Abstract
Misoprostol has revolutionized labour induction since the early 1990’s, because it is inexpensive and very effective. Eclampsia is common unless the pregnancy can be terminated by induction or by caesarean section. This study was done to determine the impact of Misoprostol used for induction of labour, on the outcome in patients with pre-eclampsia (PE) at the University of the West Indies Kingston Jamaica. This was a retrospective analysis of pre-eclamptic women who were managed before and after the introduction of misoprostol into routine usage for induction of labour. We compared 793 women (controls) in the pre misoprostol era (1986-1991) with 709 in the misoprostol era (1993-1998). Outcome variables were the frequency of mild and severe PE, eclampsia, misoprostol and syntocinon inductions, foetal complications and use of caesarean section (CS). Analysis of frequency of eclampsia, neonatal admissions and CS, during the misoprostol years, was also done to eliminate other confounding variables because of the influence of each era. Logistic regression was used to determine the impact of all variables. In comparison to controls, patients induced in the misoprostol years had a greater incidence of severe PE (p < 0.05), neonatal admissions (p = 0.007), foetal distress (p < 0.05); a higher CS rate (p < 0.05); but fewer oxytocin inductions (p < 0.05). However, sub group analysis of the misoprostol years alone, showed a reduction in the incidence of CS, eclampsia, and neonatal admissions in women who were induced with misoprostol (p < 0.05). Logistic regression revealed a lower odds of CS delivery (OR 0.867, 95% confidence interval .02, .37) using misoprostol. These findings suggest that in patients with PE, induction of labor with Misoprostol had a beneficial effect on pregnancy outcome with a decreased incidence of CS, eclampsia and neonatal admissions, but it has not had a significant impact on the main problems in these patients between the two eras as other factors may be important in the management of these patients independent of misoprostol induction.
Highlights
Pre-eclampsia is defined as the occurrence of hypertension in combination with proteinuria, developing after 20 weeks gestation in a previously normotensive non-proteinuric patient
These findings suggest that in patients with PE, induction of labor with Misoprostol had a beneficial effect on pregnancy outcome with a decreased incidence of caesarean section (CS), eclampsia and neonatal admissions, but it has not had a significant impact on the main problems in these patients between the two eras as other factors may be important in the management of these patients independent of misoprostol induction
The primary outcome variables were the number of patients with a diagnosis of mild and severe pre-eclampsia; misoprostol and oxytocin inductions; eclampsia and other maternal complications such as HELLP syndrome, maternal deaths, ICU admissions and abruption; foetal complications as measured by the amount Special Care Nursery (SCN) admissions, APGAR Score, neonatal deaths and intrauterine growth retardation (IUGR); Caesarean Sections and indications such as foetal distress, failure to progress, failed induction and previous C-section
Summary
Pre-eclampsia is defined as the occurrence of hypertension in combination with proteinuria, developing after 20 weeks gestation in a previously normotensive non-proteinuric patient It occurs in approximately 3 to 14 % of all pregnancies worldwide and is the leading cause of maternal mortality in Jamaica [1,2]. Misoprostol was first used at the University hospital in 1992 and has been the principal induction agent used in patients with an unfavourable cervix, since its introduction [11] Prior to this time patients with pre-eclampsia requiring delivery, were either delivered by caesarean section or had induction of labour with oxytocin if the cervix was favourable or with dinoprostone, which because of cost was not always available. We were no longer hampered by the presence of an unfavourable cervix and its associated complication of failed induction This factor is relevant in preterm patients with severe pre-eclampsia, in whom expeditious delivery is sometimes necessary. Our secondary aim was to see if the use of misoprostol in pre-eclamptic patients, had any influence on pregnancy outcome, such as, a decreased incidence of severe pre-eclampsia, eclampsia or other maternal complications; an improved perinatal outcome; or a decrease in the caesarean section rate
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