Study of vaginal misoprostol for labour induction in intra uterine fetal demise
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20170366Keywords:
Bishop’s score, Induction of labour, IUFD, MisoprostolAbstract
Background: Intrauterine fetal demise (IUFD) is the most undesirable consequence of pregnancy which causes psychological distress to mother and family. It also carries risk of infection and DIC. In literature, various methods have been described to manage the cases of IUFD. Practically prostaglandin analogues are routinely used for induction of labour in cases of IUFD. The objectives of this study were to assess the effectiveness and safety of vaginal misoprostol for induction of labour in IUFD.
Methods: In this prospective study, consecutive series of 100 women with IUFD ≥ 28 weeks of gestation are studied. Detailed clinical history, physical examination and investigations are recorded. All selected cases were induced with vaginal misoprostol 50 μg and the doses are repeated every 6th hourly depending on uterine contractions and Bishop’s score changes.
Results: The average induction to delivery interval is 14.68 hours. All women delivered within 40 hours of administration of first dose of misoprostol with 47%, 86% and 100% delivering within 12 hours, 24 hours and 40 hours respectively. There was significant correlation between mean induction delivery interval and maternal age, parity and Bishop’s score. Minor side effects like chills and fever were noted in 5% of patients and retained placenta and atonic PPH was seen in 2% each.
Conclusions: The low dose vaginal misoprostol for induction of labour in IUFD is a safe, effective and cost effective regimen.Metrics
References
Pritchard JA. fetal death. Inutero Obstet Gynecol. 1959;14:573-80.
Dodd JM, Crowther CA. Misoprostol for induction of labour to terminate pregnancy in the second or third trimester for women with a fetal anomaly or after intrauterine fetal death. Cochrane Database of Systematic Review. 2010;4:CD004901:1-11.
Draycott T, Hawkes N, Read MD. Induction of labor with vaginal misoprostol after intrauterine death from 24 weeks gestation. J Obstet Gynecol. 1996;16:517-8.
Fletcher HM, Wharfe G, Simeon D, Mitchell S, Brown D. Induction of labour with intra vaginal misoprostol versus dinoprostone in intrauterine death: a retrospective study. J Obstet Gynecol. 1996;16:155-8.
Bugalho A, Bique C, Machungo F, Faundes A. Induction of labour with intravaginal misoprostol in intrauterine fetal death. Am J Obstet Gynecol. 1994;171:538-41.
Nyende L, Towobola OA, Mabina MH. Comparison of vaginal and oral misoprostol, for the induction of labour in women with intra-uterine foetal death. 2004;81(4)179-82.
Ezechi OC, Kalu BK, Ndububa VI, Nwokoro CA. Induction of labour by vaginal misoprostol for intra uterine fetal death. J Obstet Gynaecol Ind. 2004;54(6).
Srisomboon J, Pongpisuttinun S. efficacy of intracervico-vaginal misoprostol in second trimester pregnancy termination: a comparison between live and dead fetus. J Obstet Gynecol Res. 1998;24:1-5.
Mariani NC, Leão EJ, Barreto EM, Kenj G, De Aquino MM, Tuffi VH. Use of misoprostol for labor induction in stillbirth. Rev Paul Med. 1987;105:325-8.
Isabel do Nascimento M, de Almeida Cunha A, Regina dos Santos S, Oliveira M, Gonzaga Nunes G, Alvarez FS, et al. Misoprostol use under routine conditions for termination of pregnancies with intrauterine fetal death. 2013;59(4):354-9.
Chittacharoen A, Herabutya Y, Punyavachira P. A randomized trial of oral and vaginal misoprostol to manage delivery in cases of fetal death. Obstet Gynecol. 2003;101(1):70-3.
El-Gharib MN, El-Ebyary MT, Alhawary TS, Elshourbagy SH. Low dose vaginal misoprostol in the management of women with intrauterine fetal death. Clinical Medicine insights: Women’s Health 2010;3:15-21.
Stanton C, Lawn JE, Rahman H, Wilczynska-Ketende K, Hill K. Stillbirth rates: delivering estimates in 190 countries. Lancet. 2006;367:1487-94.
Gomez ponce de leon R, Wing D, Fiala-Misoprostol C. For intra uterine fetal death. Inter J Gynecol Obst. 2007;99:S190-193.