TITRATED ORAL MISOPROSTOL SOLUTION COMPARED WITH INTRAVENOUS OXYTOCIN FOR LABOR AUGMENTATION¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬
Osama Hassan Sayed Ahmed Mohamed Amer;
Abstract
Despite numerous reports on augmentation of labor, the questionremains on efficacy and maternal/neonatal safety of oxytocinand misoprostol.
This work aimed tocompare the efficacy and safety of titrated oral misoprostol with intravenous oxytocin for labor augmentation.
This clinical prospective study " double blinded "will be conducted at Ain Shams Maternity Hospital, to estimate the efficacy and safety of titrated oral misoprostol with oxytocin for labor augmentation.
This study including 200 pregnant women attending for delivery in Ain Shams Maternity Hospital from December 2015 to October 2016. Women in spontaneous labor will be eligible if they have cervical dilation of 4–8 cm and require labor augmentation.This study was in 200 participant women, they were randomly distributed divided in two groups, the first arm was misoprostol"Group I" (n = 100), the second arm was intravenous oxytocin"Group II" (N = 100). The cumulative dosage of oral misoprostol administration was 1600 mcg divided into several doses by hours 20 mcg per hour. Elsewhere oxytocin at rate 1 milliunit per minute and exceed to 10 milliunit per minute.
We hypothesis the efficacy of oral misoprostol in induction of labor during the spontaneous labor of active phase 4-8 cm, for women that weren’t show further ripening of the cervix.
The results of this work showed no statistical differences between two studied groups concerning maternal Age (years), Gestational age (weeks), maternal height (cm), parity, cervical dilatation and percentage of ruptured membrane. These findings represent uniformity between two studied groups. Exclusion of primipara and women with cervical dilation less than 4 cm are the main differences between the present study and similar studies.
The total dose used in the current study used 62.5±11.72 µg (40-80) in misopristol group and 940.87±277.54 mIU (637–1851) in syntocinon group.
This work showed that that there were no significant differences between the groups in the percentages of women who delivered vaginally within 12 and significant difference within 24 hours of augmentation. Therefore, labor augmentation with titrated oral misoprostol solution is an effective alternative method.The relative high percentage of vaginal delivery which were higher and shorter than similar studies and Ain Shams maternity hospital vaginal delivery percentage which ranged between 40 to 60% in last 3 years; the relative high incidence could be explained by exclusion of primipara and those with cervical dilation less than 4 cm with higher mean Bishop score exceeding 5.2 in both misopristol and syntocinon group.
As regards percentage of cesarean deliveries; In this study The were 17% in misoprostol group compared to 29% in Oxytocin group, the less amount of these cases due to the small misoprostol dose (62.5±11.72) mcg and (940.87±277.54) milliunit in oxytocin group.
The reporting failure of induction 9 cases from 10 Cesarean in misoprostol arm, and 4 cases from 5 cesarean deliveries. Which show no statistically significance in differences. P value (0.181)between cesarean and P (0.153) between failed of induction.
The failure is due to failure of induction of labor by misoprostol or oxytocin due to inability to ripening the cervix more than active phase or stop of progression of labor or occurring of any complications to fetus including the non-reassuring fetal heart rate (FHR) or any meconium in the placenta. So at this time the babies were delivered by cesarean.
As regards percentage of failed induction; this work showedpercentage of 15%in misoprostol group compared to 23% in Oxytocin group (p-value=0.15 i.e NS)
As regards uterine complications: Tachysystole, hypertonus and hyperestimation; in this study showed no statistical significant difference between the 2 groups, (6 in misoprostol compared with 12 in oxytocin P vale (0.14); for hypertonus (1 in misoprostol compared with 2 in oxytocin P vale (0.56);and hyperestimation 3 in misoprostol compared with 5 in oxytocin) P vale (0.6). The considerable low incidence of uterine complications (Tachysystole, hypertonus and hyperestimation) in the current work and similar studies could be explained by low doses of misopristol and or oxytocin thanks to titration methods used maintaining their high efficacy with reduction in uterine complications especially when compared with other traditional studies.
