A PROSPECTIVE STUDY OF THE EFFECTIVENESS OF THE ROUTE OF ADMINISTRATION OF MISOPROSTOL (ORAL VERSUS VAGINAL), IN INDUCTION OF LABOUR

Abstract

Background and Objective Induction of labour is a common intervention performed in cases when continuing a pregnancy present clear health and safety risk to the mother and or her fetus. Around 20% of all deliveries are preceeded by labour induction, a proportion that has not varied dramatically over recent years. Safety, success and patient’s satisfaction are the major objective with economic evaluation becoming a significant factor in search for an ideal induction method. Misoprostol is an oral prostaglandin compound, structurally related to prostaglandin E1, and manufactured as a treatment for peptic ulcer disease in patients on chronic use of nonsteriodal anti-inflammatory drugs. Though unlicenced for this indication, misoprostol is now being used increasingly in induction of labour, with vaginal and oral administrations. This randomised controlled trial is done to ascertain the effectiveness and safety of the route of administration of misoprostol (oral versus vaginal) in induction of labour in Port Harcourt South- South Nigeria.

Subject and Method A prospective study (Randomized Controlled Trial) involving booked antenatal cases. The experimental group consisted of eligible women billed for induction of labour. An informed consent was obtained from the patients. A logbook of patient was prepared containing details such as hospital number, age, and trial number. A profoma was also prepared for each participant.
On admission into the labour ward, each eligible woman was allocated to one of the experimental groups (oral) or (vaginal route) entirely by chance following randomization sequence. (discussed below).
Result The result showed that the vaginal route of misoprostol was more likely to achieve vaginal delivery within 24 hours than the oral route.The Bishop score was more favourable within 24hours amongst the vaginal route group. The oral route needed further doses of misoprostol, had more side effects and a higher caesarean section rate. The induction delivery interval was shorter with the vaginal route and the fetal outcome was better with the vaginal route. Conclusion In conclusion, the vaginal route of administration of misoprostol is more effective and safer than the oral route especially for the women in our sub-region. The clinical outcome of the vaginal route is also better than that of the oral route. The induction delivery interval is comparable in both groups but the response is rather unpredictable with the oral route. The oral route is more likely prone to abuse of misoprostol.

A PROSPECTIVE STUDY OF THE EFFECTIVENESS OF THE ROUTE OF ADMINISTRATION OF MISOPROSTOL (ORAL VERSUS VAGINAL), IN INDUCTION OF LABOUR