Use of oxytocin and misoprostol for induction or ... - POPPHI

perinatal outcomes. This is likely due to the fact that these procedures are carried out
following guidelines, with appropriate equipment and with an appropriate one-to-one
staff to patient ratio with ready surgical facilities.
In contrast, little is known about the safety of elective or medically indicated induction
and augmentation in developing countries. Seven descriptive studies from sub-Saharan
Africa, China and Nepal documented between ten to greater than 50 percent of uterine
ruptures associated with induction, and the authors commented that these oxytocinrelated
ruptures were due to injudicious, unskilled, unmonitored or excessive use of
oxytocin both in and out of the health system (17)(6-9, 33, 104). The results of three
small studies (two in sub-Saharan Africa one and one in India) suggest that induction
with misoprostol relative to oxytocin may be associated with an increased risk of
meconium staining, but this did not translate to neonatal asphyxia or NICU admissions
(96, 99, 105).
Non-pharmacological methods, which are used to encourage the initiation of labor but are
not expected to result in the immediate onset of labor, are often used internationally in
obstetric care as complementary practices which may avoid formal induction of labor.
Meta-analyses of the effectiveness of non-pharmacological methods have reported: no
differences in the risk of Cesarean section associated with mechanical dilators such as
laminaria tents and balloon catheters relative to no treatment/placebo, to prostaglandins
or to sweeping of the membranes (109); decreased risk of Cesarean section associated
with these mechanical methods relative to oxytocin; decreased risk of hyper-stimulation
of the uterus with fetal heart changes associated with mechanical methods relative to
prostaglandins; and importantly, decrease in the risk of post-date pregnancies and shorter
duration of pregnancy associated with sweeping of the membranes(108). Given their low
cost and concerns regarding the use of elective induction in developing countries, use of
selected non-pharmacological methods to avoid formal induction in low resource settings
warrants further discussion.
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