Abstract
Introduction: Induction of labor has become an increasingly utilized obstetric intervention in developed countries. It contributes to reduce the maternal and perinatal morbidity and mortality. Dinoprostone derivatives are often used under cardiotocography. In poor countries, health structures have neither fetal monitoring, nor means of preserving Dinoprostone derivatives. Misoprostol therefore constitutes an alternative. This study seeks to establish the efficacy and safety of oral Misoprostol and to assess maternal and perinatal prognosis in an area with limited resource. Methods: This is a multi-center clinical trial, conducted in 3 hospitals centers in Kisangani, Tshopo Province/Democratic Republic of Congo from December 1, 2020 to May 31, 2021. Our sample was constituted with 68 pregnant women with term pregnancy. Fifty micrograms of Misoprostol was administered orally. The data were collected prospectively, their encoding was carried out on an Excel sheet 2013 and their analysis carried out using the EPI INFO software. Results: The average age of the pregnant women was 23.17 ± 5.76 years. The average parity was 1.02 ± 1.2. The average body mass index (BMI) was 24.98 ± 2.55 Kg/m2. 66 (97.1%) patients had received a maximum of 3 doses of Misoprostol. Out of the 16 parturients who received 3 doses or more, 11 (68.8%) had a BMI ≥ 25. The average duration of labor was 16.03 ± 7.99 hours. 66 (97.1%) pregnant women had delivered vaginally. 57 (83.8%) patients delivered within 24 hours. Out of the 11 patients who delivered after 24 hours, 7 (63.6%) had a BMI ≥ 25. The induction failure rate was 2.9% (2 patients). 2 (2.9%) fetuses had presented pathological modification of fetal heart rate (FHR). 2 (2.9%) patients had undergone cesarean section. Conclusion: Labor induction with oral Misoprostol is effective and associated with low maternal and perinatal morbidity. A BMI ≥ 25 kg/m2 increases the number of doses to be given and the duration of labor.
Highlights
Induction of labor has become an increasingly utilized obstetric intervention in developed countries
Snehil D et al [37] found average labor duration of 10.84 ± 3.37 hours. This duration was less than that we found in our series because in their study, they only started labor in pregnant women with prelabor rupture of membranes, which can induce labor and cause the cervical maturation
Oral Misoprostol is effective in labor induction on term pregnancy, and is not associated with many maternal and perinatal complications
Summary
Induction of labor has become an increasingly utilized obstetric intervention in developed countries. Labor is the set of mechanical and physiological phenomena characterized by the apparition of forceful and painful uterine contractions that affect cervical dilatation and cause the fetus to descend through the birth canal [1] [2] These phenomena normally occur spontaneously in a term pregnancy. Labor induction is a medical intervention that consists of using a drug or non-drug method to induce uterine contractions in order to help the pregnant woman to have a vaginal delivery [7]. This intervention is aimed at pregnant women who have not started labor, regardless of the state of the membranes [7]. The labor induction is successful when a vaginal delivery is obtained within 24 hours [8]
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