Influence of Combined Intramuscular Hyoscine and Vaginal Misoprostol for Cervical Ripening on the Need for Labour Augmentation and Pregnancy Outcome in a Tertiary Hospital in South-East Nigeria

Abstract

Background Induction of labour failure is a challenge to the parturient and her Obstetrician and is an indication for caesarean section. Misoprostol, a prostaglandin E1 analogue has been commonly used for cervical ripening and induction of labour with variable outcomes and Hyoscine N-Butyl bromide, a smooth muscle relaxant, has been well studied for its use in active phase labour. The use of both drugs for cervical ripening and labour induction may have a better prognosis than using misoprostol alone.  Objectives To compare the influence combined intramuscular Hyoscine butyl bromide and vaginal misoprostol as opposed to vaginal misoprostol alone has on the need for labour augmentation and pregnancy outcome 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). However, there were 37 labour augmentation in the control group as opposed to 18 in the hyoscine group which was statistically significant (P=0.001).  Conclusion The need for labour augmentation reduces in post- date pregnancies when combined intramuscular hyoscine and vaginal misoprostol is used for cervical ripening and labour induction as opposed to vaginal misoprostol alone however, there is no difference in pregnancy outcome between the two methods.  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 7uy67/with vaginal misoprostol can be studied to see if there would be a different outcome.