Impact of combined intramuscular hyoscine and vaginal misoprostol on the median number of misoprostol insertion and time to achieve full cervical ripening in post-date pregnancies in federal medical center Owerri, Nigeria

Abstract

Background: Failed induction of labour is a challenge to both the Obstetrician and patients and remains a common cause of primary caesarean section. Misoprostol, a prostaglandin E1 analogue has been frequently used for cervical ripening and induction of labour with variable outcomes and Hyoscine N-Butyl bromide, which is a smooth muscle relaxant, has been studied widely for its use in labour. The combined effect of both drugs for cervical ripening and labour induction may have a better outcome in labour. Objectives: To compare the impact of combined intramuscular hyoscine and vaginal misoprostol as opposed to vaginal misoprostol alone on the median number of misoprostol insertion and time to achieve full cervical ripening in post-date pregnancies in Federal Medical Center Owerri, Nigeria. Study Design: A randomised double blinded clinical trial involving post-date pregnant women who received combined imtramuscular hyoscine and vaginal misoprostol and those who received vaginal misoprostol only for cervical ripening and induction of labour. Methodology: A total of 130 postdated pregnant women who satisfied the inclusion criteria were recruited for the study by systematic sampling. These were equal number of 65 participants each as case and control. They were matched for gestational age and social status. The case group received both vaginal misoprostol and intramuscular hyosine while the control received vaginal misoprostol alone for cervical ripening and induction of labour The results were analysed using SPSS version 21 with appropriate tables and figures generated. Results: The mean induction-delivery interval was (18.74±3.00 hours) in women who were given vaginal misoprostol + placebo and (16.6 ±3.00 hours) in those who received both vaginal misoprostol and intramuscular hyoscine. The median number of misoprostol inserted in the placebo group was 2 (2,3) while for hyoscine group it was 3(2,3). The mode of delivery between the hyoscine group and the control group did not show any statistically significant difference (P=0.152). Conclusion: The combined intramuscular hyoscine and vaginal misoprostol for cervical ripening and induction of labour as opposed to vaginal misoprostol alone reduces the median number of misoprostol insertion as well as the time to achieve full cervical ripening. Recommendations: The use of combined intramuscular hyoscine and vaginal misoprostol for cervical ripening and induction of labour should be routinely implemented and also the use of hyoscine pessaries with vaginal misoprostol can be studied to see if there would be a different outcome.