The effectiveness and safety of oral misoprostol as compared to intravenous oxytocin in labour induction due to prelabour rupture of membranes at term: a randomised clinical trial At the Kenyatta National Hospital
Abstract
Prelabour rupture of membranes (PROM) is associated with various maternal and fetal
complications, the most notable being sepsis. Infection rates increase with the duration of
rupture of membranes. Thus, timely induction of labour is recommended in order to
reduce this complication. The timing of labour induction is related to the gestation if
there are no other complications.
Objective: To determine the effecacy and safety of oral misoprostol as compared to
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intravenous oxytocin in labour induction in mothers with prelabour rupture of membranes
at term at the Kenyatta National Hospital.
Design: This was a randomized clinical trial.
Setting: Kenyatta National Hospital Maternity Unit.
Participants: 83 pregnant women with prelabour rupture of membranes at term without
an indication for caeserian section were consented and randomized for labour induction
with either oral misoprostol at a dose of 20mcg 2-hourly up to a maximum of 4-doses, or
with intravenous oxytocin according to the WHO protocol. 41 were randomized to the
misoprostol arm while 42 were randomized to the oxytocin arm.
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Main outcome measures: Induction to delivery interval; maternal complications and
early neonatal outcomes.
Results: The overall induction success rates in the misoprostol arm was 81% versus 83%
in the oxytocin arm (P=0.447). The mean induction to vaginal delivery interval in the
misoprostol arm was 8.4 hours as compared to 9.45 hours in the oxytocin arm (P=0.116).
The caeserian section rates were 19% in the misoprostol arm and 17% in the oxytocin
arm (P=0.447, table 4), which was not statistically significant. The maternal outcomes
were similar in the two study arms. Four women had tachysystole in the misoprostol arm.
compared to three in the oxytocin arm (P=O.253). In the misoprostol arm two women had
hypertonus compared to three in the oxytocin arm (P=O.322).There was one case of
hyperstimulation in the misoprostol arm and t•w• o in in the oxytocin arm. There were no
differences in the fetal/ neonatal outcomes. No baby had an Apgar score of less than 7 at
1 or 5 minutes. No baby was admitted to the New Born Unit in either of the two arms.
Conclusion: Oral misoprostol solution solution 20mcg 2-hourly is as efficaccious and as
safe as intravenous oxytocin for labour induction in women presenting with prelabour
rupture of membranes at term at the Kenyatta National Hospital.
Recommendation: Oral misoprostol solution administered at a dose of 20mcg 2-hourly
can be used safely and successfully for labour induction in women with pre labour rupture
of membranes at term at the Kenyatta National Hospital.
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Citation
Master of Medicine in Obstetrics and GynaecologyPublisher
University Of Nairobi College of Health Sciences