New perspectives in labour induction at term - with particular reference to the role of the PGE1 analogue misoprostol
The main research question for this thesis was to see if misoprostol is effective in labour induction at term while maintaining safety for both mother and baby, and to determine its most appropriate dosage and route of administration for any future clinical use. The other objectives of the thesis were: 1. to review the understanding of the physiology of the onset of labour and the development of the currently used pharmacological agents for artificial initiation of labour with a viable fetus; 2. to review the evidence on the trends of labour induction and the clinical efficacy and safety of the currently used induction regimens with a view to suggesting improvements; 3. to evaluate the use of oral misoprostol for the specific indication of active management of pre-labour rupture of membranes at term; 4. to investigate the use of mifepristone in outpatient cervical ripening and labour induction at term, with the addition of misoprostol regimens if mifepristone alone is unsuccessful in ripening the cervix. The management of pre-labour rupture of membranes is still a matter of debate. Oral inducing agents may have an advantage in the induction of labour after PROM by reducing the need for internal examinations and therefore of sepsis, both neonatal and maternal. The trial comparing conservative management with active management with oral misoprostol n the management of PROM is presented. Mifepristone has not been extensively investigated for labour induction at term. The results of a pilot study evaluating the clinical regimen of mifepristone and misoprostol is presented. There is an observational comparison group of women managed with the routine protocol of vaginal PGE2 for labour induction.