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Abstract
Various methods of induction of labour (IOL) are used for intrauterine fetal death (IUFD) at the Norfolk & Norwich University Hospital. Only recently has the RCOG published green-top guidance.1 Previously, management of IOL was often reliant on consultant experience and contradicting literature. Historically practice used prescription dosing similar to pregnancy-terminations with the unlicensed prostaglandin-E1-analogue misoprostol (miso), and anti-progesterone, mifepristone (mife). Dangerous misoprostol-dosage was highlighted by Fiala & Weeks'2 data, which suggested the danger of uterine misoprostol sensitivity in later gestations. Our audit studied the safety and efficiency of our IOL of IUD in comparison with published practice. 20 women with IUFD over a 1-year period were audited.
Conclusion 50% of women had mife/miso, with an average induction to delivery interval (IDI) of 11.7 h, compared to 18 h for those 5 women given dinoprostone. Two requested caesarean section, and three received oxytocin and artificial rupture of membranes. Diagnosis to delivery interval was 36.5 and 30 hrs respectively for mife/miso and prostin. Therefore, although with mife/miso the resultant delay in commencing IOL is a disadvantage, IDI was preferable. Historically-acceptable, high, potentially dangerous misoprostol-doses were regularly used despite Gomez et al3 recommendations for 25–50 mcg. Significant safety issues and hyperstimulation-risk has been highlighted to the department, and new guidelines have been written.