Safety and efficacy of misoprostol in induction of labour in prelabour rupture of fetal membrane in Nigerian women: a multicenter study

Background: Misoprostol, a prostaglandin E1 analogue compared to prostaglandin E2, has the advantage of being inexpensive and stable at room temperature, with its proven efficacy and safety. However studies on the effect of pH on the efficacy of misoprostol have yielded conflicting results. Thus its use in the induction of labour in patients with premature rupture of membrane requires further investigation. Objective: To evaluate the safety and efficacy of misoprostol in induction of labour in Nigerian women with prelabour rupture of membrane after 34 weeks of gestation. Materials and Methods: Three hundred and forty six Nigerian women with prelabour rupture of membrane who consented to participate in the trial were randomised into two arms of misoprostol and oxytocin. Labour was managed with WHO partograph. The primary outcome was the caesarean section rate and induction vaginal delivery interval. Results: The mean induction to vaginal delivery interval was significantly shorter in the misoprostol arm (504 mins) compared to 627 mins in the oxytocin arm (t=3.97; p=0.005). The caesarean section rate of 18.1% among the misoprostol arm was also significantly lower than the 41.4% recorded in the oxytocin arm (p=0.002). Among patients with Bishop score greater than 6 there were no statistically significant differences between the two groups in the outcomes measured. Conclusion: Misoprostol is not only effective but also safe when compared with titrated oxytocin in Nigerian parturients with prelabour rupture of membrane after 34 weeks.