Abstract
This study was conducted to compare the efficacy and safety of oral (50 μg) and vaginal (25 μg) misoprostol for cervical ripening and induction of labour. Two hundred patients with indications for labour induction randomly received either 50 μg oral misoprostol every 4 h (Group-I) or 25 μg vaginal misoprostol every 4 h (Group-II), for maximum of six doses. Mean induction to delivery time, delivery within 24 hrs, mode of delivery, oxytocin use, number of doses used, failed induction rate and maternal complication and fetal outcomes were compared for the two groups. Mean induction delivery time was significantly longer in Group-I (20.55±5.59 hrs) than in Group-II (16.70±7.12 hrs) (with mean difference of 3.85 and P-value of <0.001). Mean number of doses of misoprostol used for oral and vaginal misoprostol study populations were 2.61±0.94 and2.37±1.20respectively. Oxytocin augmentation was required in significantly more number of patients in oral group (80%) than in vaginal group (68%) with P-value of 0.027. There were 3 failed inductions in the oral and 4 in the vaginal group after a total of six doses of misoprostol. Incidence of maternal and fetal complications was similar between two groups. Our findings indicated that, 25μg vaginal misoprostol has the potential to induce labor as safely as, and more effectively than, 50 μg oral analogue. JMS 2017; 20(1):18-21
Highlights
Induction implies stimulation of contraction before spontaneous onset of labour
PGE2 analog dinoprostone is currently the only prostaglandin approved by United States Food and Drug Administration (US FDA) for cervical ripening and induction of labour
Exclusion criteria included patients in active labour, multiple pregnancy, malpresentation, estimated fetal weight ≥4kg or
Summary
Induction implies stimulation of contraction before spontaneous onset of labour. The primary condition that must be fulfilled to interfere with this natural process is that terminating pregnancy would benefit the mother and/or fetus. PGE2 analog dinoprostone is currently the only prostaglandin approved by United States Food and Drug Administration (US FDA) for cervical ripening and induction of labour. Advantages of misoprostol over dinoprostone are that it is not expensive, is stored, can be administered by more than one route and can be used in ruptured membranes. For induction of labour misoprostol is mainly used by oral and vaginal routes. There are several reports describing orally administered misoprostol for induction of labour[7,8,9]. Bennett et al found that orally administered misoprostol induced labour as effectively as vaginally administered misoprostol; the time interval from administration to vaginal. The most common vaginal dose used has been 50 μg misoprostol, inserted once or administered every four to six hours. Inserting 25μg misoprostol every six hours intra-vaginally has been associated with the fewest side effects[14, 15]
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