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The Capital Region of Denmark - a part of Copenhagen University Hospital
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Induction of labor with high- or low-dosage oral misoprostol - a Danish descriptive retrospective cohort study 2015-16

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INTRODUCTION: In Denmark, the rate of induced labor from 37 gestational weeks has increased by 108% from 12.4% in 2000 to 25.1% in 2012, and today more than one in four deliveries are induced. Standard procedure at North Zealand Hospital changed 2016 from a dosage of 50µg oral misoprostol 2-3 times daily, to 25µg up to 8 times daily. Also, since 2016 healthy uncomplicated pregnant women (primi- and multiparous) have been offered induction as outpatient procedure. This study aimed to compare current low-dosage procedure (25µg) to former high-dosage procedure (50µg) in terms of induction to delivery time, maternal and fetal outcomes, and risk of uterine hyper-stimulation.

MATERIAL AND METHODS: Data from June 2015 to October 2016 was included. Comparable baseline, demographic and obstetric data for women induced according to high-dosage or low-dosage protocols were retrieved from local medical files. Descriptive statistics, Pearson's chi-squared tests, Kaplan-Meier survival estimates, and logistic regression analyses were performed.

RESULTS: The study included 816 induced deliveries. The high- and low-dosage groups differed in rates of plurality and place of induction. Induction to delivery times lasting longer than 72 hours were significantly decreased in the low-dosage group (adjusted odds ratio (ORa) 0.48 (95% CI 0.27 to 0.86)). Women in the low-dosage group also less often needed additional induction (p=0.02), and the rate of uterine hyper-stimulation was low irrespective of protocol (1% vs. 3%, p=0.16). There were no cases of uterine rupture in either group. The probability of vaginal delivery in the low-dosage group increased (adjusted hazard ratio 1.27 (95% CI 1.08 to 1.49)), as did the risk of delivery with vacuum extraction (ORa 2.27 (95% CI 1.24 to 4.15)) whereas delivery by caesarean section slightly decreased (ORa 0.89 (95% CI 0.59 to 1.33)). The risk of meconium-stained liquor was non-significantly decreased (ORa 0.82 (95% CI 0.55 to1.23)).

CONCLUSIONS: The low-dosage induction protocol was associated with favorable obstetric outcomes in terms of increased probability of vaginal delivery, however with higher risk of vacuum extraction. Protracted inductions and additional non-medical interventions were reduced. There were no cases of uterine rupture. Statistically non-significant, the risk of uterine hyper-stimulation was increased whereas the risk of meconium-stained liquor and of caesarean section was slightly decreased.

Original languageEnglish
JournalActa Obstetricia et Gynecologica Scandinavica
Volume99
Issue number2
Pages (from-to)222-230
ISSN0001-6349
DOIs
Publication statusPublished - 2020

ID: 59134314