Comparison of the Effect of Vaginal Misoprostol and Intravenous Oxytocin on Fetal-Neonatal Complications in Primigravid as Who Referred to Shahid Sadoughi Hospital, Isfahan, Iran in 2017

Document Type : Original Article


1 Department of Midwifery, School of Nursing and Midwifery, Nursing and Midwifery Care Research Center, IsfahanUniversity of Medical Sciences, Isfahan, Iran

2 Department of Obstetrics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

3 Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran

4 Department of Midwifery, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran


Background: Oxytocin and misoprostol are used to initiate labor which can sometimes cause complications to the fetus and neonate. The purpose of this study was to determine the combined effect of vaginal misoprostol and intravenous oxytocin on fetal/neonatal outcomes in primigravidas whoreferred to Shahid Sadoughi Hospital, Isfahan, Iran.
Methods: This clinical trial study was performed on 102 pregnant mothers in Isfahan Shahid Sadoughi Hospital. The participants were randomly divided into two groups of oxytocin induction with vaginal misoprostol (n=51) and oxytocin alone (n=51). Finally, fetal heart rate decline during labor and delivery, Apgar scoresat1and 5min, presence of meconium, and admission to neonatal intensive care unit (NICU)were evaluated. The data were then analyzed in SPSS software (version 22).
Results: The results revealed that the meconium excretion was significantly higher in the intervention group than the control group (P<0.05). The frequency of early deceleration was significantly lower in the intervention group than in the control group (P<0.05). There was no significant difference between the two groups regarding the frequency of late deceleration and variable deceleration in the fetal heart (P>0.05). Frequency of late deceleration and beat-to-beat changes were quite similar in both groups. There was no significant difference in mean Apgar scoresat1 and 5 min between two groups (P<0.05). Frequency of neonatal hospitalization in the intervention group was significantly higher than the control group (P<0.05). Frequency of neonatal need for resuscitation was similar in both groups.
Conclusion: According to the results of this study, concurrent use of misoprostol and oxytocin increased neonatal meconium excretion and NICU admission.


1. Cunningham F, Leveno KG, Bloom SL, Hauth JC, Gilpptrap LC, Wenstrom KD. Williams’s obstetrics.24thed.New York: McGraw-Hill; 2014. P. 426-531.
2. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship between cesarean delivery rate and maternal and neonatal mortality. JAMA. 2015;314(21):2263-70.
3. World Health Organization. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.
4. Kelly AJ, Alfirevic Z, Dowswell T.Outpatient versus inpatient induction of labour for improving birth outcomes. Cochrane Database Syst Rev. 2009; 2:CD007372.
5. Beigi A, Tabarestani H, Moini A, Zarrinkoub F, Kazempour M, Amree AH. Sublingual misoprostol versus intravenous oxytocin in the management of postpartum hemorrhage. Tehran Univ Med J. 2009;67(8):556-61.
6. Chen WH, Lai HC, Tang YH, Liu HS. Fetal doppler hemodynamic changes in spontaneous versus prostaglandin E1-induced active labor. Acta Obstet Gynecol Scand. 1999;78(7):599-604.
7. Nahar A, Ghani A, Khatun A, Sultana R, Akter FM, Yusuf MA. Neonatal outcome among the misoprostol induced term pregnant women. J CurrAdv Med Res. 2015;2(1):3-6.
8. Aalami-Harandi R, Karamali M, Moeini A. Safety and effectiveness of oral misoprostol versus oxytocin for labor induction in term pregnancy. J North Khorasan Univ Med Sci. 2012; 4(3):303-9.
9. American College of Obstetricians and Gynecologists. Neonatal encephalopathy and cerebral palsy: defining the pathogenesis and pathophysiology. Washington, DC: Amer College of Obstetricians; 2003.
10. Mohammad-Yari F, Mohit M, Bakhtiyari M, Khezli M, Latifi A. Comparing the effects of vaginal misoprostol and oxytocin in successful induction of labor. J Mazandaran Univ Med Sci. 2012;22(89):77-86.
11. Luthy DA, Malmgren JA, Zingheim RW.Cesarean
delivery after elective induction in nulliparous women: the physician effect. Am J Obstet Gynecol. 2004; 191(5):1511-5.
12. Hernandez JS, Wendel GD Jr, Sheffield JS: Trends in emergency peripartum hysterectomy at a single institution: 1988–2009. Am J Perinatol. 2013; 30(5):365-70.
13. Balci O, Mahmoud AS, Ozdemir S, Acar A. Induction of labor with vaginal misoprostol plus oxytocin versus oxytocin alone. Int JGynecolObstetr. 2010; 110(1):64-7
14. Bahadori F, Behroozilak T, Bromand F, Nanbakhsh F. A comparative study of vaginal misoprostol plus oxytocin and oxytocin alone in the preparation and induction of labor in the third trimester of pregnancy. JUrmia NursMidwifery Facul. 2011; 9(6):425.
15. Kreft M, Krähenmann F, Roos M, Kurmanavicius J, Zimmermann R, Ochsenbein-Kölble N. Maternal and neonatal outcome of labour induction at term comparing two regimens of misoprostol. JPerinat Med.2014;42(5):603-9.
16. de Aquino MM, Cecatti JG.Misoprostol versus oxytocin for labor induction in term and post-term pregnancy: randomized controlled trial. Sao Paulo Med J. 2003;121(3):102-6.
17. Pandey K, Bhagoliwal A, Singh N, Arya S, Rao YK, Mishra S. Evaluation of cardiotocographic and cord blood changes in induced labor with dinoprostone and misoprostol. Int JReprod Contracept Obstet Gynecol. 2016;3(1):199-203.
18. Jalilian N, Tamizi N, Rezaei M. The effect of vaginal misoprostol and intravenous oxytocin for labor induction.JKermanshah UnivMed Sci. 2010; 14(3): 206-10.