LABOUR INDUCTION;

USE OF SUBLINGUAL MISOPROSTOL VERSUS OXYTOCIN IN CASE OF RUPTURED MEMBRANES AT TERM

Abstract

Objective: To compare the efficacy of misoprostol 50ug (sublingual) in
comparison with oxytocin infusion than for induction of labour in cases of PROM (premature
rupture of membrane at term). Design: Prospective randomized study. Setting: Mujahid Trust
Hospital, Faisalabad. Duration: Conducted from Dec 2006 to April 2008. Methods: Women
were randomized to receive either 50 microgram of sublingual misoprostol every 4 hours with
Ringer’s lactate solution or oxytocin infusion 10 lU in one litre of Lactated Ringer’s solution with
a sublingual placebo. Main outcome measures: The number of women delivering vaginally
within 24 hours of labour induction. Results: Fifty two women (83%) in misoprostol group and
48 (77 %>) in oxytocin group delivered vaginally within 24 hours [relative risk (RR)1.1. However,
the induction to vaginal delivery was significantly shorter in the misoprostol group 15+3.7 hours
compared with the oxytocin group 18+4.1. The incidence of tachysystole was more than three
folds higher in misoprostol than in the oxytocin group (14%) versus 4.3%) RR3.3) but this was
not statistically significant. There was no significant difference in the incidence of hypertonus
or hyperstimulation syndrome, mode of delivery intervention for fetal distress or neonatal
outcomes between the two groups. Conclusions: The group of women received misoprostol
for labour induction were found more successful in achieving vaginal delivery in comparatively
shorter time and more acceptable to patients. Further studies on safety with large numbers of
women need to be conducted before routine use.