The use of misoprostol for labour and delivery

Chapter 1 gives a general introduction to the thesis and covers the pharmacological, physiological and clinical background for induction of labour and the prevention and treatment of postpartum haemorrhage. Chapter 2 describes a randomised controlled trial of 200 nulliparous patients undergoing induction of labour with 50 mug of intravaginal misoprostol regimen versus intravaginal dinoprostone regimen. The study shows that the misoprostol resulted with a quicker induction to delivery time with no difference in neonatal outcome. However it was noticed that more suboptimal cardiotocographs were recorded and there was more clinician input in this group. Chapter 3 describes an observational randomised trial of 104 multiparous patients as it was thought that the labour dynamics of nulliparous patients and multiparous patients differed and therefore should be investigated separately. A two dose regimen of 50mug intravaginal misoprostol was compared with a single dose regimen on an intention to treat basis. The two dose regimen led to a quicker induction to delivery time, despite there being no difference in misoprostol doses in 70% patients in both study arms. The results were surprising, and this is discussed in the chapter. Chapter 4 describes a randomised controlled trial of 64 patients, located in South Africa in hospitals whose resources were those of a developing country. The study compared first line treatment options for primary postpartum haemorrhage, which was caused by uterine atony. 800mug rectal misoprostol was compared with the local routine treatment of intramuscular Syntometrine and an intravenous infusion of oxytocin. Misoprostol performed so well that the study was terminated early due clear differences between the treatments arms. Chapter 5 describes an observational randomised study of 40 patients, comparing 500mug oral misoprostol with 10 i.u. oxytocin for the third stage at caesarean section. It shows that the misoprostol and oxytocin group did not reveal any difference with respect to blood loss at caesarean section, peri-operative haemoglobin changes and need for further oxytocic agents. Chapter 6 contains an overall discussion of the role of misoprostol in induction of labour and postpartum haemorrhage. Nonetheless chapter 2 to 5 also contain a discussion pertinent to each clinical trial that comprised this MD thesis. This chapter reflects the great controversy and debate surrounding this area and draws conclusions. Future areas of research work are postulated.