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Prediction of adverse outcome associated with vaginal misoprostol for labor induction
M Mutlu Meydanli1, Eray Caliskan, Ali Haberal
1SSK Maternity and Women's Health Teaching Hospital, Ankara, Turkey. mmmeydanli@superonline.com
Objective:
To identify predictors of adverse outcome in pregnant women at term receiving 50 microg of intravaginal misoprostol for labor induction.
Study Design:
A prospective observational study was conducted of 720 pregnant women at term with an unfavorable cervix and a medical or obstetric indication for labor induction. All patients received 50 microg of intravaginal misoprostol every 4h up to three doses. The primary outcome measure was "adverse outcome" defined as: neonatal death, fetal acidemia and emergent cesarean delivery performed for non-reassuring fetal heart rate tracings. A stepwise logistic regression analysis was used to identify predictors of adverse outcome.
Results:
Tachysystole (frequent uterine contractions) (odds ratio (OR), 3.7; 95% confidence interval (CI), 1.2-10.8) and fetal tachycardia (OR, 4.8; 95% CI, 1.4-16.2) were determined as significant predictors of adverse outcome. The specificity of the model was 94.2%, whereas the sensitivity was 20.4%.
Conclusion:
In the absence of tachysystole and fetal tachycardia, an uneventful delivery might be expected for women receiving 50 microg of intravaginal misoprostol.