Publication:

Study of vaginal misoprostol for labour induction in intra uterine fetal demise

Background Intrauterine fetal demise (IUFD) is the most undesirable consequence of pregnancy which causes psychological distress to mother and family. It also carries risk of infection and DIC. In literature, various methods have been described to manage the cases of IUFD. Practically prostaglandin analogues are routinely used for induction of labour in cases of IUFD. The objectives of this study were to assess the effectiveness and safety of vaginal misoprostol for induction of labour in IUFD.

Methods In this prospective study, consecutive series of 100 women with IUFD ≥ 28 weeks of gestation are studied. Detailed clinical history, physical examination and investigations are recorded. All selected cases were induced with vaginal misoprostol 50 μg and the doses are repeated every 6th hourly depending on uterine contractions and Bishop’s score changes.

Results The average induction to delivery interval is 14.68 hours. All women delivered within 40 hours of administration of first dose of misoprostol with 47%, 86% and 100% delivering within 12 hours, 24 hours and 40 hours respectively. There was significant correlation between mean induction delivery interval and maternal age, parity and Bishop’s score. Minor side effects like chills and fever were noted in 5% of patients and retained placenta and atonic PPH was seen in 2% each.

Conclusions The low dose vaginal misoprostol for induction of labour in IUFD is a safe, effective and cost effective regimen.