The effect of misoprostol on fetal heart rate parameters during induction of labour from 38 weeks gestation : a retrospective audit

Feketshane, Anthony M. (2013-12)

Thesis (MMed)-- Stellenbosch University, 2013.

Thesis

ENGLISH ABSTRACT: Misoprostol is often used for the purpose of induction of labour. However, its effect on fetal heart rate has not been systematically studied. Objective To assess the effect of misoprostol on fetal heart rate parameters during induction of labour from 38 completed weeks in women with previous intrauterine death or postterm pregnancy. Study design A retrospective descriptive study of 127 women for a period of 18 months. Method Women who underwent induction of labour with misoprostol for either previous intrauterine death or postterm pregnancy at Tygerberg hospital were eligible. The selected process of induction of labour happened according to the departmental protocol. The primary outcomes were changes in fetal heart rate (variability, accelerations and decelerations) pre-and post-administration of misoprostol. Secondary outcomes were neonatal highcare or intensive care unit (ICU) admissions. Results There was no statistical difference in the mean fetal heart rate and baseline variability in relation to time recordings after administration of misoprostol. There were no statistically significant differences in the distribution of accelerations and decelerations in different time intervals before and after administration. There were more reactive patterns at all time intervals after the administration of misoprostol, but these differences did not quite reach statistical significance. In both study groups no neonatal complications or intensive care admissions were reported. Conclusion In the absence of contra indications, 50mcg of oral misoprostol can be given to mothers for induction of labour as no harmful fetal heart tracing abnormalities were found for 45 minutes; however large prospective randomized controlled trials are still needed to confirm effectiveness and evaluate further maternal and neonatal safety issues. Optimal dose and frequency also still need robust interrogation. Based on this thesis it does appear that misoprostol is probably not harmful to the fetus under these circumstances.

AFRIKAANSE OPSOMMING: Misoprostol word dikwels gebruik vir induksie van kraam. Die effek daarvan op fetale hartspoed is egter nie sistematies ondersoek nie. Doel Om die effek van misoprostol op fetale hartspoedparameters gedurende die induksie van kraam van 38 voltooide weke in vroue met vorige intra-uteriene dood or oortyd swangerskap te evalueer. Studei-ontwerp „n Retrospektiewe beskrywende studie van 127 vroue oor „n periode van 18 maande. Metode Vroue wat induksie van kraam met misoprostol ondergaan het vir of vorige intra-uteriene dood of oortyd swangerskap by Tygerberg Hospitaal is ingesluit. Die proses van induksie van kraam is volgens departementele protokol uitgevoer. Die primêre uitkomste was veranderinge in fetale hartspoed (variasie, versnellings en verstadigings) pre- en post-toediening van misoprostol. Neonatale hoësorg of intensiewe sorg toelatings was sekondêre uitkomste. Resultate Ons het geen statistiese verskille in gemiddelde fetale hartspoed en basislynvariasie in verhouding tot die tyd na toediening van misoprostol gevind nie. Daar was geen statisties betekenisvolle verskille in die verspreiding van versnellings en verstadigings in verskillende tydsintervalle nie. Daar was meer reaktiewe patrone gedurende alle tydsintervalle na die toediening van misoprostol, maar hierdie verskille was nie statisties betekenisvol nie. In beide studiegroepe was daar geen neonatale komplikasies of intensiewe sorg toelatings nie. Gevolgtrekking In die afwesigheid van kontra-indikasies kan 50 mcg misoprostol aan moeders toegedien word vir induksie van kraam aangesien geen skadelike fetale hartsped abnormaliteite gevind is nie. Groot prospektiewe gerandomiseerde gekontroleerde studies word steeds benodig om effektiwiteit te bevestig en om moederlike en fetale veiligheidskwessies verder te evalueer. Optimale dosis en frekwensie benodig ook robuuste ondersoek. Gebaseer op hierdie tesis kom dit voor of misoprostol waarskynlik nie skadelik vir die fetus onder hierdie omstandighede nie.

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