Oral or Vaginal Misoprostol for Cervical Ripening

Abstract

<h2>Poster Presentation</h2><h3>Objective</h3> To compare vaginal and oral administration of misoprostol as a cervical‐ripening agent for induction of labor at dose levels commonly used in clinically practice. <h3>Design</h3> Noninferiority, double‐blind, randomized, placebo‐controlled trial. <h3>Setting</h3> Labor and delivery unit of a 12‐bed labor and delivery unit in a 409 bed, not‐for‐profit hospital in the Midwest. <h3>Sample</h3> Convenience sample of 258 women admitted to a labor and delivery unit with medical orders for elective induction of labor. <h3>Methods</h3> According to treatment assignment, women received a 25 mcg dose of misoprostol vaginally or a 50 mcg misoprostol dose orally. Repeat doses of the assigned treatment were provided every 4 hours for up to three total doses until an adequate contraction pattern was present and/or the Bishop score was ≥ 7. Depending on treatment assignment, placebo tablets were administered by the opposite route at the same time as the active drug. Oral and vaginal tablets were administered by the participant's care provider. Participants remained in semirecumbent positions for 2 hours following administration. Investigators, participants, and caregivers were blinded to group assignment throughout the study period. <h3>Results</h3> The average time to a Bishop score of at least 7 and to delivery was similar for the two methods for administration. Neonatal outcomes for the two groups were also similar. The group who received oral misoprostol had a significantly greater number of cesarean births. <h3>Conclusion/Implications for Nursing Practice</h3> Study results suggested that the two routes of administration for misoprostol have comparable outcomes. Other research has been based on greater doses of misoprostol for oral administration and has not shown a significant difference between delivery routes. Consideration should be given to the adequacy of dosing. Given that oral misoprostol is the preferred route of administration for nursing, further studies should be done to validate this finding.