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Efficacy of Vaginal Misoprostol for Labor Induction in Intrauterine Fetal Death: A Cohort Study from West Java
Vania Flowerina1, Dini Hidayat1, Muhammad Alamsyah Aziz1
1Obstetrics and Gynaecology Department, Faculty of Medicine Universitas Padjadjaran - Dr. Hasan Sadikin General Hospital, Bandung, Indonesia.
Purpose:
To evaluate the efficacy of vaginal misoprostol for labor induction in intrauterine fetal death (IUFD) at ≥20 weeks' gestation.
Patients And Methods:
This retrospective cohort study reviewed medical records of IUFD cases between 2021 and 2023 at Dr. Hasan Sadikin General Hospital, Bandung, Indonesia. Women with IUFD at ≥20 weeks' gestation who underwent vaginal misoprostol induction were included, and cases with incomplete key data were excluded. Outcomes included induction-to-contraction interval, induction-to-delivery interval, and cumulative misoprostol dose. Comparisons across gestational age groups (21-27, 28-36, and ≥37 weeks) were performed using the Kruskal-Wallis test; categorical variables were analyzed using the chi-square test.
Results:
Of 155 IUFD cases, 71 received misoprostol-only induction and were analyzed. Median induction-to-contraction intervals were 12 hours, 6 hours, and 3 hours in the 21-27, 28-36, and ≥37 weeks groups, respectively (p<0.001). Median induction-to-delivery intervals were 13 hours, 10 hours, and 6 hours, respectively (p=0.010). Median cumulative misoprostol doses decreased significantly with advancing gestational age: 200 µg, 100 µg, and 50 µg, respectively (p<0.001). Maternal age and parity did not differ significantly among groups.
Conclusion:
Vaginal misoprostol was associated with shorter induction intervals and lower cumulative dose requirements at later gestational ages in IUFD. Prospective multicenter studies are needed to confirm optimal regimens and safety.
