Misoprostol to induce labour: A review of its use in a NSW hospital

Background: Induction of labour (IOL) is a common procedure in maternity care. Misoprostol is a prostaglandin E1 analogue that is effective, cheap and easily stored but not licensed for this use in Australia. Despite evidence supporting the use of misoprostol for IOL, few Australian maternity units use it. Aims: To review the outcomes of women who received vaginal misoprostol for IOL. Methods: A retrospective review of all births induced with vaginal misoprostol from July 1998 to October 2005 at one hospital in New South Wales. Women who had an IOL for multiple pregnancy, known fetal death or congenital abnormality were excluded. Results: In total, 1998 women with a normal, viable, single fetus received vaginal misoprostol for IOL. More than half (57%) of women did not require augmentation during labour. More than one third (37%) had epidural analgesia, 25% had an emergency Caesarean section, 7% had a post‐partum haemorrhage and 16% of babies were admitted to the special care nursery. Uterine rupture occurred in two women, one of whom had a history of uterine surgery. There were two neonatal deaths, both because of Group B Streptococcus infection. Conclusions: In this cohort of women, misoprostol was an effective and safe agent to induce labour. Recent legal concerns at this hospital make its future use in normal clinical practice unlikely.