Title-Retrospective analysis of use of vaginal Misoprostol for Induction of Labour in a tertiary care institute in India.

Authors- Dr Kshama Uplenchwar, Dr Rachana Jagade

Institute- Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India

INTRODUCTION

 Induction of labour is the most commonly performed obstetric intervention. 

Prevalence of induction of labour is reported from 10 to 25%. It is increasing in 

recent times due to various factors including lifestyle.

Various methods for induction of labour are described in literature and 

practiced widely across the world including PGE2 gel, and oral or vaginal 

Misoprostol (PGE1 ), mechanical methods and membrane sweeping.

Misoprostol is a safe, effective, cheap induction agent which is stable at room 

temperature and therefore important in day-to-day obstetric practice.

We hereby present a retrospective study of 500 cases of induction of labour 

using low-dose vaginal Misoprostol 25 mcg 4 hourly in a tertiary healthcare 

institute in India in urban population.

AIMS AND OBJECTIVES-

To determine the safety and efficacy of use of low dose vaginal Misoprostol 25 

mcg for induction of labour.

MATERIALS AND METHODS

A retrospective analysis of 500 cases of Induction of labour with vaginal 

Misoprostol 25 mcg 4 hourly administered, upto maximum 6 doses. All 

women who required induction of labour were studied including those with 

high risk factors like GDM, PIH, FGR.

The induction to delivery interval, percentage of women requiring 

caesarean section, incidence of fetal distress, meconium staining and 

failure of induction was studied.

DISCUSSION

The overall incidence of vaginal delivery in women who underwent induction of labour 

was 55.2%. In low-risk patients, the incidence was 57.3% and in high-risk patients, it was 

50.9%.

Among primiparas (392), rate of vaginal delivery was 46.9% (184) whereas among the 

multipara (108), it was 85.2% (92).

Rate of vaginal delivery was 54.4% (253) even in women with Bishop score</=6. Thus, use 

of vaginal Misoprostol for induction of labour is suitable even in cases with unfavourable 

Bishop score.

Induction to delivery interval was </=24 hours in 75% cases.

Incidence of Meconium staining of amniotic fluid was seen in 9.6% cases (48). 

Of all the cesarean sections, LSCS for suspected fetal compromise was performed in 54.9% 

(123) cases.

The use of vaginal Misoprostol resulted in fewer cases of failed inductions of 2% (10).

Thus, vaginal Misoprostol for induction of labour is effective in achieving vaginal births, 

reducing the induction to delivery time with very few cases of failed inductions. It is 

cheap, easy to administer, stable at room temperature, so no need for freezing. 

Vaginal Misoprostol has an additional advantage that it can be removed in case there 

is hyperstimulation after administration. 

CONCLUSION

Low dose vaginal Misoprostol 25 mcg 4 hourly can be considered as a good option for 

induction of labour in low resource countries considering low costs and ease of 

administration, promising success rate and very few cases of failure of induction.

Induction to delivery interval of less than 24 hours was observed in 75% cases thus 

reducing the costs and burden on resources.

A larger multi-centre study may be needed to confirm the results.

REFERENCES

• Redling, Katharina, Schaedelin, Sabine, Huhn, Evelyn Annegret and Hoesli, Irene. "Efficacy and safety of misoprostol vaginal 

insert vs. oral misoprostol for induction of labor" Journal of Perinatal Medicine, vol. 47, no. 2, 2019, pp. 176-182. 

• Megan L. Stephenson, Deborah A. Wing,Misoprostol for induction of labor,Seminars in Perinatology,Volume 39, Issue 

6,2015,Pages 459-462.