A comparative interventional study on fixed-dose versus titrated- dose oral misoprostol solution for induction of labour at term gestation in a tertiary care centre of Eastern Uttar Pradesh

Abstract

Induction of labor entails the deliberate initiation of uterine contractions before the spontaneous onset of labor, irrespective of whether the amniotic membranes have ruptured or not. The Modified Bishop’s score of six or higher indicates that the cervix is ripe, or “favorable” – when there is a high likelihood of spontaneous labor or responsiveness to interventions designed to induce labor. Misoprostol being cost-effective, easily available and stable at room temperature makes itself a promising agent in future for induction of labour if the feto-maternal safety concerns are proved with evidence. The aim of our study was to compare the efficacy of titrated versus fixed dose oral misoprostol solution regimen as inducing agents and the effects on fetomaternal outcome.A comparative interventional study was conducted for one year and study population consisted of term pregnant women admitted to the labour room of the hospital. A total sample size of 150 was deemed necessary, with 75 participants required per group. Following allocation into groups, induction of labor was carried out using either oral titrated-dose misoprostol solution or fixeddose misoprostol solution.Successful induction of labour was higher in fixed -dose group (Group F) (80%) as compared to 65.53% in titrated-dose group (Group T), the difference was statistically significant (p=0.0439). The need for augmentation was lower in group F (30.67%) than in group T (56%). Statistically, this difference was significant (p = 0.0017). Uterine hyper stimulation and atonic post-partum haemorrhage were noted more in group T but this difference was not significant (p = 0.1461; p = 0.3108). Requirement of newborn resuscitation was observed higher in group T [34 (45.34%)] than group F [16(21.33%)]. Statistically, this difference was significant [p=0.0081]. NICU admissions were more in group T (21.34%) than group F (13.33%), but difference was not significant (p = 0.0574).This study concludes that both fixed- dose and titrated-dose oral misoprostol solution regimens are effective in induction of labour but fixed-dose regimen has an advantage of less mean total dose of misoprostol administered, reduced induction to delivery interval, less uterine hyperstimulation, atonic postpartum hemorrhage and better fetomaternal and neonatal safety profile.