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Abstract
Prolonged pregnancy is a real problem in modern obstetrics. It causes anxiety and distress for many women, their families and obstetricians. For many women who are eagerly or anxiously awaiting the birth of their child, emotional or even psychological disturbances may be encountered if delivery does not occur at or soon after estimated date of delivery. This may be exacerbated by poor counseling (Sounders and Paterson, 1991).
It is now well recognized that prolonged pregnancy is associated with an increased risk of perinatal mortality and morbidity (Hollis, 2002). It is generally unwise to allow pregnancy to continue past 42 weeks and early delivery is indicated either by induction of labor or cesarean section. The best approach should consider both fetal and maternal prognosis favors in selection of the most appropriate strategy of management (Pernol, 1991).
Induction of labor in the presence of an unfavorable cervix is often prolonged, and may lead to induction failure. Most commonly used labor-inducing agents are oxytocin, prostaglandin E2 (PGE2) and prostaglandin E1 (PGE1). Although oxytocin, accepted as a safe and effective initiator of uterine contractions, is widely used, its success depends on the condition of the cervix at the beginning of induction (Lemancewicz et al, 1997). PGE2 has been found to be superior for preinduction cervical ripening yielding a greater increase in bishop score and a decrease in induction failure and cesarean section (Keirse, 1993). Misoprostol a synthetic prostaglandin E1 analog has been proposed as an effective agent for labor induction. A number of studies have compared different dosages of misoprostol with intravenous oxytocin and different doses of intravaginal or intracervical PGE2 for cervical ripening and induction of labor. In most of these studies misoprostol has been shown to be more effective than oxytocin or PGE2 but few studies were appropriately blinded thus leaving a window for bias in assessment OF changes in Bishop score and clinical management of labor and delivery (Daniel et al, 1997}. The question remains whether misoprotol might still reveal pharmacodynamic advantage over PGE2 and oxytocin or not,
In this study, the goal is to study the effect of using these drugs on blood flow in uteroplacental circulation, in postterm pregnancy, by using Doppler ultrasound measurement of uterine and umbilical arteries.