Maternal and Neonatal Outcomes of Induction of Labor with Vaginal Misoprostol Versus Intravenous Oxytocin

Background: There are many different situations in obstetrics where there is the need for labor induction in women with unripe cervices. This indication stems from a situation where the continuation of pregnancy may be life-threatening for the mother and/or fetus. Objective: To compare maternal and neonatal outcomes of induction of labor with vaginal misoprostol versus intravenous oxytocin. Methods: A follow up study was conducted at the delivery unit of Ismailia University Hospital. The study subjects included two equal groups of women, group I (50) who received vaginal misoprostol and group II (50) who received oxytocin infusion. A structured interviewing schedule and an observation checklist were developed, validated and used to collect data related to maternal and neonatal outcomes. Results: Uterine contractions of longer duration (>70-90 seconds) and strong intensity were found to be significantly higher in the misoprostol group compared to the oxytocin group (p<0.01). Within the first 12 hours, the misoprostol group recorded statistically significant higher rates of normal fetal heart rate and of vaginal delivery compared to the oxytocin group (p=0.003, 0.008 respectively). On the other hand, the incidence of cesarean delivery was higher in the oxytocin group compared to the misoprostol group. Conclusion and Recommendations: Misoprostol 25μg vaginally (every 4 hours, up to 200 μg) is more safe and efficient for cervical ripening than oxytocin infusion. It is recommended for parturient women with Bishop score ≤4.