Open AccessBishop score and the outcome of labor induction with misoprostol
Author(s) -
Szczesny Witold,
Kjøllesdal Møyfrid,
Karlsson Bengt,
Nielsen Sven
Publication year - 2006
Publication title -
acta obstetricia et gynecologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.401
H-Index - 102
eISSN - 1600-0412
pISSN - 0001-6349
DOI - 10.1080/00016340500451101
Subject(s) - misoprostol , medicine , bishop score , cervix , labor induction , gestation , obstetrics , gestational age , logistic regression , pregnancy , vaginal delivery , gynecology , abortion , oxytocin , cancer , genetics , biology
Background. The aim of the study was to retrospectively identify possible factors for predicting the outcome of induction with misoprostol. Methods. Fifty micrograms of misoprostol were administered intravaginally every 6 h during the first 2 days of induction, up to a maximum of 4 doses. The Bishop score, indication for induction, gestational length, maternal age, and parity were analyzed. The study involved 99 patients (47 primiparous and 52 multiparous) at term (>36 weeks of gestation) with unripe cervices. Results. Forty‐five per cent of the patients achieved ripening of cervix and went into labor after a single dose of misoprostol; a further 45% required 2 doses. Nine patients received more than 2 tablets. Ninety‐seven per cent of all vaginal deliveries occurred within the first 2 days of induction. Ninety‐five per cent of the patients delivered vaginally when the Bishop score was >3, compared with 75% of those with a Bishop score of ≤3 ( p =0.003). Among factors creating the Bishop scoring system, in logistic regression analysis effacement of the cervix was the only independent, significant predictor of cesarean section ( p =0.003, OR = 0.16) even after adjusting for maternal age, which also was a significant predictor in the regression analysis. Eleven patients had previously had a cesarean section; one of them had a uterine rupture with a fatal outcome for the fetus. All women with a previously scarred uterus are now excluded from misoprostol treatment. Conclusion. Misoprostol 50 μg administered intravaginally every 6 h according to this protocol is highly effective for inducing labor in carefully selected patients with unripe cervices.