This work aimed tocompare the efficacy and safety of titrated oral misoprostol with intravenous oxytocin for labor augmentation.
This clinical prospective study " double blinded "will be conducted at Ain Shams Maternity Hospital, to estimate the efficacy and safety of titrated oral misoprostol with oxytocin for labor augmentation.
This study including 200 pregnant women attending for delivery in Ain Shams Maternity Hospital from December 2015 to October 2016. Women in spontaneous labor will be eligible if they have cervical dilation of 4–8 cm and require labor augmentation.This study was in 200 participant women, they were randomly distributed divided in two groups, the first arm was misoprostol"Group I" (n = 100), the second arm was intravenous oxytocin"Group II" (N = 100). The cumulative dosage of oral misoprostol administration was 1600 mcg divided into several doses by hours 20 mcg per hour. Elsewhere oxytocin at rate 1 milliunit per minute and exceed to 10 milliunit per minute.
We hypothesis the efficacy of oral misoprostol in induction of labor during the spontaneous labor of active phase 4-8 cm, for women that weren’t show further ripening of the cervix.
The results of this work showed no statistical differences between two studied groups concerning maternal Age (years), Gestational age (weeks), maternal height (cm), parity, cervical dilatation and percentage of ruptured membrane. These findings represent uniformity between two studied groups. Exclusion of primipara and women with cervical dilation less than 4 cm are the main differences between the present study and similar studies.
The total dose used in the current study used 62.5±11.72 µg (40-80) in misopristol group and 940.87±277.54 mIU (637–1851) in syntocinon group.
This work showed that that there were no significant differences between the groups in the percentages of women who delivered vaginally within 12 and significant difference within 24 hours of augmentation. Therefore, labor augmentation with titrated oral misoprostol solution is an effective alternative method.The relative high percentage of vaginal delivery which were higher and shorter than similar studies and Ain Shams maternity hospital vaginal delivery percentage which ranged between 40 to 60% in last 3 years; the relative high incidence could be explained by exclusion of primipara and those with cervical dilation less than 4 cm with higher mean Bishop score exceeding 5.2 in both misopristol and syntocinon group.
As regards percentage of cesarean deliveries; In this study The were 17% in misoprostol group compared to 29% in Oxytocin group, the less amount of these cases due to the small misoprostol dose (62.5±11.72) mcg and (940.87±277.54) milliunit in oxytocin group.
The reporting failure of induction 9 cases from 10 Cesarean in misoprostol arm, and 4 cases from 5 cesarean deliveries. Which show no statistically significance in differences. P value (0.181)between cesarean and P (0.153) between failed of induction.
The failure is due to failure of induction of labor by misoprostol or oxytocin due to inability to ripening the cervix more than active phase or stop of progression of labor or occurring of any complications to fetus including the non-reassuring fetal heart rate (FHR) or any meconium in the placenta. So at this time the babies were delivered by cesarean.
As regards percentage of failed induction; this work showedpercentage of 15%in misoprostol group compared to 23% in Oxytocin group (p-value=0.15 i.e NS)
As regards uterine complications: Tachysystole, hypertonus and hyperestimation; in this study showed no statistical significant difference between the 2 groups, (6 in misoprostol compared with 12 in oxytocin P vale (0.14); for hypertonus (1 in misoprostol compared with 2 in oxytocin P vale (0.56);and hyperestimation 3 in misoprostol compared with 5 in oxytocin) P vale (0.6). The considerable low incidence of uterine complications (Tachysystole, hypertonus and hyperestimation) in the current work and similar studies could be explained by low doses of misopristol and or oxytocin thanks to titration methods used maintaining their high efficacy with reduction in uterine complications especially when compared with other traditional studies.
Other data
| Title | TITRATED ORAL MISOPROSTOL SOLUTION COMPARED WITH INTRAVENOUS OXYTOCIN FOR LABOR AUGMENTATION¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬ | Other Titles | مقارنة استخدام عقار الميزوبرستول المحسوب بالفم بعقار الأوكسيتوسين بالوريد في مساعدة الولادة | Authors | Osama Hassan Sayed Ahmed Mohamed Amer | Issue Date | 2016 |
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