Misoprostol

Misoprostol, an orally active, stable prostaglandin E1 analogue, has entered clinical use in Obstetrics and Gynaecology on a wide scale without having been registered for such use [10].

The American College of Obstetricians and Gynecologists' Guidelines for induction of labour recommend that misoprostol 25 ^g 3- to 6- hourly is effective for induction of labour (level A evidence), and 50 ^g 6-hourly may be appropriate in some situations, though increased risk of complications has been reported (level B evidence).

Table 23.2 Various methods of labour induction compared with PGE2 administered vaginally as the 'gold standard', extracted from the respective systematic reviews in the Cochrane Library

Outcomes: relative risk (RR) (95% confidence interval) [n]

Table 23.2 Various methods of labour induction compared with PGE2 administered vaginally as the 'gold standard', extracted from the respective systematic reviews in the Cochrane Library

Outcomes: relative risk (RR) (95% confidence interval) [n]

Serious

Efficacy (RR for

Vaginal

Uterine

neonatal

Serious

vaginal delivery

Method

delivery not

hyperstimulation

morbidity

maternal

in 24 h x RR for

compared with

achieved

with fetal heart

or perinatal

morbidity or

uterine

PGE2

within 24 h

rate changes

Caesarean section

death

death

hyperstimulation)

Intravenous

1.9 (1.4-2.4)

0.35 (0.04-3.3) [767]

1.1 (0.95-1.3) [4649]

3.0 (0.3-29)

1.1 (0.15-7.6)

0.7 (0.56-7.9)

oxytocin

[360]

[3084]

[275]

Amniotomy

No events [260]

1.2 (0.38-3.8) [260]

Intravenous

0.9 (0.46-1.8)

0.81 (0.45-1.5) [739]

1.06 (0.79-1.4) [1140]

1.00 (0.07-15)

No events

0.73 (0.21-2.7)

oxytocin with

[42]

[612]

[378]

amniotomy

Vaginal

0.80 (0.73-0.87)

2.0 (1.5-2.8) [3121]

0.97 (0.86-1.1) [3484]

6.0 (0.25-146)

1.6 (1.1-2.4)

misoprostol

[2906]

[360]

Vaginal PG

0.51 (0.05-5.4)

1.0 (0.07-14) [106]

1.0 (0.47-2.2) [107]

0.51 (0.0035-76)

F2-alpha

[75]

Oral misoprostol

1.2 (0.94-1.5)

0.87 (0.49-1.6) [929]

0.90 (0.70-1.2) [959]

No events

No events

1.04 (0.46-2.4)

[691]

[267]

[962]

Mechanical

1.7(1.2-2.5)

0.14 (0.04-0.53) [484]

1.2 (0.94-1.6) [786]

No events

0.24 (0.045-1.3)

methods

[109]

[88]

Membrane

0.70 (0.44-1.1) [339]

sweeping

Extra-amniotic

1.26 (1.0-1.6)

No events [261]

0.89 (0.42-1.9) [142]

prostaglandins

[261]

Oral

0.69 (0.33-1.5) [63]

prostaglandins

Oestrogens (with

5.0 (0.25-100) [60]

0.88(0.36-2.11) [60]

amniotomy)

Comparisons are expressed as relative risks (95% confidence intervals), [n]. Arelative risk below 1 indicates that the outcome was less frequent with the method being compared with PGE2.

Comparisons are expressed as relative risks (95% confidence intervals), [n]. Arelative risk below 1 indicates that the outcome was less frequent with the method being compared with PGE2.

Getting Back Into Shape After The Pregnancy

Getting Back Into Shape After The Pregnancy

Once your pregnancy is over and done with, your baby is happily in your arms, and youre headed back home from the hospital, youll begin to realize that things have only just begun. Over the next few days, weeks, and months, youre going to increasingly notice that your entire life has changed in more ways than you could ever imagine.

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