Misoprostol sleepover Camp - A review of the vicious cycle created by holding doses of prostaglandins during induction

Abstract

Background: Induction of labor using prostaglandins is a common and effective strategy for induction of labor. In order to improve safety associated with the administration of prostaglandins, health systems have developed protocols dictating when subsequent doses of prostaglandins must be held. Ideally, these criteria would prevent the administration of prostaglandins when they were likely to cause hyperstimulation. Unfortunately, these protocols are often "triggered" by uterine irritability that is not likely to contribute to hyperstimulation. This vicious cycle of prolonged hospitalization without medication administration to induce labor secondary to prostaglandins being held by hospital protocols has been coined "Misoprostol Sleepover Camp."

Methods: We performed searches of all relevant literature and Pubmed, Medline and Google scholar. All articles that published a protocol of misoprostol usage for induction of labor were considered and reviewed.

Results: Most published, described protocols for oral or vaginal misoprostol induction include parameters for holding doses, while very few of these protocols seem to take into consideration fetal status or maternal appreciation of the contractions. Most of the protocols reviewed out of simply used contractions in ten minutes as the absolute criteria for holding doses.

Conclusion: Initial review of the data seems to indicate that the described phenomenon seems inherent to the protocols described and unavoidable by obstetricians adhering to the protocols.

Keywords: Induction; Labour; Misoprostol; Oxytocin.