Labor Induction with Orally Administrated Misoprostol: A Retrospective Cohort Study

Abstract

Introduction. One great challenge in obstetric care is labor inductions. Misoprostol has advantages in being cheap and stable at room temperature and available in resource-poor settings. Material and Methods. Retrospective cohort study of 4002 singleton pregnancies with a gestational age ≥34 w at Sodersjukhuset, Stockholm, during 2009-2010 and 2012-2013. Previously used methods of labor induction were compared with misoprostol given as a solution to drink, every second hour. Main outcome is as follows: Cesarean Section (CS) rate, acid-base status in cord blood, Apgar score < 7,5′, active time of labor, and blood loss > 1500 ml (PPH). Results. The proportion of CS decreased from 26% to 17% when orally given solution of misoprostol was introduced at the clinic (p<0.001). No significant difference in the frequency of low Apgar score (p=0.3), low aPh in cord blood (p=0.1), or PPH (p=0.4) between the different methods of induction was studied. After adjustment for different risk factor for CS the only method of induction which was associated with CS was dinoproston (Propess®) (aor = 2.9 (1.6-5.2)). Conclusion. Induction of labor with misoprostol, given as an oral solution to drink every second hour, gives a low rate of CS, without affecting maternal or fetal outcome.