The effect of introduction of misoprostol for induction of labour on pregnancy in gravidas with pre-eclampsia

Horace Fletcher, Marvin Reid, Nadine Johnson

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DOI: 10.4236/ojog.2011.12013                

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.

Keywords

Misoprostol; Eclampsia; Labour Induction

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Walker, G., McCaw-Binns, A., Ashley, D. and Bernard, W. (1990) Identifying Maternal deaths in developing countries: Experience in Jamaica. International Journal of Epidemiology, 19, 599-605. doi:10.1093/ije/19.3.599
[2]	Keeling, J., McCaw-Binns, A., Ashley, D. and Golding, J. (1991) Maternal mortality in Jamaica; Health care provisions and causes of death. International Journal of Gynecology & Obstetrics, 35, 19-27. doi:10.1016/0020-7292(91)90058-D
[3]	Xiong, X., Mayes, D., Demianczuk, N., Olson, D.M., Davidge, S.T., Newburn-Cook, C., and Saunders, L.D. (1999) Impact of pregnancy-induced hypertension on fetal growth. American Journal of Obstetrics & Gynecology, 180, 207-213. doi:10.1016/S0002-9378(99)70176-6
[4]	Cunningham, F.G. and Lindheimer, M.D. (1992) Hyper- tension in pregnancy. The New England Journal of Medi- cine, 326, 927-932. doi:10.1056/NEJM199204023261405
[5]	Campos, G.A., Guzman, S., Rodriguez, J.G., Voto, L.S. and Margulies, M. (1994) Misoprostol--a PGE1 analog for induction of labor at term: comparative and randomized study with oxytocin. Revista chilena de obstetricia y ginecologia, 59, 190-195 (in Spanish).
[6]	Chuck, F.J. and Huffaker, B.J. (1995) Labor induction with intravaginal misoprostol versus intracervical prostaglandins E2 gel. randomised comparison. American Journal of Obstetrics & Gynecology, 173, 1137-1142.
[7]	Wing, D.A., Ortiz-Omphroy, G. and Paul, R.H. (1997) A comparison of intermittent vaginal administration of misoprostol with continuous dinoprostone for cervical ripening and labor induction. American Journal of Obstetrics & Gynecology, 177, 612-618. doi:10.1016/S0002-9378(97)70154-6
[8]	Fletcher, H., Mitchell, S., Simeon, D., Brown, D. (1993) Intravaginal misoprostol as a cervical ripening agent. British Journal of Obstetrics & Gynecology, 100, 641-644. doi:10.1111/j.1471-0528.1993.tb14230.x
[9]	Fletcher, H., Mitchell, S., Simeon, D. and Brown, D. (1994) Intra-vaginal misoprostol versus dinoprostone as cervical ripening and labor-inducing agents. Obstetrics & Gynecology, 83, 244-247.
[10]	Del Valle, G.O., Sanchez-Ramos, L., Jordan, C.W., Gaudier, F.L. and Delke, I. (1996) Use of misoprostol (prostaglandin E1 methyl analogue) to expedite delivery in severe pre-eclampsia remote from term. Journal of maternal-fetal medicine, 5, 39-40. doi:10.1002/(SICI)1520-6661(199601/02)5:1<39::AID-MFM9>3.0.CO;2-U
[11]	Fletcher, H. and Hutchinson, S. (2001) A retrospective review of pregnancy outcome after misoprostol (prostaglandin E1) induction of labour. West Indian Medical Journal, 50, 47-49.
[12]	Walker, G., Ashley, D., McCaw, A. and Bernard, G. (1986) Maternal Mortality in Jamaica. Lancet, I, 486-488.
[13]	Alexander, J.M., Bloom, S.L., McIntire, D.D. and Leveno, K.J. (1999) Severe pre-eclampsia and the very low birth weight infant: Is induction of labor harmful? Obstetrics & Gynecology, 9, 485-488. doi:10.1016/S0029-7844(98)00488-8
[14]	Hofmeyr, G.J. and Gulmezoglu, A.M. (2001) Vaginal misoprostol for cervical ripening and induction of labour (Cochrane Review). Cochrane Database System Review, 1, CD000941.
[15]	Bassaw, B., Roopnarinesingh, S., Mohammed, A. and Kuruvilla, A. (1994) An audit of eclampsia. West Indian Medical Journal, 43, 18-19.
[16]	Rockhead, C., Fletcher, H., Reid M. and Morgan O. (2003) Induction of labour with Vaginal misoprostol: A comparison of 50 ug twice daily (50bd) with 100ug used once daily (100 od). International Journal of Gynecology & Obstetrics, 80, 271-277. doi:10.1016/S0020-7292(02)00348-X
[17]	McCaw-Binns, A., Standard-Goldson, A., Ashley, D., Walker, G. and MacGillivray, I. (2001) Access to care and maternal mortality in Jamaican Hospitals 1993-1995. International Journal of Epidemiology, 30, 796-801. doi:10.1093/ije/30.4.796