Comparison of Two Misoprostol Doses for the Occurrence and Severity of Meconium-stained Liquor in Pre-labor Rupture of Membranes

Abstract

Background: Premature rupture of membranes (PROM) and meconium-stained liquor (MSL) are important obstetric conditions and may increase the risk of neonatal complications, including meconium aspiration syndrome (MAS), necessitating timely assessment and appropriate labor management.

Objective: To compare the severity of MSL between two doses of misoprostol (25 µg vs. 50 µg) used for labor induction in patients with PROM.

Methods: This observational study was conducted from July 2024 to September 2024 at Kohi Goth Women's Hospital, Karachi, Pakistan. A total of 100 confirmed PROM women underwent labor induction either immediately or after expectant management for up to 24 hours were categorized into two groups according to the misoprostol dose received. The primary outcome was severity of MSL (Grade I–III). Secondary outcomes included mode of delivery and number of doses required.

Results: Mean age was 27.10±4.10 years in the 25 µg group and 26.68±4.47 years in the 50 µg group. The 50 µg group had a higher proportion of women requiring only one dose (44% vs. 30%, p =0.107); however, the difference was not significant. The rate of spontaneous vaginal delivery was higher in the 25 µg group (86%) compared with 52% in the 50 µg group, where the rate of cesarean section was 48%   (p <0.001). There was also a significant difference in the severity of MSL (p <0.001), which was considerably greater in the 50 µg group.

Conclusion: The 25 µg dosage i.e. lower-dose regimen was associated with less severe MSL and a higher proportion of spontaneous ............