JSWMC

Abstract:

Intrauterine foetal death (IUFD) is the most undesirable consequence of pregnancy which is psychologically stressful for the woman including her family members and the health care providers. If the fetus is retained for more than 4 weeks, mother is in risk of development of disseminated intravascular coagulation (DIC) and when the membrane is ruptured there is also risk of development of chorioamnionitis and its sequelae of endotoxic shock, sepsis and ultimately maternal death. Therefore, it is necessary to ensure safe delivery of mother with low cost as well as effective method. This study was conducted in the Department of Obstetrics and Gynaecology, Sylhet M.A.G Osmani Medical College Hospital, from July 2016 to June 2018 to compare the effectiveness of vaginal misoprostol versus intracervical Foley’s catheter for induction of labour in intrauterine foetal death. A total number of 132 pregnant women with IUFD without labour pain, intact membrane, singleton pregnancy, cephalic presentation, adequate Pelvis and low Bishop score (£5) were selected.  They were divided into two groups, each consisting of 66 patients. One group (Group- I) was treated with 50 micrograms misoprostol intravaginally every 6 hourly for a maximum of eight doses. In another group (Group-II), an 18-sized Foley's catheter was inserted into the endocervial canal and inflated with 30 ml of distilled water. The catheter was taped to the inner thigh with slight traction. The cervix was reexamined after six hours in both groups. Vaginal misoprostol and intracervical Foley’s catheter treated groups were comparable in respect to maternal age (mean  ±  SD) of 25.23  ±  4.60  years versus 26.39  ± 4.84 years, p>0.05; gestational age (mean ± SD) of 33.84 ± 3.81 weeks versus 34.45 ± 3.73 weeks, p> 0.05; and initial Bishop’s score (mean  ± SD) of 1.68 ± 0.71 versus 1.68 ± 0.69; p>0.05. The time interval from induction to delivery (mean ± SD) was 21.39 ± 5.71 hours in misoprostol treated group and 24.29 ± 8.15 hours in intracervical Foley’s catheter treated group. Difference in induction to delivery interval was significant (p<0.05). Delivery mode was vaginal delivery in 98.5% cases in misoprostol group and 100% cases in intracervical Foley’s catheter group; difference in delivery mode was not significant (p>0.05). Frequency of successful induction was significantly higher (p<0.05) in vaginal misoprostol group (77.3%) compared to intracervical Foley's catheter group (60.6%). Maternal complications such as postpartum haemorrhage (1.5%) and hyperstimulation (1.5%) occurred in vaginal misoprostol group and none in intracervical Foley's catheter group with no significant difference (p>0.05). Results support the notion that vaginal misoprostol is more effective than intracervical Foley's catheter for induction of labour in intrauterine fetal death with comparable safety profile.