Abstract
Subject While the synthetic prostaglandin E1 analogue misoprostol is the most effect labour
induction agent, its use is off-label for the most part. For this reason, and in view
of its potential adverse effects and varying approaches to its administration, the
drug has recently once again become a focus of critical attention. The objective of
this survey was thus to establish a record of labour induction with misoprostol in
German clinics and determine the impact of the negative reporting on everyday obstetric
practice.
Material and Methods In this cross-sectional study, 635 obstetrics and gynaecology departments in Germany
were requested by email to participate in our survey in February/March 2020. Online
responses to 19 questions were requested regarding the clinic, use of misoprostol
before and after the critical reporting, use of misoprostol (sourcing, method of administration,
dosage, monitoring) and other labour induction methods.
Results A total of 262 (41.3%) of the clinics solicited for the survey completed the questionnaire.
There were no differences regarding the care level (Perinatal Centre Level I, Perinatal
Centre Level II, Clinic with Perinatal Focus or Obstetric/Private Clinic; p = 0.2104)
or birth counts (p = 0.1845). In most cases, misoprostol was prepared in the clinicʼs
own pharmacy (54%) or imported from another country (46%) and administered orally
in tablet form (95%). Misoprostol dosage levels varied (25 µg [48%], 50 µg [83%],
75 µg [6%], 100 µg [47%] and > 100 µg [5%]). Most of the clinics used premanufactured
tablets/capsules (59%), although Cytotec tablets were also divided (35%) or dissolved
in water (5%). Misoprostol administration intervals were mainly every 4 hours (64%)
or every 6 hours (30%). CTG checks were run in most cases before and after administration
of a dose of misoprostol (78% and 76%) and before and after administration of a dose
of prostaglandin E2
(both 88%). Presence of contractions led to no misoprostol (59%) or no prostaglandin
E2 (64%) being administered in most cases. The critical reporting resulted in discontinuation
of use of misoprostol in 17% of the clinics – mainly smaller obstetric/private clinics
with fewer than 1000 births. Labour cocktails were used mainly in obstetric and private
clinics (61%).
Conclusion Misoprostol is an established agent for labour induction in German clinics. The dosing
schemes used vary. Improvements of currently common management practices are required,
especially in the area of labour induction (CTG checks before and after administration
of labour-inducing medication, no administration of prostaglandin if contractions
are ongoing). The discussion of use of misoprostol in the media resulted in stoppage
of its use mainly in smaller clinics.
Key words misoprostol - labour induction - Cytotec
