Outpatient misoprostol cervical ripening without subsequent induction of labor to prevent post-term pregnancy

Abstract

Background: Interventions that may help shorten the duration of pregnancy in an African setting where facilities for fetal monitoring in post-term pregnancy are limited, and induction is not without its hazards, are needed.

Aim: To determine whether outpatient administration of intravaginal misoprostol safely decreases the interval to delivery in postdate pregnancies.

Design: Open randomized controlled trial.

Setting: Zonal district hospitals, Kwale, Southern Nigeria (August 2000 to October 2001).

Methods: Seventy-seven women were randomized at 40 weeks gestation to receive either 25 microg misoprostol intravaginally (38) or gentle cervical assessment only (39) on an outpatient basis. Subjects were then allowed to go into spontaneous labor unless an indication for induction developed.

Main outcome measures: Interval to delivery, duration of labor, and incidence of side-effects.

Results: Misoprostol was associated with significant decrease in mean time to delivery (4.5 +/- 4.1 versus 7.4 +/- 5.2 days; P = 0.008), earlier gestational age at delivery (40.6 +/- 0.6 versus 41.4 +/- 0.05 weeks; P < 0.001) and shorter duration of active labor (6.1 +/- 4.0 versus 8.2 +/- 5.3 h; P = 0.028), without any significant increase in fetal distress, low Apgar score at delivery or other side-effects.

Conclusion: Outpatient administration of low-dose misoprostol can safely shorten the length of gestation in postdate pregnancies.