Outpatient-based misoprostol to prevent prolonged pregnancy

Background: Prolonged pregnancy is defined as the one that persist at or beyond 42 weeks of gestation. Incidence of prolonged pregnancy is around 10%. Aim of the study was to evaluate the efficacy and safety of single dose vaginal misoprostol (25 µg) in preventing prolonged pregnancy when given on outpatient basis at 40 completed weeks of gestation. Objective was to compare number of women entering spontaneous labor between 40 to 41 weeks of gestation, time from enrolment in study till delivery, need for cesarean section and neonatal outcome in early neonatal age in study vs control group. Methods: Total no. of 130 subjects of uncomplicated singleton pregnancy with vertex presentation with bishop score ≤5 were recruited for the study. Patients were randomly allocated into two equal study and control groups. Women allocated to study group received intra-vaginal 25µg misoprostol and control group did not receive any intervention. Results: 92.3% (60/65) of women in the study group had onset of spontaneous labor in one week in comparison to only 72.3% (47/65) in the control group. Mean duration from enrolment to delivery was 1.33±2.03 days in study group and 4.98±2.74 days in control group, which is nearly four times less in women in study group. Women in study group did not have any side effects from single dose of misoprostol given. Mean birth weight, meconium stained liquor rate, NICU admission rate and neonatal morbidity were found to be comparable in both the groups. No neonatal or perinatal mortality was observed in either group. Conclusions: The present study supports the use of 25µg single dose vaginal misoprostol at 40 weeks of gestation to prevent prolonged pregnancy.