CC BY-NC-ND 4.0 · Geburtshilfe Frauenheilkd 2021; 81(08): 955-965
DOI: 10.1055/a-1538-2200
GebFra Science
Original Article/Originalarbeit

Labour Induction with Misoprostol in German Obstetric Clinics: What Are the Facts on Such Use?

Article in several languages: English | deutsch
Sven Kehl
1   Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
Christel Weiss
2   Abteilung für Medizinische Statistik, Biomathematik und Informationsverarbeitung, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
Werner Rath
3   Medizinische Fakultät, Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
Michael Schneider
1   Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
Florian Stumpfe
1   Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
Florian Faschingbauer
1   Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
Matthias W. Beckmann
1   Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
Patrick Stelzl
1   Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
4   Abteilung für Gynäkologie, Geburtshilfe und Gynäkologische Endokrinologie, Kepler Universitätsklinikum Linz, Linz, Austria
› Author Affiliations


Subject While the synthetic prostaglandin E1 analogue misoprostol is the most effect labour induction agent, its use is off-label for the most part. For this reason, and in view of its potential adverse effects and varying approaches to its administration, the drug has recently once again become a focus of critical attention. The objective of this survey was thus to establish a record of labour induction with misoprostol in German clinics and determine the impact of the negative reporting on everyday obstetric practice.

Material and Methods In this cross-sectional study, 635 obstetrics and gynaecology departments in Germany were requested by email to participate in our survey in February/March 2020. Online responses to 19 questions were requested regarding the clinic, use of misoprostol before and after the critical reporting, use of misoprostol (sourcing, method of administration, dosage, monitoring) and other labour induction methods.

Results A total of 262 (41.3%) of the clinics solicited for the survey completed the questionnaire. There were no differences regarding the care level (Perinatal Centre Level I, Perinatal Centre Level II, Clinic with Perinatal Focus or Obstetric/Private Clinic; p = 0.2104) or birth counts (p = 0.1845). In most cases, misoprostol was prepared in the clinicʼs own pharmacy (54%) or imported from another country (46%) and administered orally in tablet form (95%). Misoprostol dosage levels varied (25 µg [48%], 50 µg [83%], 75 µg [6%], 100 µg [47%] and > 100 µg [5%]). Most of the clinics used premanufactured tablets/capsules (59%), although Cytotec tablets were also divided (35%) or dissolved in water (5%). Misoprostol administration intervals were mainly every 4 hours (64%) or every 6 hours (30%). CTG checks were run in most cases before and after administration of a dose of misoprostol (78% and 76%) and before and after administration of a dose of prostaglandin E2 (both 88%). Presence of contractions led to no misoprostol (59%) or no prostaglandin E2 (64%) being administered in most cases. The critical reporting resulted in discontinuation of use of misoprostol in 17% of the clinics – mainly smaller obstetric/private clinics with fewer than 1000 births. Labour cocktails were used mainly in obstetric and private clinics (61%).

Conclusion Misoprostol is an established agent for labour induction in German clinics. The dosing schemes used vary. Improvements of currently common management practices are required, especially in the area of labour induction (CTG checks before and after administration of labour-inducing medication, no administration of prostaglandin if contractions are ongoing). The discussion of use of misoprostol in the media resulted in stoppage of its use mainly in smaller clinics.

Publication History

Received: 07 April 2021

Accepted after revision: 25 June 2021

Publication Date:
09 August 2021 (online)

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