Comparison between vaginal Misoprostol and intravenous oxytocin in induction of labor at Mubimbili National Hospital, Dar es Salaam, Tanzania.

Abstract

Objective: To compare the safety, efficacy and cost effectiveness of vaginal misoprostol and intravenous oxytocin in induction of labor. Design: Randomized trial. Setting: Labor ward at Muhimbili National Hospital (MNH), Dar es Salaam Tanzania. Methods: One hundred and forty two non-grandmultiparous (S gravida 4) women with indication for labor induction were randomly selected for vaginal misoprostol and intravenous oxytocin methods of induction of labor. Misoprostol was administered to 71 women at a dose of 25/lg four hourly, not exceeding 4 doses, whereas oxytocin infusion was titrated based on patient response. Main outcome measures: The main parameters measured were: induction -to- delivery interval, time from induction to onset of contraction, maternal and fetal outcomes, safety and the cost of induction between the two drugs. Results: The median induction -delivery interval was significantly shorter in the misoprostol group as compared to the oxytocin group (10.86 versus 15.45 hours, p<0.001). The time from induction to beginning of contraction was also significantly shorter in the misoprostol group than in the oxytocin group (2.59 versus 3.57 hours p<0.0015). There was no difference in fetal and maternal morbidity between the groups. There was no single case of uterine rupture. Majority of women in the misoprostol group (70%), required less than 0.2 USD for successful induction, whereas in the oxytocin group 77% spent >2.10 USD for induction. Misoprostol was significantly cheaper (p<O.OS). Conclusion: Misoprostol at a dose of 25/lg IS safe, effective and cheaper than oxytocin for induction•oflabor.