The efficacy and safety of intravaginal misoprostol for the induction of labor in patients with obstetrical or medical indication for labor induction

A.R Mesquita Rocha,D Frade Bernardes,E Pereira Alves Filho,F.C Nogueira Arcanjo,M.H Oliveira Santos,N.L Pereira Coutinho

doi:10.12891/ceog4364.2019

Abstract

Background: Labor induction is becoming one of the most frequent procedures in maternity hospitals. However, the optimal agent for labor induction has not yet been established. Misoprostol, a prostaglandin E1 analogue, is receiving much attention due to its labor induction properties. Objective: The aim of this study was to evaluate the efficacy and safety of 25 and 50 mcg of intravaginal misoprostol, every four hours, for the induction of labor. Materials and Methods: This was a randomized controlled study to compare two different regimens of vaginal misoprostol, in women with obstetrical or medical indication for induction of labor. Participants received either a 25- or 50-mcg dose of misoprostol inserted into the posterior vaginal fornix repeated every four hours (maximum six doses), until adequate labor was established. Close monitoring of uterine activity and fetal heart rate was performed in all patients. Data were collected prospectively on epidemiological, obstetric, and care aspects. Results: Both regimens of misoprostol were effective in the induction of labor and most of the women had normal vaginal deliveries (81.08%). Although the mean time intervals from induction to the onset of active labor, and from induction to vaginal delivery for the 50-mcg regimen were lower, there was no significant difference between the two regimens. There were very few complications, with one case of uterine tachysystole in each treatment regimen. Conclusion: The results of the present study show that both regimens of misoprostol appear to be effective for the induction of labor in patients with indication, with few fetal complications.

Highlights

The induction of labor, in term pregnant women with unfavorable cervix, remains one of the great challenges of modern obstetrics [1]
Misoprostol has several potential advantages over other synthetic prostaglandin analogues, such as it is stable at room temperature, it is relatively low cost, and it can be administered via several routes, making it an ideal agent for induction of labor [7-11]
Women received either a 25- or 50-mcg dose of misoprostol inserted into the posterior vaginal fornix repeated every four hours, until adequate labor was established

Summary

Introduction

The induction of labor, in term pregnant women with unfavorable cervix, remains one of the great challenges of modern obstetrics [1]. The optimal agent for uterine cervix maturation and induction of labor has not yet been established [2]. Misoprostol is a prostaglandin E1 analogue, which has been recently receiving a great amount of attention due to its labor induction properties [4-6]. Misoprostol has several potential advantages over other synthetic prostaglandin analogues, such as it is stable at room temperature, it is relatively low cost, and it can be administered via several routes (oral, vaginal, sublingual or buccal), making it an ideal agent for induction of labor [7-11]. Since standard doses of misoprostol for labor and induction of labor in pregnant women with live fetuses are not well established in the literature, the objective of this study was to evaluate the efficacy and safety of 25 and 50 mcg of intravaginal misoprostol, every four hours, for the induction of labor, in patients with obstetrical or medical indication for labor induction

Objectives

Methods

Results

Discussion

Conclusion