Use of misoprostol for induction of labour
Essential maternal & Newborn clinical
guideline 2022
Dr. Sam Ononge
Senior lecturer (MakCHS)
Obstetrician & Gynaecologist
Member of AOGU, ECSAOGS, NASMEC-
SLT/PPH sub-committee

What is induction of labour
• Artificial stimulation of uterine
contractions before spontaneous
onset of labour with the purpose of
accomplishing successful vaginal
delivery

When to we perform Induction (Indications)
Preeclampsia,
PROM
Post-term pregnancy (>41 wks)
Abruptio placenta
Medical conditions-DM, Heart dx, HPT etc
IUFD
Foetal malformations
4/1/2022 3

When should not induce labour (contra)
Contracted pelvis
Major degree placenta praevia
Transverse lie
Previous CS scar
H/O Myomectomy
Hypersensitivity to inducing agent eg misoprostol
When you do not have all CEmONC functions (*Blood &
functional theatre)
23/03/2023
4

Pre-requisite for induction of labour
• Establish clear indication
• Confirm the gestational age
• Do CBC
• Estimate fetal size & presentation
• Pelvic assessment
• Cervical assessment (BISHOPs score)
• Availability of trained personnel (Dr, anaesthesia and
• No contraindication to vaginal delivery
• Book blood
• Get Informed consent

Methods of induction
• Mechanical methods
• Membrane stripping
• Artificial rupture of membrane
• Balloon catheters
• Drugs
• Oxytocin
• Misoprostol
• Dinoprostone gel

Misoprostol for Induction of labour
Available as a 200 microg tablet
Low cost
Stable at room temperature
Easily administered: Orally or Vaginally for induction
MOA
Enables ripening of cervix
A relaxation of cervical smooth muscle facilitates dilatation.
Increase in intracellular calcium levels, causing contraction of myometrial muscle.

Misoprostol for induction of labour
Orally 25mcg (in solution) every 2 hours,
maximum 8 doses or when labor is established
Oral solution of misoprostol
How to make the oral solution:
 Dissolve 200mcg (1 tablet) of misoprostol in
200mls of drinking water.
Give 25mls of the solution every 2 hours

Misoprostol for induction of labour:
Monitoring and documentation
• Foetal well being
• Foetal heart rate (120-160)
• Liqour when membranes have ruptured
• Maternal well being
• Copying well or distressed
• Vital signs: BP, Pulse & Temp
• Progress of induction (labour)
• Contractions ; frequency and duration
• Descent of PP
• Cervical dilatation

Complications of induction using misoprostol
Failed induction
Uterine hyperstimulation (contraction lasting 60 secs or 4
contractions in 10 mins)
Fetal distress
Meconium aspiration
Foetal death
Rupture uterus
Increased CS delivery
PPH

Conclusion
• Never induce labour when you are not a functional
CEmONC facility
• Use recommended dose as per the guidelines
• Monitor the induction process and document

Thank you