Misoprostol use under routine conditions for termination of pregnancies with intrauterine fetal death

To analyze the misoprostol use in pregnancies with intrauterine fetal death (IUFD), considering mode of delivery and induction-delivery interval.

Descriptive study including 171 pregnant women with IUFD, in the second or third trimester, submitted to labor induction with vaginal misoprostol and/or induction/augmentation with intravenous oxytocin, from 2005 to 2008, at a teaching-hospital of the Brazilian Unified Health System (Sistema Único de Saúde - SUS).

Misoprostol alone (treatment A), misoprostol plus oxytocin (treatment B), and oxytocin alone (treatment C) were administered in 9.3%, 19.9%, and 70.8% of the cases, respectively. One-third of pregnancies were less than 28 weeks, and 2.9% required a caesarean section. The percentage of vaginal delivery in treatments A and B combined (98.0%) was similar to treatment C (96.7%). The mean induction-delivery interval was 15.4hours. Comparing multiple groups, the mean induction-delivery interval was significantly shorter in treatment A (20.1hours) than in treatment B (33.3hours), and was longer than in treatment C (9.7hours). The majority (71%) of cases required a single administration of misoprostol, and the total dosage was lower in treatment A (mean: 98.4μg) compared with treatment B (mean: 157.0μg).

Misoprostol effectively contributed to delivery of IUFD by vaginal route assisted under routine conditions of a public health service in Brazil, demonstrating its importance in cases resistant to usual induction methods, and its availability in Brazilian public health services is recommended.