Evaluation of maternal and neonatal results after immediate labor induction by vaginal misoprostol and expectational treatment

Abstract

Annual incidence of induced or strengthened labor in the United States, with nearly doubled increase, has risen from 20% in 1989 to 38% in 2002. For the success of labor induction, cervical status or its desirability is important. Different techniques are used to prepare the cervix. One of these techniques is using misoprostol tablets (Prostaglandin E1 (PGE1)). The aim of this study is to evaluate the maternal and neonatal results after immediate labor induction by vaginal misoprostol and expectational treatment. In a clinical trial conducted in Kosar hospital on 100 patients with diagnosis of premature rupture of the membranes (PROM) in 2006, the maternal and neonatal results that followed the immediate labor induction by vaginal misoprostol and expectational treatment for 12 h and then induction by oxytocin were investigated. The mean age of women was 23.8 ± 4.9 years in misoprostol group and 25.2 ± 5.6 years in the expectational treatment group (P = 0.197). The mean duration of pregnancy in women was 38.5 ± 1.2 weeks in misoprostol group and 38.5 ± 1.1 weeks in the expectational treatment group (P = 0.927). Mean parity of women was 1.74 ± 0.98 in misoprostol group and 1.56 ± 0.86 in the expectational treatment group (P = 0.333). The mean latency was 9.5 ± 2.6 in misoprostol group and 14 ± 4.3 expectational treatment group, which in misoprostol group was significantly less than that in the expectational treatment group (P < 0.000). The mean interval from peak recruitment contraction was 12.3 ± 2.9 in misoprostol group and 17.5 ± 4.9 in the expectational treatment group which in misoprostol group was significantly less than in the expectational treatment group (P < 0.000). Mean Apgar score in misoprostol group was significantly greater than that in the expectational treatment group (P = 0.02). The mean hospitalization duration of misoprostol group was significantly less than that of the expectational treatment group (P < 0.000). Frequency of vaginal delivery was 92% in the misoprostol group and 76% in the expectational treatment group; and the frequency of cesarean delivery was 8% in the misoprostol group and 24% in the expectational treatment group; so, frequency of cesarean delivery in the misoprostol group was significantly lower than that in the expectational treatment group (P < 0.029). Whereas labor induction by misoprostol shortens the duration of delivery and requires no long-term hospitalization and reduces costs for patient and hospital, its application is recommended in all low-risk patients. Since misoprostol reduces cesarean sections (CS) level, it is better to be used in low-risk women and this way, the risks of surgery and anesthesia risks related problems would be decreased. Also, regarding the fact that misoprostol, when compared with oxytocin, it administration requires no tight control and no individuals to constantly be on the clinical presence of the patient, it is more economical in terms of employment and need for medical personnel.