Effect of Combined Intramuscular Hyoscine and Vaginal Misoprostol on the Mean Induction to Delivery Interval among Post-date Pregnant Women in Federal Medical Center Owerri, Nigeria

Background: Induction of labour is saddled with a lot of uncertainties; its failure is a challenge to the parturient and her Obstetrician and as well results in abdominal delivery. Misoprostol, a prostaglandin E1 analogue has increasingly been used for cervical ripening and induction of labour with variable outcomes and Hyoscine N-Butyl bromide, a smooth muscle relaxant, has been studied extensively for its use in active phase labour. The combination of both drugs for cervical ripening and labour induction may have a positive synergistic effect.

Objectives: To compare the effect of combined intramuscular hyoscine and vaginal misoprostol with vaginal misoprostol alone on the mean induction to delivery interval during post-date pregnancy cervical ripening in the 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).

Conclusion: The mean induction to delivery interval shortens when a combined intramuscular hyoscine and vaginal misoprostol is used for cervical ripening and induction of labour in post-date pregnant women as opposed to vaginal misoprostol alone.

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 with vaginal misoprostol can be studied to see if there would be a different outcome.