Does Misoprostol for Induction of Labor Increase the Risk of Uterine Rupture?

Kiswa Anggreany(1*), Mohammmad Luthfi(2), Risanto Siswosudarmo(3)

(1) Department of Obstetrics and Gynecology, Faculty of Medicine, University of Gadjah Mada
(2) Department of Obstetrics and Gynecology, Faculty of Medicine, University of Gadjah Mada
(3) Department of Obstetrics and Gynecology, Faculty of Medicine, University of Gadjah Mada
(*) Corresponding Author


Background: Misoprostol is a synthetic prostaglandin E1 analogue which is now commonly used for induction of labor. Hyperstimulation is a complication of misoprostol that may lead to uterine rupture.

Objective: To find the association between misoprostol exposure for induction of labor with uterine rupture.

Methods: Case were all women who delivered in Sardjito and affiliate Hospitals from January 2007 to November 2012 with the diagnosis of uterine rupture. Controls were taken randomly from the same hospital. Chi square test and logistic regression model were used for statistical analysis.

Result and Discussion: There were 53 cases of uterine rupture and 199 controls. The incidence of uterine rupture was 53 over 64,244 deliveries or 0,08%. Risk of of uterine rupture associated with misoprostol exposure was 1, 09 (CI 95% 0,52-2,2), while that of oxytocin exposure was 0,80 (CI 95% 0,35-1,85). Logistic regression analysis showed that the highest risk factor associated with uterine rupture was fetal weight > 3500 (OR 3,46; 95% CI 1,48-8,56) followed by parity (OR 2,56;95% CI 1,019-6,465) and vacuum extraction
(OR 2,45;95% CI 0,94-6,39).

Conclusion: There was no association between misoprostol exposure with uterine rupture. Fetal weight> 3500 gram, Parity more than 3, and vacuum extraction increased the risk of uterine rupture associated with misoprostol use.

Keywords: Misoprostol, induction of labor, uterine rupture, fetal weight, parity.


Misoprostol; induction of labor; uterine rupture; fetal weight; parity.

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Goldberg AB, Greenberg MB, and Darney PD. Misoprostol and Pregnancy. N Engl J Med 2001; 344 (1): 38-45.

Wing DA and Paul RH. Induction of labor with misoprostol for premature rupture of membrane beyond thirty six-weeks’ gestation. Am J Obstet Gynecol 1998; 179:94-9.

Idris SB. Perbandingan keefektifan misoprostol dengan oksitosin untuk induksi persalinan pada kehamilan postterm. Thesis PPDS Obstetri dan Ginekologi 2001. Fakultas Kedokteran UGM Yogyakarta.

Kolderup L, McLean L, Grulon K, Safford K and Kilpatrick SJ. Misoprostol is more efficacius for labor induction than prostaglandin E2, but is it associated with more risk? Am J Obstet Gynecol 1999; 180: 1543-50.

Hee LC and Raynor BD. Misoprostol induction of labor among women with a history of cesarean delivery. Am J Obstet Gynecol 2001; 184:1115-7.

Mathews J, Mathai M, George A. Uterine rupture in a multiparaous women during labor induction with oral misoprostol. And Int J Gynecol Obstet 2000, 4344

ACOG Committee Opinion New U.S. Food and Drug Administration Labeling on Cytotec (Misoprostol) Use in Pregnancy. ACOG Committee on Obstetric Practice 2003, 283.

Guise JM, McDonagh MS, Osterweil P, Nygren P, Chan, BK, Helfand M. Systematic review of the incidence and consequences of uterine rupture in women with previous caesarean section. BMJ 2004;329:19

Hofmeyr G, Gülmezoglu AM, Pileggi C. Vaginal misoprostol for cervical ripening and induction of labor, Cochrane database [Art. No.: CD000941. DOI: 10.1002/14651858].2010

Gupta A, Nanda S. Uterine rupture in pregnancy: a five-year study. Arch Gynecol Obstet 2011; 283 (3):437-41.

Zwart JJ, Richters JM, Ory F, de Vries JI, Bloemenkamp KW, van Roosmalen J. Uterine rupture in The Netherlands: a nationwide population-based cohort study. BJOG. 2009;116(8):1069.

Aslan H, Unlu E, Agar M, Ceylan Y. Uterine rupture associated with misoprostol labor induction in women with previous cesarean delivery. Eur J Obstet Gynecol Rep Biol; 2004; (113):45-48.

Plaut MM, Schwartz ML and Lubarsky SL. Uterine rupture associated with the use of misoprostol in the gravid patient with a previous cesarean section. Am J Obstet Gynecol 1999; 180:1535-42.

Afolabi B, Oyeneyin O, Ogedengbe O. Intravaginal misorotol vs. Folley catheter for cervical ripening and induction of labor. Int J Gynecol Obstet 2005; 89:263-67.

Majoko F, Magwali T, Zwizwai. Uterine rupture associated with use of misoprostol for induction of labor. Inter J Gynecol Obstet, 2002, 77-78

Alfirevic Z, Weeks A. Oral misoprostol for induction of labor. Cochrane database [Art. No.: CD001338. DOI: 10.1002/14651858]. 2010

Muzonzini G, Hofmeyr G. Buccal or sublingual misoprostol for cervical ripening and induction of labor. Cochrane database [Art. No.: CD004221. DOI: 10.1002/14651858]. 2010

Jastrow N, Roberge S, Gauthier RJ, Laroche L, Duperron L, Brassard N, Bujold E. Effect of birth weight on adverse obstetric outcomes in vaginal birth after cesarean delivery, 2010, 115:338-43

Zeteroglu S, Sahin GH, Sahin HA. Labor induction in pregnancies with advanced maternal age, 2006, 140-144

Wei SQ, Luo ZC, HP Qi, Xu H, Fraser WD. High dose versus low dose oxytocin for labor augmentation: a systematic review. Am J Obstet Gynecol 2010

Wang LY, Su TH, Lee R. Obstetrics uterine rupture: A 20 year clinical analysis. Taiwanese J Obstet Gynecol, 2004, 43:3

Gardeil F, Daly S, Turner JM. Uterine rupture in pregnancy reviewed restaurants. European J of Obstetrics and gynecology and reproductive biology 1994, 56:107-110


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