A comparative study of 25mcg of oral and vaginal misoprostol in induction of labour at term gestation in primigravida

Abstract

Background: Labour induction is one of the common medical procedures in obstetrics. The aim is to end the pregnancy when continuity is a risk to mother or fetus. Prostaglandins have been used successively for cervical ripening and for induction of labour since early 1970’s.This comparative study is undertaken to evaluate the safety and efficacy of oral and vaginal routes of administation of misoprostol for induction of labor. Material and Methods: A prospective randomised controlled trial done on 196 Patients of admitted in Rajkiya Mahila chikitsalaya, JLN Medical College, Ajmer as per inclusion and exclusion criteria, informed consent was taken and randomization into two groups. The women in the oral group were 25 µg of misoprostol with a sip of water, and vaginal group had one 25 µg of misoprostol tablet inserted in the posterior vaginal fornix without use of lubricant (maximum upto 6 doses). Results: Our study showed that Full term (26.5%), followed by severe preeclampsia (24.4%), post-dated (16.3%), Mild PE (12.2%), Antepartum eclampsia (10.2%) and Polyhydramnios (10.2%) were indication for induction of labor. High rate of caesarean section in oral group than vaginal group 32 (32.6%) vs 16(16.3%). The commonest indication of caesarean section was fetal distress in both the groups. Failed induction was also higher in oral group than vaginal group 8(8.1%) vs 4(4%). Conclusion: Our study shows that for induction of labour vaginal route is preferable to oral route when used in equivalent dosage of 25 µg in primigravida. In vaginal route of administration compared to oral route number of dosage required is less, induction delivery interval is less, less incidence of failed induction, less rate of caesarean section, less requirement of oxytocin augmentation, less maternal side effects of the drug. The onset of uterine activity was earlier in oral group. Neonatal outcome is comparable in both groups. The increase efficacy associated with vaginal misoprostol raises the possibility of a local cervical effect with the vaginal administration.