Abstract
Purpose: To study the efficacy of Misoprostol for induction of labour, to know induction delivery interval in the patients induced with misoprostol and to assess the role of intermittent CTG monitoring in induction of labour.
Materials and methods: During the 8 months study period a total number of 150 women were studied. 25 mcg of misoprostol was used for induction of labour. 75 women in Group-1 FHR was monitored using intermittent CTG and group-2 other 75 with intermittent auscultation using a stethoscope. These women were compared with respect to age, parity, cervical status, mode of delivery, induction delivery interval, the total number of doses required, incidence of meconium, various fetal heart rate patterns, maternal and fetal complications.
Results: Induction of labour was required in 60% in group 1 and 76% in group 2 who were primigravidae. The incidence of meconium stained liquor was 18.6% in group 1 and 21.3% in group 2. The operative vaginal delivery rate was 4% in group 1 and 2% in group 2. The incidence of APGAR <7 was 5.3% in group 1 and 9% in group 2. NICU admission rate was 13.3% in group 1 and 21.3% in group 2. Neonatal death rate was 4% in group 2 whereas there were no neonatal deaths in Group 1.
Conclusion: Intermittent CTG monitoring of fetal heart rate is better than intermittent auscultation in deducting fetal distress early in labour and thus avoiding neonatal morbidity and mortality.
Key words: Misoprostol, CTG monitoring, Fetal heart rate
References
1. Dražančić A. Kardiotokografija - njeni dosezi i pretkazljivost. Gynaecol Perinatol. 2006;15(2):71–87.
2. Harni V, Gudelj M, Šemnički N. Kardiotokografija: od otkrića kucaja čedinjeg srca do FIGO smjernica.Gynaecol Perinatol. 2006;15(1):19–29.
3. Low JA. Intrapartum fetal asphyxia: Definition, diagnosis and classification. Am J Obstet Gynecol. 1999;176(5):957–959.
4. Wilken HP, Hackel B, Wilken H. Klinishe Erfahrungen mit dem antepartalen CTg - Auswertererfahren nach fisher, Hammacher, Hodr und Kubli. Zentralbl Gynekol. 1980;102:909–914.
5. Ivanišević M. Kardiotokografija i pH-metrija kod fetalne asfiksije i acidoze. XVII Perinatalni dani.Gynaecol Perinatol. 1999;(Suppl.1):61–64.
6. Škrablin S, Dražančić A, Letica-Protega N, Tadić V. Trudnoća i porod u novorođenčadi s encefalopatijom u ranom neonatal-nom razdoblju. LiječVjesn. 1992;114:10–15.
7. Nelson KB, Dambrosia JM, Tiny TY, Grehter JK. Uncertain value of electrinc fetal monitoring in predicting cerebral palsy. N Engl J Med. 1996;334:613–618.
8. Sanchez-Ramos L, Kaunitz AM , Del Valle GO, Delke I, Schroeder DA, Briones DK, Labour induction with the PGE1 Analogue. Misoprostol versus oxytocin; a randomized trail. Obstet Gynecol 1993 ; 332- 336.
9. Sifakis S, Angelakis E, Avgoustinakis E et al. Cochrane meta-analysis on misoprostol. A randomised comparison between intravaginal misoprostol and prostaglandin E2 for labour induction. Arch Gynaecology Obstet 2007;27:263- 267.
10. Dodd JM, Crowther CA, Robinson JS, Oral misoprostol for induction of labour at term: randomized controlled trial. BMJ 2006; 332: 509 – 513. 2.
11. G.M ires, F. Williams, P Howie .Randomised controlled trail of CTG versus Doppler auscultation of fetal heart in low risk obstetric population. BMJ 2001: 16 : 322
12. Chauhan SP, Sanderson M, Hendrix NW, et al. Perinatal outcome and amniotic fluid index in the antepartum and intrapartum periods: a meta-analysis. Am J Obstet Gynecol. 1999;181(6):1473–1478
13. Mahomed K, Nyoni R, Mulambo T et al. (1994) Randomised controlled trial of intrapartum fetal heart rate monitoring. British Medical Jou. 308(6927): 497-503
14. Garcia J, Corry M, Macdonald D, Elbourne D et al. (1985) Mothers’ views of continuous electronic fetal heart moni-toring and intermittent auscultation in a randomised controlled trial. Birth 12:79-86
15. Wing Deborah A. MD : Ortiz – Omphroy , Grabriele. MD: Paul, Richard H. MD. Effect of vaginal misoprostol versus dino-prostone on cervical ripening and labour induction.AJOG(1997) 177(3) :612-618.
16. Alexandre Megalo, Patrick Petignat, Patrick Hohlfeld, Influence of misoprostol or prostaglandin E2 for induction of labor on the incidence of pathological CTG tracing: a randomized trial, European Journal of Obstetrics & Gynecology and Reproductive Biology, vol.116,1, 2004, p. 34-38
17. Toppozada M.K, M.Y.M.Anwar, H.A. Hassan, W.S.EL.Gazaerly, International journal of gynecology and obstetrics 56 (1997) 135- 139.