Introduction : Misoprostol is a molecule used for inducing labor these days in order to reduce perinatal morbidity and mortality. This study aimed at appreciating maternal and fetal prognosis after induction of labor on indication for delivery with misoprostol on live fetus at CHUD/B in 2016. Patients and Method: It was an observational case-control type study with prospective data collection carried out in the gynecology and obstetrics department of CHUD/B. Were included, 37 WA healthy pregnant women whose Bishop score was less than 6. Their fetal heart rate and their pelvis were normal. Fisher chi-2 test was used and the significance threshold of different associations was 5%. Results: In the study, 99 women involved were divided into 33 cases and 66 case-controls. The average age of cases was 29.70 ± 5.03 years old with extremes of 20 and 40 years and that of case-controls was 29.44 ± 4.96 years with extremes of 21 and 40 years. Out of the 1195 deliveries which took place in the gynecology and obstetrics department of CHUD/B, 33 inductions of labor on full-term live fetuses with misoprostol were performed that is to say a frequency of 2.76%. The factors associated with maternal and fetal prognosis were profession, mode of admission, Bishop score with respectively p-values of 0.049, 0.00005, 0.00001. Conclusion: The use of misoprostol seems beneficial as regards maternal and fetal prognoses in our practice at a low cost.
Artificial induction of labor is carried out for maternal or fetal indications in order to reduce perinatal morbidity and mortality without increasing the mother’s ones [
It was an observational case-control type study with a prospective data collection carried out in the gynecology and obstetrics department of CHUD/B which took place over a period from 1 January to 31 July 2016. A comprehensive census of all the women who met the inclusion criteria and who delivered during the survey period was performed.
The target population consisted of all the women who had been pregnant since the 37th WA and who met the following criteria.
Definition of cases: Any woman whose delivery term was more than or equal to 37 WA determined on the LMP or the ultrasound for dating basis and whose labor had been induced with misoprostol.
Definition of controls: Any pregnant woman whose delivery term was more than or equal to 37 WA determined on the LMP or the ultrasound for dating basis and who had spontaneously gone into labor.
Inclusion criteria: Were included, healthy pregnant women of at least 37 WA meeting the following criteria:
1) Medical or obstetric indication for induction of labor.
2) Bishop score was less than 7.
3) Normal fetal heart rate: fetal heart rate which vary between 120 beats per minute and 160 beats per minute.
4) Normal female pelvis: when at the upper strait basin.
a) the promonto-retropubic diameter ≥ 10.5 cm,
b) the median transverse diameter ≥ 12.5 cm and,
c) the oblique diameters ≥ 12 cm.
5) Monofetal pregnancy with cephalic presentation.
Exclusion criteria: Were excluded, pregnant women of at least 37 WA following the criteria below:
1) Refusal to use misoprostol for induction of labor.
2) Scarred uterus.
3) Absolute contraindication to vaginal delivery.
4) Known allergy to misoprostol.
Matching criteria: Matching of cases and case-controls was based on:
1) The parturient woman’s age.
2) Gravidity.
3) Parity.
4) Gestational age.
5) Cephalic presentation.
Choice of control-cases: They were pregnant women who met the matching criteria and who were received after the case.
The induction was performed after making sure that the fetus was well, and that the condition of the cervix has a Bishop score < 7. After that, 50 µg misoprostol (a quarter of 200 µg scored tablet) is deposited in the posterior fornix. This misoprostol dose is renewed every six hours without exceeding the total dose of 200 µg in 24 hours. If the induction does not work after this total dose, it is considered as a failure.
The main variable was the maternal and fetal prognosis. The maternal prognosis was defined as the mother’s condition at the time of the child’s birth and during her hospitalization as well as complications. The fetal prognosis is defined as the aspect of the fluid before and after the induction and also the recording of fetal heart sounds (FHS) before and after the first placement of misoprostol. Independent variables were socio demographic and clinical ones. After the collection, data were coded and entered with Epi Data version 3.1 software and analyzed with the SPSS version 21 software. Qualitative variables were expressed in percentage and quantitative variables were expressed in averages. Fischer chi-2 test was used and the significance threshold of the different associations was 5%.
