Comparison of two labor induction regimens with intravaginal misoprostol 25 μg and adverse perinatal outcomes

Santiago, Marcela Beraldo; Santiago, Talita Beraldo; Oliveira, Samuel Machado; Caldas, João Victor Jacomele; Araujo Júnior, Edward; Peixoto, Alberto Borges

doi:10.1590/1806-9282.20240286

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ORIGINAL ARTICLE • Rev. Assoc. Med. Bras. 70 (9) • 2024 • https://doi.org/10.1590/1806-9282.20240286 copy

Comparison of two labor induction regimens with intravaginal misoprostol 25 μg and adverse perinatal outcomes

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

OBJECTIVE:

The aim of the study was to compare two labor induction regimens (4 and 6 h), to determine predictors of successful labor induction with intravaginal misoprostol 25 μg tablets, and to evaluate the association with adverse perinatal outcomes.

METHODS:

This was a retrospective cohort study that included singleton pregnancies undergoing induction of labor with an intravaginal misoprostol 25 μg tablet between 37 and 42 weeks of gestation. The pregnant women were divided into two groups: Group 1—intravaginal misoprostol 25 μg every 4 h and Group 2—intravaginal misoprostol 25 μg every 6 h.

RESULTS:

Pregnant women were divided into Group 1 (n=289) and Group 2 (n=278). Group 1 had a higher median number of intravaginal misoprostol 25 μg tablets (3.0 vs. 2.0 tablets, p<0.001), a lower prevalence of postpartum hemorrhage (7.6 vs. 32.7%, p<0.001), and a higher need for oxytocin (odds ratio [OR]: 2.1, 95%CI: 1.47–2.98, p<0.001) than Group 2. Models including intravaginal misoprostol 25 μg tablets every 4 and 6 h [x²(1)=23.7, OR: 4.35, p<0.0001], parity [x²(3)=39.4, OR: 0.59, p=0.031], and Bishop’s score [x²(4)=10.8, OR: 0.77, p=0.019] were the best predictors of failure of labor induction. A statistically significant difference between groups was observed between the use of the first intravaginal misoprostol 25 μg tablet at the beginning (Breslow p<0.001) and the end of the active labor phase (Long Hank p=0.002).

CONCLUSION:

Pregnant women who used intravaginal misoprostol 25 μg every 4 h had a longer time from the labor induction to the beginning of the active phase of labor and higher rates of adverse perinatal outcomes than women who used intravaginal misoprostol 25 μg every 6 h.

KEYWORDS
Labor induction; Misoprostol; Outcomes assessment

	Group 1 (289)	Group 2 (278)	Statistics	p-value
Maternal age (years)	23.0 (15.0–43.0)	23.0 (14.0–45.0)	38.9	0.535^∫ ∫: median (minimum–maximum); chi-square
Number of previous pregnancies	1.0 (1.0–9.0)	1.0 (1.0–11.0)	39.5	0.715^∫ ∫: median (minimum–maximum); chi-square
Number of previous deliveries	1.0 (0.0–8.0)	0.0 (0.0–8.0)	28.6	<0.001^∫ ∫: median (minimum–maximum); chi-square
Number of vaginal deliveries	1.0 (0.0–10.0)	0.0 (0.0–10.0)	33.3	<0.001^∫ ∫: median (minimum–maximum); chi-square
Number of cesarean sections	0.0 (0.0–2.0)	0.0 (0.0–1.0)	33.4	0.815^∫ ∫: median (minimum–maximum); chi-square
Gestational age (weeks)	40.0 (37.0–42.1)	40.0 (37.0–43.0)	39.4	0.691^∫ ∫: median (minimum–maximum); chi-square
Bishop’s score	4.0 (1.0–8.0)	3.0 (1.0–7.0)	32.5	<0.001^∫ ∫: median (minimum–maximum); chi-square
Premature rupture of ovular membranes	23.2% (67/289)	27.2% (77/278)	1.52	0.217^ƒ ƒ: percentage (n/N). p<0.05.
Type of delivery			0.41	0.520^ƒ ƒ: percentage (n/N). p<0.05.
Vaginal	64.7% (187/289)	67.3% (187/278)
Cesarean section	35.3% (102/289)	32.7% (91/278)
Birth weight (g)	3,230 (2,070–4,685)	3,272 (2,180–4,230)	37.5	0.179^∫ ∫: median (minimum–maximum); chi-square
APGAR score at the first minute	8.0 (1.0–10.0)	9.0 (2.0–10.0)	25.8	<0.001^∫ ∫: median (minimum–maximum); chi-square
APGAR score at the fifth minute	8.0 (5.0–10.0)	9.0 (6.0–10.0)	31.3	<0.001^∫ ∫: median (minimum–maximum); chi-square

	Group 1 (289)	Group 2 (278)	Statistics	p-value
Number of intravaginal misoprostol tablets	3.0 (1.0–8.0)	2.0 (1.0–8.0)	32.0	<0.001^∫ ∫: median (minimum–maximum); chi-square
Oxytocin use	46.4% (134/289)	29.1% (81/278)	17.0	<0.001^ƒ ƒ: percentage (n/N). p<0.05.
Failure of labor induction	20.4 % (59/289)	6.8% (19/278)	22.0	<0.001^ƒ ƒ: percentage (n/N). p<0.05.
APGAR score at first minute <7	6.2% (22/353)	8.5% (18/212)	1.03	0.311^ƒ
Admission of neonatal intensive care unit	1.7% (5/289)	1.8% (5/278)	0.003	0.951^ƒ ƒ: percentage (n/N). p<0.05.
Hasty labor	19.0% (55/289)	0.0% (0/278)	58.6	<0.001^ƒ ƒ: percentage (n/N). p<0.05.
Tachysystole	1.0% (3/289)	0.4% (1/278)	0.931	0.335^ƒ ƒ: percentage (n/N). p<0.05.
Postpartum hemorrhage	7.6% (22/289)	32.7% (91/278)	56.0	<0.001^ƒ ƒ: percentage (n/N). p<0.05.
Neonatal death within 48 h	0.0% (0/289)	0.0% (0/278)	–	–

	OR	95%CI	X²	R² (Nagelkerke)	p-value
Intravaginal misoprostol 25 μg every 4 and 6 h	4.35	2.38–7.93	23.7	0.075	<0.0001
Number of pregnancies	0.97	2.56–8.42	34.7	0.109	0.899
Number of deliveries	0.59	0.36–0.95	39.4	0.123	0.031
Bishop’s score	0.77	0.62–0.95	10.8	0.142	0.019

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[1] *Corresponding author: araujojred@terra.com.br