Abstract

A STUDY ON INDUCTION OF LABOUR USING PROSTAGLANDIN ANALOGUES AND TO MEASURE THE OUTCOMES

Nayana C.*, Soukhya C. N. and Apoorva Dev

ABSTRACT

Background: Induction of labour is an artificial initiation of uterine contractions after the period of viability, with the intention of accomplishing delivery period to onset of spontaneous labour. It is performed when the benefits of expeditious delivery to either mother or fetus outweigh the risk of continuing the pregnancy The frequency of induction has been increasing, and while it is a beneficial procedure, it is not without risks. At Rangadore Memorial Hospital (RMH) currently prostaglandin E2 (Dinoprostone) and prostaglandin E1 (Misoprostol) are used for pharmacological labour induction of viable pregnancies with indications. Aim: To study and evaluate the safety and efficacy of PGE2 and PGE1. Objectives 1. To measure the delivering intervals in 2 groups. 2. To compare the mode of delivery. 3. To assess maternal complications 4. To describe neonatal outcomes and associated complications. Methodology: 60 women were recruited in this prospective interventional study who were admitted to labour wards with indications for induction of labour and unfavourable cervices after 34 weeks of gestation. These women who were planned/emergency booked for IOL were randomly assigned into 2 types i.e PGE1 group (n=30) who received T. Misoprostol 25 mcg orally 2 hours (h) maxixum of 5 doses per day and PGE 2 group (n=30) who were administered 10mg Propess (Dinoprostone) pessary intravaginally as a single insert for 24 hrs. Observations were made in terms of improvement in Bishop’s score and Fetal heart rate monitoring. Analysis regarding safety and efficacy of the drugs was done with regards to maternal, perinatal outcomes and Induction delivery interval. Results: The mean Bishop’s score improvement at the end of induction was shown by PGE2 group(4.66 to 8.73). Duration of induction to active phase of labour in both the groups was 14.79 vs 18.41 which was statistically significant (p=0.0010). Induction delivery interval was 18.82 and 21.69 in PGE1 and PGE2 with P value of 0.0033 which was statistically significant. Cesarean section rates was slightly higher in PGE2 group(23.3% vs 26.6%) with higher indications of CTG abnormalities(6.7% vs 20%). Comparable maternal and neonatal complications were noted in both the groups which was statistically insignificant. Conclusion: The present preliminary data suggests that both Misoprostol and Dinoprostone are safe effective drugs for cervical ripening and labour induction. Oral misoprostol is easy to store, most cost effective and has better patient compliance and acceptability. Vaginal Dinoprostone is expensive and requires continuous refrigeration. The longer time from induction to delivery and price suggests, this may be a more expensive way to induce labour. Hence it was found that Misoprostol is a better cervical ripening agent with similar maternal and fetal safety profile while other prostaglandins are expensive and storage at low temperature is a problem.

Keywords: prostaglandins, misoprostol, PGE2, apgar, arm. IOL.