The present research work was approved by the ethics committee local in Parakou.
In the survey, 99 women were involved and divided into 33 cases and 66 control-cases.
The average age of the pregnant women, the average parity and the average gestational age of cases and control-cases are documented in
The age group between 25 and 34 years old predominates in cases (66.6%) but in control-cases it was those between 20 and 30 years old (74.2%).
Primiparous women represented the largest number among cases with
Case | Control-cases | P | ||||
---|---|---|---|---|---|---|
Average | Extreme | Average | Extreme | |||
Age (year) | 29.70 ± 5.03 | 20 - 40 | 29.44 ± 4.96 | 21 - 40 | 0.900 | |
Parity | 1.64 ± 1.45 | 0 - 5 | 1.59 ± 1.56 | 0 - 6 | 0.900 | |
Gestational age | 39.31 ± 1.07 SA | 37 - 41 | 39.31 ± 1.07 SA | 37- 41 | 1.000 | |
Bishop score | 3.22 | 1 - 6 | - | - | - | |
SA: Gestational age in Week of Amenorrhea.
30.30%. Nulliparous and pauciparous with 27.27% each ranked second. In control-cases, pauciparous represented the largest number 36.36% nulliparous 33.33% in second position.
Bishop score in all cases was unfavorable before induction.
Out of 1195 deliveries which took place in the gynecology and obstetrics department of CHUD/B, 33 inductions of labor on full-term live fetuses with misoprostol were initiated that is to say a frequency of 2.76%. The number of labor induced was 29 that is to say 87.87% of cases. In 4 cases, the failure of the induction led to cesarean section. The main indications for induction are presented in
Clinically, the pregnant women were directly admitted. Bishop score was between 1 and 4 in 75.75% of cases and statistically, there was no significant difference between the two groups as regards the maternal and fetal conditions before induction (
As regards prognosis, the average duration of labor was, from the induction of labor to the expulsion of the fetus, 4.04 ± 2.59 hours with extremes of 2 and 12 hours. Cesarean section rate was 39.39% in cases as against 30.3% in case-controls without difference statistically p = 0.36. In the group of cases, all cesarean sections were performed for Bishop scores between 1 and 4.
Acute fetal distress was observed in the proportion of 15.15% in the group of cases as against 21.21% in the group of case-controls. No perinatal death was reported in the two groups.
Sociodemographic and clinical characteristics were associated with the induction of labor namely Bishop score, mode of admission and profession with nine times greater risks of maternofetal complication for housewives whose labor was induced with misoprostol (
In total, 99 subjects divided into 33 cases and 66 case-controls were surveyed. The average as regards age, parity, gestational age was similar in the two groups.
Indications | Number | Percentage |
---|---|---|
PROM | 13 | 39.40 |
Exceedance of term | 12 | 36.36 |
Pregnancy HBP | 8 | 24.24 |
Total | 33 | 100.00 |
Cases | Control-cases | P | |||
---|---|---|---|---|---|
Number | % | Number | % | ||
FHS | |||||
Bradycardia | 0 | 00 | 3 | 4.54 | |
Normal | 33 | 100 | 59 | 89.4 | 0.152 |
Tachycardia | 0 | 0.00 | 4 | 6.06 | |
Amniotic sac | |||||
Intact | 20 | 60.61 | 37 | 56.06 | |
Ruptured | 13 | 39.39 | 29 | 43.94 | 0.666 |
Amniotic fluid | |||||
clear | 11 | 84.62 | 14 | 51.86 | |
Meconium-stained | 2 | 15.38 | 13 | 48.14 | 0.08 |
Bishop score | |||||
[1 - 4] | 25 | 75.75 | 0 | 0 | |
[5 - 6] | 8 | 24.24 | 1 | 1.51 | 0.000 |
≥7 | 0 | 0 | 65 | 98.48 |
As for parity, it should be noted that although averages were close to each other in the two groups, primiparous women predominate among the cases (30.30%) and (33.33%) in the control-group. This difference can account for the length of labor which is shorter for case-controls (2.5 ± 2.59 hours) than for cases (4.04 ± 2.59 hours). Moreover, there is no statistical difference between the two groups.
