OUTCOME OF MISOPROSTOL AND

OXYTOCIN IN INDUCTION OF LABOR

TRISHNA ACHARYA, RAMESH DEVKOTA, BIMBISHAR BHATTARAI, AND ADHA ACHARYA
BACKGROUND

• Induction of labor (IOL) is the process to initiate labor by artificial means from 24 weeks of
gestation.
• IOL occurs in over 20% of pregnancies and most commonly applies to cases where there are
deviations from the normal physiological processes such as hypertension or diabetes or fetal
problems such as fetal growth restriction or macrosomia
• Determining the effectivity of misoprostol vs oxytocin can help guide the management in
induction of labor
POPULATION
Inclusion criteria
 alive singleton pregnancy
 cephalic presentation
 gestational age of 37 completed weeks and above
Exclusion criteria
 grand multiparity (>5 deliveries)
 women with previous lower segment caesarean section (LsCs)
 antepartum hemorrhage
 prelabor rupture of membrane (PROM)
INTERVENTION

25μg was inserted

in the posterior Repeated every 6
Misoprostol Max of 2 doses
fornix of the hours
vagina

2.5 units given increased by 10

with 500mL of drops/min every 5 units oxytocin at
Oxytocin
dextrose or NSS at 30 min up to 60 30 drops/min
10 drops/min drops/min
PRIMARY OUTCOME

Onset of labor and induction-to-delivery time

Induction method Sample size Mean (SE) onset time of action

Misoprostol 136 13.6 (0.9) h

Oxytocin 46 6.6 (1.2) h

Induction method Sample size Mean (SE) induction to delivery time

Misoprostol 136 17.9 (1.3) h

Oxytocin 46 16.9 (2.3) h
SECONDARY OUTCOME

Maternal complication
Fetal outcome/ complications
Induction method Mean Apgar score (SE) at 2 mins Mean Apgar score (SE) at 5 mins

Misoprostol 5.7 (0.9) 7.5 (0.1)

Oxytocin 5.3 (0.2) 67.3 (0.1)
METHOD

• Observational study
ARE THE RESULTS OF THE STUDY VALID?

A.Primary Guides:
1.Was the assignment of patients to treatment randomized?

NO
2. Were all patients who entered the trial accounted for and attributed at its
conclusion?

YES
3. Was follow up complete?

NO
4. Were patients analyzed in the groups to which they were
randomized?

NO
B. Secondary Guides:
1.Were patients, health workers, and study personnel “blind” to
treatment?

NO
Were the groups similar at the start of the trial?

NO
3. Aside from the experimental intervention, were the groups treated
equally?

YES
4. Can the results be applied to my patient care?

5. Were all clinically important outcomes considered?

STUDY’S CONCLUSION

In this trial, the data could not rule out a relevant difference in favor of elective repair with regard to the
primary endpoint. Nevertheless, in view of all other findings, authors of this study feel that the results justify
watchful waiting as a reasonable alternative compared with surgery in men aged 50 years and older.
INTERN’S CONCLUSION