Vaginal Versus Oral Administration of Misoprostol for Labor Induction Among Obese Women [28K

Abstract

INTRODUCTION: Obese women have an increased risk for failed induction of labor. We compare the effectiveness of vaginal versus oral administration of misoprostol for induction. METHODS: A retrospective chart review was performed of women undergoing induction of labor from November 2012 to June 2015. Included were viable, singleton pregnancies at 34 weeks gestation or beyond whose initial agent of cervical ripening was either misoprostol 25 mcg administered vaginally or 50 mcg orally. Obesity was defined as body mass index greater than or equal to 30. Primary outcome was defined as percentage of patients achieving vaginal delivery within 24 hours. Secondary outcomes included mean interval from start of induction to delivery, rate of neonatal intensive care unit admission, and cesarean rate. RESULTS: Of the 390 women who received misoprostol as initial cervical ripening agent, 124 (31.8%) were obese. Among obese women, 25 (20.2%) were treated vaginally compared to 99 (79.8%) treated orally. No differences in baseline characteristics were observed between groups. Sixty percent receiving vaginal misoprostol delivered vaginally within 24 hours compared to 54.6% (P=.79) treated orally. Mean (± standard deviation) interval from start of induction to delivery was shorter in those receiving vaginal (16.3±9.5 hours) versus oral misoprostol (19.5±7.3 hours, P=.02). Other secondary outcomes were similar in each group. CONCLUSION: In labor induction among obese women, vaginal administration of misoprostol may be associated with decreased time to delivery.