Abstract
INTRODUCTION: Cervical ripening is frequently needed for labor induction in nulliparous women. The objective of this study was to determine if the rate of cervical change and time to active labor were different when misoprostol is administered by vaginal or buccal route. METHODS: This was a secondary analysis of nulliparous women enrolled in the IMPROVE Study- A comparison of vaginal versus buccal misoprostol for cervical ripening in women for labor induction at term: a triple-masked randomized controlled trial. Primary outcomes were time to active labor (defined as at least 6 cm cervical dilation) and rate of change of cervical dilation up to active labor. Survival analysis using Product-Limit Survival Estimate and Kaplan-Meier method was utilized for time to active labor. IRB approval was obtained. RESULTS: Of the 300 women enrolled in the trial, 124 (41.3%) were nulliparous, with 59 receiving vaginal misoprostol and 65 receiving buccal. Nulliparous women receiving vaginal dosing required fewer doses to reach active labor (2.0 vs 3.0, P=.003). However, this did not result in shorter time to active labor (median 23.1 hrs vs. 25.6, P=.49). The rate of cervical change for the vaginal misoprostol group from trial entry to ≥6 cm was 2.9 (±1.6) mm/hr compared to 2.9 (±1.6) mm/hr for buccal (P=.97). CONCLUSION: In nulliparous women undergoing cervical ripening with misoprostol, vaginal dosing may require fewer doses to achieve active labor but the time to active labor and rate of cervical change were similar between dosing groups. There may not be clinically meaningful differences between dosing routes in nulliparous women.
Published Version
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