Safety and efficacy of oral versus vaginal misoprostol use for induction of labour at term.

Abstract

To compare the safety and efficacy of Misoprostol through oral and vaginal routes for induction of labour at term. Quasi-experimental study. Department of Gynaecology and Obstetrics (Unit-IV), Liaquat University Hospital, Jamshoro, Pakistan, from January to December 2004. Eighty term patients who met the inclusion criteria were selected for induction of labour with (50 microg) Misoprostol, either by oral or vaginal route. The patients were allocated in two groups-A and B, using non-probability convenient sampling technique. The dose was repeated at an interval of 6 hours upto maximum dose of 150 microg. Improvement in Bishop's score, analgesic requirements, route of delivery, maternal complications, neonatal outcomes were noted. The commonest indication in group-A was premature rupture of membranes in 16 patients (40%) and in 8 (20%) patients of group-B. Mean improvement in Bishop's score after 6 hours was greater in group-A (3.6 +/- 3.09) than group-B (3.3 +/- 3.45, p=0.70). Induction to delivery interval was less in group-A (6.7 +/- 4.4 hours) than group-B (7.5 +/- 4.3 hours, p=0.41). Oxytocin augmentation was required more in group-B as compared to group-A. Normal vaginal deliveries were achieved in 95% of group-A and in 80% of group-B. The dose of 50 microg was effective in 31(77.5%) patients of group-A as compared to 24 (60.0%) patients of group-B, while 100 microg was needed in 6 (15.0%) patients of group-A as compared to 13 (32.5%) patients in group-B. There was no significant difference between both the groups with regard to analgesic requirement, instrumental delivery, maternal complications and neonatal outcome. Safety and efficacy was comparable between low-dose vaginal and oral Misoprostol uses for induction of labour. However, oral route was better with respect to treatment interval, number of doses required and route of delivery. Both routes of administration can alternatively be used for induction of labour in developing countries where cost of drug does matter.