These 33 inductions of labor were performed over a period of 7 months during which 1195 deliveries were carried out in the department that is to say a frequency of 2.76%. This frequency is by far less than those found in studies conducted in France and the USA [
Maternal and fetal complications | p | ||||
---|---|---|---|---|---|
Cases | Case-controls | OR | CI95% | ||
Educational level | 0.541 | ||||
Primary | 12 | 19 | 1 | ||
Secondary | 8 | 12 | 0.95 | [0.30 - 2.99] | |
Higher education | 6 | 12 | 1.26 | [0.37 - 4.27] | |
None | 7 | 23 | 2.08 | [0.68 - 6.31] | |
Profession | 0.049 | ||||
Trader | 15 | 16 | 1 | ||
Civil servant | 8 | 13 | 1.52 | [0.49 - 4.71] | |
Housewife | 2 | 19 | 8.91 | [1.77 - 44.93] | |
Craftswoman | 3 | 10 | 3.13 | [0.72 - 13.59] | |
Student | 4 | 7 | 1.64 | [0.40 - 6.76] | |
Others | 1 | 1 | 0,94 | [0.05 - 16.37] | |
Mode of admission | 0.00005 | ||||
Came by herself | 10 | 43 | 1 | ||
Referred by a health care center | 6 | 16 | 0.62 | [0.19 - 1.99] | |
Referred by a clinic | 13 | 7 | 0.13 | [0.04 - 0.39] | |
Amniotic sac | 0.666 | ||||
Intact | 20 | 37 | 1 | ||
Ruptured | 13 | 29 | 1.21 | [0.52 - 2.82] | |
Bishop score | 0.00001 | ||||
[1 - 4] | 25 | 0 | - | - | |
[5 - 6] | 8 | 1 | 1 | ||
≥7 | 0 | 65 | - | - | |
Maternal complications | |||||
Hyperkinesia | 1 | ||||
Yes | 2 | 3 | 1.35 | [0.15 - 10.73] | |
No | 31 | 63 | 1 | ||
Prerupture syndrom | |||||
Yes | 0 | 1 | - | 1.00 | |
No | 33 | 65 | |||
AFD | |||||
Yes | 4 | 14 | 1 | [0.13 - 1.89] | 0.270 |
No | 9 | 52 | 0.51 | ||
Apgar score | |||||
1 min | |||||
≥7 | 32 | 63 | 1,52 | [0.13 - 39.63] | 1.000 |
<7 | 1 | 3 | 1 | ||
5 mins | |||||
≥7 | 33 | 64 | - | - | 0.55 |
<7 | 0 | 2 |
countries than in developing countries [
The favorable outcome of inductions of labor with misoprostol was 8.87%. It was 70.4% in Tunis [
Other factors can be considered as being at risk of complication in case of induction of labor with misoprostol. These factors are profession, housewives, craftswomen and students running respectively 9, 3, 13 and 1.3 times greater risks of developing complications than traders. It is the same with the mode of admission. Maternal and fetal complications were statistically associated with the pregnant women’s mode of admission. This prognosis was better for pregnant women referred from clinics to the CHUD revealing thereby the advantages of referrals carried out unemotionally. Referred in such a context, the pregnant women were offered a monitoring based on a well-codified protocol implemented in a serene atmosphere. The induction of labor with misoprostol did not lead to perinatal death as reported by some authors [
The use of misoprostol seems beneficial as regards maternal and fetal prognoses in our practice at a low cost. But it becomes necessary to carry out other comparative multicenter studies in order to highlight its advantages and decide upon a standard protocol for its use in an obstetric setting. In parallel, it is appropriate to strengthen surveillance during inductions with misoprostol to derive maximum advantage from it.
Salifou, K., Sidi, I.R., Vodouhe, M., Obossou, A.A.A., Tikandé, G. and Alihonou, E. (2018) Prognostic Factors of Induction of Labor with Misoprostol at CHUD/B in Parakou, Benin in 2016. Open Journal of Obstetrics and Gynecology, 8, 306-314. https://doi.org/10.4236/ojog.2018.84033