Prediction of adverse outcome associated with vaginal misoprostol for labor induction

• Published in: European journal of obstetrics & gynecology and reproductive biology Vol. 110; no. 2; pp. 143 - 148
• Main Authors: Mutlu Meydanli, M., Caliskan, Eray, Haberal, Ali
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 10-10-2003; Elsevier
• Subjects: Administration, Intravaginal; Adolescent; Adult; Adverse outcome; Biological and medical sciences; Cesarean Section; Diseases of mother, fetus and pregnancy; Female; Fetal Blood; Fetal Diseases - epidemiology; Genital system. Reproduction; Gestational Age; Gynecology. Andrology. Obstetrics; Heart Rate, Fetal; Humans; Hydrogen-Ion Concentration; Infant Mortality; Infant, Newborn; Labor induction; Labor, Induced - methods; Logistic Models; Medical sciences; Misoprostol; Misoprostol - administration & dosage; Misoprostol - adverse effects; Pharmacology. Drug treatments; Pregnancy; Pregnancy. Fetus. Placenta; Prospective Studies; Tachycardia - epidemiology; Uterine Contraction; Labor induction; Misoprostol; Adverse outcome; Human; Prognosis; Pregnancy disorders; Induction; Prediction; Inducer; Oxytocic; Labor; Induced delivery; Prospective; Fetal diseases; Chemotherapy; Vaginal route; Secondary effect; Complication; Observation data; Female; Fetal distress; Prostaglandin derivatives
• ISSN: 0301-2115; 1872-7654
• DOI: 10.1016/S0301-2115(03)00105-2

Objective: To identify predictors of adverse outcome in pregnant women at term receiving 50
μg of intravaginal misoprostol for labor induction.
Study design: A prospective observational study was conducted of 720 pregnant women at term with an unfavorable cervix and a medical or obstetric indication for labor induction. All patients received 50
μg of intravaginal misoprostol every 4
h up to three doses. The primary outcome measure was “adverse outcome” defined as: neonatal death, fetal acidemia and emergent cesarean delivery performed for non-reassuring fetal heart rate tracings. A stepwise logistic regression analysis was used to identify predictors of adverse outcome.
Results: Tachysystole (frequent uterine contractions) (odds ratio (OR), 3.7; 95% confidence interval (CI), 1.2–10.8) and fetal tachycardia (OR, 4.8; 95% CI, 1.4–16.2) were determined as significant predictors of adverse outcome. The specificity of the model was 94.2%, whereas the sensitivity was 20.4%.
Conclusion: In the absence of tachysystole and fetal tachycardia, an uneventful delivery might be expected for women receiving 50
μg of intravaginal misoprostol.