Abstract
Introduction One great challenge in obstetric care is labor inductions. Misoprostol has advantages in being cheap and stable at room temperature and available in resource-poor settings. Material and Methods Retrospective cohort study of 4002 singleton pregnancies with a gestational age ≥34 w at Sodersjukhuset, Stockholm, during 2009-2010 and 2012-2013. Previously used methods of labor induction were compared with misoprostol given as a solution to drink, every second hour. Main outcome is as follows: Cesarean Section (CS) rate, acid-base status in cord blood, Apgar score < 7,5′, active time of labor, and blood loss > 1500 ml (PPH). Results The proportion of CS decreased from 26% to 17% when orally given solution of misoprostol was introduced at the clinic (p < 0.001). No significant difference in the frequency of low Apgar score (p = 0.3), low aPh in cord blood (p = 0.1), or PPH (p = 0.4) between the different methods of induction was studied. After adjustment for different risk factor for CS the only method of induction which was associated with CS was dinoproston⁎⁎ (Propess®) (aor = 2.9 (1.6–5.2)). Conclusion Induction of labor with misoprostol, given as an oral solution to drink every second hour, gives a low rate of CS, without affecting maternal or fetal outcome.
Highlights
One great challenge in obstetric care is labor inductions
In 2011, labor was induced in 15–20% of all singleton pregnancies in study was funded by “Enquist’s Memorial Fund (Sweden) [2,3,4,5,6,7]
The dosage does not lead to a higher frequency of hyperstimulation of the uterus or affected CTG compared with other prostaglandins
Summary
One great challenge in obstetric care is labor inductions. Misoprostol has advantages in being cheap and stable at room temperature and available in resource-poor settings. Used methods of labor induction were compared with misoprostol given as a solution to drink, every second hour. Induction of labor with misoprostol, given as an oral solution to drink every second hour, gives a low rate of CS, without affecting maternal or fetal outcome. Most common methods of induction are amniotomy, mechanical dilatation with a balloon catheter, pharmacological inductions with prostaglandin E1 (misoprostol), prostaglandin E2 (dinoproston), or oxytocin. High risks of both maternal as well as fetal complications are related to induction of labor. Recent published data of expectant management versus induction of labor shows that there is a significantly elevated risk for Cesarean Section (CS) in full time induced pregnancies, even after controlling for suspected confounders [8,9,10,11]
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