Comparative study of Misoprostol Vs Oxytocin in Induction of Labour in Term Prelabour Rupture of Membranes

Vilvapriya, S (2006) Comparative study of Misoprostol Vs Oxytocin in Induction of Labour in Term Prelabour Rupture of Membranes. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION: Prelabour Rupture of membranes is a common obstetrical problem. It is a significant event as it transforms an ordinary pregnancy into a high risk one. Management depends upon careful weighing of fetal condition, neonatal intensive care facilities and presence of complicating factors. Overall incidence is 5-10% Premature Rupture of membranes is defined as “Rupture of membranes prior to onset of labour” by Embrey (1953), Flowers (1962), Downley (1958), & Eastman (1966). According to Prof. Chauha & Arulkumaran prelabour rupture of membranes is “Spontaneous breach of chorio amnion with release of amniotic fluid with latent period before the onset of labour”. Authors like Ianios(1965) and Lebher(1963) diagnose PROM only when a latent period of 1-12 hours has elapsed following amniorrhexis occurring at anytime prior to the onset of labour, regardless of period of gestation. Majority of Cases of PROM – of about 60% occur after 37 completed weeks. PROM is a significant event that transforms pregnancy into a high risk one by increasing maternal and neonatal morbidity and mortality. Maternal complications like Chorioamnionitis, puerperal fever are more common in PROM. Active management of PROM decreases complications and associated maternal and neonatal morbidity and mortality. Induction of labour is artificial or non-spontaneous initiation of uterine contractions that leads to progressive cervical dilatation and effacement resulting in delivery of baby or products of conception. Since early days of 1950’s when Oxytocin was synthesized, induction of labour has become more popular and accepted as an option in the management of PROM. Misoprostol, a methyl ester of PGE1 is being under trial for past few years in induction of labour. Misoprostol is receiving attention as a cervical modifier and labour induction agent. This study compares the safety and efficacy of Misoprostol with Oxytocin in labour induction in Term Prelabour rupture of membranes. AIM OF THE STUDY: The present study is undertaken to compare the safety and efficacy of Misoprostol with that of Oxytocin in labour induction in TERM PROM. The effects were compared between Primipara and Multipara in a selected sample. OBJECTIVES: 1) To study the effect on labour induction and compare the induction – delivery interval between 2 drugs. 2) To compare the mode of delivery between 2 groups. 3) To compare the foetal and maternal adverse effects between 2 drug groups. 4) To compare the maternal and foetal outcome between 2 drug groups. 5) To assess the cost effectiveness between 2 drugs. MATERIALS AND METHODS: SETTING: This study was carried out in the Institute of Obstetrics and Gynecology, Madras Medical College, Chennai. STUDY DESIGN: Prospective randomized control study. STUDY PERIOD: July 2004 – Feb 2006. SAMPLE SIZE: Determined by statistical analysis. Statistical analysis was done using chi square test and student ‘t’ test used in appropriate places. About 200 women were randomized to either Misoprostol or Oxytocin. Diagnosis of prelabour rupture of membranes made on the basis of history, clinical examination, and speculum examination and confirmed with USG. INCLUSION CRITERIA: 1. Singleton pregnancy, 2. Cephalic presentation, 3. Bishop’s score < 4, 4. Completed 37 weeks of gestational age, 5. Live fetus showing no signs of fetal compromise on admission CTG. EXCLUSION CRITERIA: 1. Multiple pregnancy, 2. Non cephalic presentations, 3. Bishop’s Score > 4, 4. H/o previous scar, Uterine Surgery, 5. Any medical Conditions complicating Pregnancy, 6. Hydramnios, IUGR, Gestational age < 37 weeks, 7. Women in labour, 8. Suspected chorioamnionitis. At the time of entry into study name, age, status of booking, immunization, menstrual history, marital history, obstetrical history, medical and personal history were noted down. General Condition is assessed by pulse rate, Blood Pressure, Height, Weight with particular attention to pedal odema, anemia. Cardiovascular and respiratory systems were examined. Obstetrics examination includes size of uterus, lie, presentation, attitude, foetal heart sound and rate, liquor adequacy and estimated foetal weight Pelvic examination was done to rule out cephalo pelvic disproportion and for Bishop’s scoring. USG done for foetal maturity, Liquor status and for foetal well-being. Admission CTG done. SUMMARY: 1. Misoprostol at 25μg dose repeated 6th hourly is an effective, cheap, safe and easy to use labour induction agent. 2. Induction – delivery internal is shorter in primipara in Misoprostol group compared to Oxytocin group. 3. For multipara, no significant difference in Induction – delivery interval is observed between both the groups. 4. No statistically significant difference was observed in caesarean section rate between two drug groups. 5. Neonatal outcomes were comparable between both groups. 6. Maternal complications were not significantly different between both groups. 7. No increased incidence of tachysystole / Hyper tonus / Hyper stimulation observed. 8. Misoprostol is cost effective, easy to use and stable at room temperature. CONCLUSION: Misoprostol is an effective, cheap, safe, stable at room temperature and easy to use if it is used in appropriate dosage for induction of labour in prelabour rupture of membranes at term.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Comparative study ; Misoprostol ; Oxytocin ; Induction ; Labour ; Term Prelabour Rupture of Membranes.
Subjects: MEDICAL > Obstetrics and Gynaecology
Depositing User: Subramani R
Date Deposited: 03 Dec 2017 10:22
Last Modified: 05 Dec 2017 01:52

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