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RANDOMIZED TRIAL OF PROSTAGLANDIN E1 ANALOGUE (MISOPROSTOL) FOR LABOUR INDUCTION AT THE JOS UNIVERSITY TEACHING HOSPITAL, JOS
Abstract
BACKGROUND: Inducing labour when the cervix is ripe is not difficult, but complications increase significantly when the cervix is unripe. There is a plethora of techniques available for labour induction, but the use of PGE and their analogues remains the single most effective means of achieving cervical ripening and labour induction. The usefulness of misoprostol for labour induction is not in doubt, but the optimal dose and regimen has remained uncertain.
OBJECTIVES: To determine the effectiveness and safety of intravaginally administered misoprostol at doses of 25mcg and 50mcg compared with Foley catheter for labour induction.
STUDY DESIGN: The study was a randomized controlled trial carried out at the Jos University Teaching Hospital (JUTH), Jos.
SUBJECTS AND METHODS: This study was conducted from September 2008 to February 2009. A total of 51 obstetric patients met the criteria for inclusion in the study. Primary outcomes measured included clinical effectiveness (induction- delivery interval) and safety (foetal/neonatal outcomes). Secondary outcomes measured included oxytocin and analgesia requirement, uterine hyperstimulation, and foeto-maternal morbidity and mortality.
RESULTS: Among the outcomes measured, the following were statistically significant between Foley catheter and misoprostol groups; mean start-to- delivery interval p= 0.0001, requirement for oxytocin augmentation p=0.001, and analgesia requirement for labour pain p=0.0001. There was no significant difference when the two misoprostol groups were compared for the entire variables.
CONCLUSION: The results of this study suggest that there is no difference in effectiveness and safety between misoprostol 25mcg and 50mcg for the variables measured, but both misoprostol groups differ significantly from Foley catheter with respect to; delivery rate, oxytocin and analgesia requirement.
