developed in two women (1.8%) in the oral misoprostol group and six women (5.5%) in the vaginal misoprostol group.
In either case, we need to be concerned about the possibility of maternal hypotension (for example, post epidural), umbilical cord prolapse or occlusion, placental abruption, rapid fetal descent, tachysystole
, or uterine rupture.
There was an increased incidence of tachysystole
(P [is less than] .01) and hyperstimulation (P [is less than] .04) in the vaginal group, but these differences did not reach statistical significance by the authors' conservatively preset level for secondary analysis of P [is less than] .001.
Maternal Complications Oral Vaginal Spont- Compli Miso- Miso- Oxytocin aneous cations Prostol prostol N (%) Labour N (%) N (%) N (%) Cervix Tear 4 (5.3) 3 (4) 1 (1.3) 3(4) Tachysystole
-- 3 (4) 4 (5.3) -- Postpartum Haemo- 4 (5.3) 3 (4) 2 (2.7) 2(2.7) rrhage Vaginal Wall 3(4) Tear Prolonged -- 1 (1.3) -- 3rd Stage Total 8 (10.7) 10 (13) 7 (9.3) 8(10.7) Table 8.
The evaluation of misoprostol-related tachysystole
in normal and high risk pregnancies.
If uterine tachysystole
or hypertonus occurs, give salbutamol (Ventolin[R]) 250-500 [micro]g intravenously slowly, diluted in 10 ml water for injection, or nifedipine (Adalat[R]) 20 mg orally should be given, if there are no contraindications to these drugs.
Subjects receiving misoprostol were twice as likely to experience tachysystole
. There was also a higher incidence of hyperstimulation in the misoprostol group, but this difference was not statistically significant.
Risks also include tachysystole
, defined as five or more uterine contractions in 10 minutes for two consecutive 10-minute periods and meconium-stained liquor.
The covering ObGyn allegedly made 4 departures from accepted medical practice that caused the child's injury: ordering and administering oxytocin, failing to closely monitor the FHR, failing to timely administer terbutaline, and failing to timely respond to and correct tachysystole
Le Roux et al in a trial gave 50 gm of oral Misoprostol, and 50 gm of vaginal misoprostol randomly to women and compared them with vaginal dinoprostone, and showed that vaginal misoprostol was as effective as dinoprostone tablet but associated with more tachysystole
and caesarean section for fetal distress17.
As expected, tachysystole
(five or more contractions in 10 minutes over a 20-minute period) was more common with misoprostol (20.1% vs.
We did not encounter any case of tachysystole