with a live fetus and 152 hours with a dead fetus. Respective values in women with ruptured and intact membranes were approximately 9 and 13 hours. Women with a ripe cervix had an average AEI of 82 hours, compared with 142 hours with an unripe cervix. Vaginal misoprostol is an effective and relatively inexpensive means of inducing labor in grand multiparous women. It is a useful alternative to oxytocin whether or not the fetus is alive, especially in low-income settings where there is an appreciable risk of uterine rupture.