VAGINAL MISOPROSTOL AS AN ALTERNATIVE TO OXYTOCIN FOR INDUCTION OF LABOR IN WOMEN WITH LATE FETAL DEATH

Background. Induction of labor in women with late fetal death is often difficult in settings with scarce resources. The purpose of this stud y was to assess the value of vaginal misoprostol for induction of labo r in women with such fetal death. Methods. In Maputo 156 women with la te fetal death were allotted in a non-randomised way to either vaginal misoprostol or intravenous infusion of oxytocin. Treatment outcomes w ere compared as to cost-effectiveness and safety. In the misoprostol g roup none received more than 800 mu g. Oxytocin infusion followed an e stablished routine. Statistical analyses were performed by EPI Info so ftware. Results. In cases with Bishop's score <6 the induction-to-deli very interval averaged 14.8 hours in the misoprostol group and 31.0 ho urs in the oxytocin group (p=0.001). The corresponding values for wome n with Bishop's score greater than or equal to 6 were 6.6 and 8.7 hour s, respectively (p=0.4). Women with intact membranes had an induction- to-delivery interval of 13.8 hours in the misoprostol group and 26.9 h ours in the oxytocin group (p=0.002). The corresponding values in wome n with ruptured membranes were 7.8 and 10.5 hours, respectively (p=0.6 ). Successful induction was achieved in 81% of misoprostol-treated wom en at a dose of 100 mu g or less. Conclusions. Vaginal misoprostol is a safe, low-cost drug particularly suitable in women of high average p arity having late, fetal death.