Misoprostol vs oxytocin
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Misoprostol VS Oxytocin in Induction of Labor
By : Rafi Mahandaru / 2012
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Misoprostol VS Oxytocin in Induction of Labor
By : Rafi Mahandaru / 2012
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Background
• Induksi persalinan merupakan hal yang sering dilakukan dalam praktek kedokteran
• Peningkatan angka induksi persalinan– Indikasi / elektif– Ripe cervix / unripe
cervix
Background
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Non-pharmacological methodsMechanical dilators: Cochrane
review menunjukan resiko yang lebih rendah dari pada oxytocin or misoprostol
Stripping of membranes: memendekan durasi persalinan, menurunkan angka post date dan resiko infeksi
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PharmacologicalOxytocin Misoprostol
V S
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Literature Review• Induksi Persalinan Induksi persalinan adalah
usaha agar persalinan mulai berlangsung sebelum atau sesudah kehamilan cukup bulan dengan jalan merangsang timbulnya his
• IOL refers to iatrogenic stimulation of uterine contractions to accomplish delivery prior to the onset of spontaneous labor (ACOG)
Literature Review
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• 9.5% to 2.5% 1990 & 2006 (PPOHI,2008)• to 33 % 2008
Indications
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Contraindications
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• Jaringan ikat : otot polos > di bag. Distal
• Kolagen disintesis kontinu : Kolagenase
• Peningkatan Reseptor oksitosin 300 x
• Oksitosin Ca2+ & PG
CERVIX
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• Ukuran dan Tekanan dorongan tekanan hidrostatik
• Asam Hialuronat• PG kemotaktik
CERVIX
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Factor
Oksitosin Asam hialuronat
Prostaglandin
Invasi sel radang &Mediator radang
Kadar air meningkat
Tekanan hidrostatik
Kolagenase degradasi kolagen
MMP disosiasi dan pecahnya kumparan kolagen
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• < 5 = blm matang• 9 – 13 = keberhasilan tinggi persalinan pervaginam• > 6 = perlu pematangan serviks
BISHOP SCORE
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• Neurohipofisis• Kadar sama dari masa kehamilan – kala I fase
laten dan fase aktif• Reseptor 100 x lipat 300 x lipat saat 32
minggu• Peningkatan significant saat kala 2 di daerah
periumbilical• Reseptor = membran plasma miometrium
Oxytocin
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Oxytocin• Reseptor di
membran plasma miometrium
• Di non-aktifkan oleh oksitosinase
• Plasenta, ginjal dan hati
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• Dosis rendah (fisiologis) = dosis tinggi (farmakologis)
• Pemberian nasal, bucal, parenteral• Pemberian per-oral dirusak oleh tripsin di
lambung
Oxytocin
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Oxytocin
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Oxytocin
• Side effect :• Uterine tachysystole , can lead to fetal distress,
uterine rupture, abruptio placentae• Water intoxication with hyponatremia• Hypotension
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• Methyl 7-{3-hydroxy-2-[(E)-4-hydroxy-4-methyloct-1-enyl]-5-oxocyclopentyl}heptanoate
• PGE synthetic, PGE1 analog• Cervical modifying agent dan labor inductor• Disintesis dalam tubuh melalui proses yang panjang
Fosfolipid Fosfolipase As. Arakidonat COX PGG, PGH isomerase PGF, PGE, PGD• Cervical ripening• Merangsang kontraksi uterus
Misoprostol
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• Side effect :– Uterine tachysystole +/- FHR changes 50>25mg– Meconium stained amniotic fluid– Uterine rupture in scarred uterus
(avoid in 3rd trimester in these pts)
Misoprostol
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Misoprostol
MuntahDiare
MenggigilDemam > 100 F
Perdarahan Post PartumHiperstimulasi Uterus
Meconium StainingBradicardia
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Result dan
Discussions
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Hasil dan DiskusiSC, Fase laten, waktu dari induksi sampai ke persalinan lebih cepat pada kelompok Misoprostol
Alterasi kontraksi uterus, tachysistole > misoprostol
Hypoxia dan Morbiditas neonatal sama
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Persalinan Pervaginam lebih banyak terjadi pada kelompok Misoprostol
SC Delivery > Oxytocin
Dystocia lebih banyak terjadi pada kelompokFetal Distress lebih besar pada kelompok oksitosin
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Persalinan Pervaginam lebih banyak terjadi pada kelompok Oksitosin
SC Delivery > Misoprostol
Interval waktu persalinan > cepat pada kelompok Misoprostol
Ketuban Pecah > pada Misoprostol
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Persalinan Pervaginam pada cervix yang sudah masak lebih banyak terjadi pada kelompok Oksitosin
SC = lebih banyak pada kelompok OksitosinRawat inap dirumah sakit < misoprostol
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• Tidak ada perbedaan yang signifikan dalam angka persalinan pervaginam pada kelompok misoprostol dan oksitosin
• Interval waktu Induksi hingga persalinan lebih cepat pada kelompok misoprostol
• Tachysistole, hiperstimulasi uterus, aspirasi mekonium dan efek samping lain yang berkaitan lebih banyak terjadi pada kelompok misoprostol
• Angka Kegagalan Induksi dan SC beragam pada kedua kelompok
Conclusion
Conclusion
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DAFTAR PUSTAKA1. Cuningham FG,et al. Diabetes. In Williams Obstetrics. 21st ed. McGraw Hill Medical Publishing Devision.
New York. 2006
2. Wiknjosastro GH, Hudono ST. Penyakit Endokrin. Dalam Ilmu Kebidanan. Edisi 3. Yayasan Bina Pustaka
Sarwono Prawiroharjo. Jakarta. 2010
3. Hofmeyr GJ, Gülmezoglu AM, Vaginal misoprostol for cervical ripening and induction of labour (Review),
The Cochrane Colaboration. 2007
4. Kelly AJ, Tan B, Intravenous oxytocin alone for cervical ripening and induction of labour (Review), The
Cochrane Colaboration. 2007
5. Aquino MA, Cecallti J, Misoprostol versus oxytocin for labor induction in term and post-term pregnancy:
randomized controlled trial, Maternity Hospital Leonor Mendes de Barros, São Paulo, Brazil, 2010
6. Ramsey PS, et al, Vaginal Misoprostol Versus Concentrated Oxytocin and Vaginal PGE2 for Second-
Trimester Labor Induction, American College of Obstetric and Gynecologist, 2007
7. Linseca F, Wood HC, et al, Randomized trial of preinduction cervical ripening: misoprostol vs oxytocin,
American journal of Obstetric and Gynecologist, 2010
8. Le Roux PA, et al, Oral and Vaginal Misoprostol Compared With Dinoprostone for Induction of Labor: A
Randomized Controlled Trial, American Colleges of Obstetric and Gynecologist, 2008