Efficacy Of Intravaginal Misoprostol Research Articles

A PROSPECTIVE STUDY TO COMPARE COMBINED USE OF INTRAVAGINAL MISOPROSTOL AND INTRACERVICAL FOLEY CATHETER VERSUS INTRAVAGINAL MISOPROSTOL ALONE FOR TERMINATION OF MID-TRIMESTER PREGNANCY IN DEPARTMENT OF OBSTETRICS AND GYNAECOLOGY SMS MEDICAL COLLEGE, JAIPUR

Aims and Objectives: The aims and objectives of the study are to compare the mean induction to abortion interval and efficacy of intra-vaginal misoprostol alone versus combined use of intravaginal misoprostol and intracervical Foley catheter in termination of mid-trimester pregnancy. Methods: This was prospective, comparative study conducted during March 2021 to April 2022 at Department of Obstetrics and Gynaecology, SMS Medical College, Jaipur. The study included sample size of 60 cases (30 cases in each group). 60 cases were randomly allocated to either intravaginal misoprostol alone (Group A) or combined use of intravaginal misoprostol and Foley catheter (Group B) for termination of mid-trimester pregnancy. The study included all pregnant females between 14 and 20 weeks of gestation who were admitted for termination of pregnancy. Results: Mean induction to abortion interval±standard deviation for Group A was 20.79±2.01 h and for Group B, it was 17.29±3.58 h. Mean dose of tablet misoprostol required for Group A±standard deviation was 1453.3±267.47 mcg and for Group B, it was 1053.33±267.47 mcg. Conclusion: In this study, we found that with the combined use of intravaginal misoprostol and intracervical Foley catheter, there was a significant reduction in duration of induction to abortion, total dose misoprostol required, and hospital stay than in intravagnial misoprostol alone in termination of mid-trimester pregnancy.

Intravaginal misoprostol alone versus intravaginal misoprostol and extraamniotic Foley catheter for second trimester pregnancy termination: an observational study.

No systematic empirical research exists addressing the question of optimal pregnancy termination method in second trimester pregnancies. The purpose of this study was to determine the efficacy and safety of intravaginal misoprostol and extraamniotic Foley catheter combination for second trimester pregnancy termination. A single center observational study was conducted in a total of 91 pregnancies. Women who met the termination of pregnancy criteria due to feto-maternal indications between 13 to 26 gestational weeks were included into the study. Study participants received intravaginal misoprostol in combination with Foley catheter (n = 46) or intravaginal misoprostol alone (n = 45). The efficacy of intravaginal misoprostol and Foley catheter insertion combination was comparable to that of intravaginal misoprostol alone in terms of time to abortion/birth [median (95% Confidential Interval [95% CI]): 14.33 (11.33-17.25) hours and 12.08 (9.50-15.33) hours, respectively Hazard Ratio: 0.73, 95% CI: 0.47 to 1.12, p = 0.14 (log-rank)]. The only serious maternal event was uterine rupture observed in one woman in Foley combination group. The combination of intravaginal misoprostol and extraamniotic Foley catheter for second trimester pregnancy termination does not provide additional efficacy.

Prospective randomised controlled trial to compare safety and efficacy of intravaginal Misoprostol with intracervical Cerviprime for induction of labour with unfavourable cervix

SummaryA randomised prospective trial was carried out to compare the efficacy and safety of intravaginal Misoprostol with intracervical dinoprostone gel for induction of labour in cases of unfavourable cervix. One hundred women with an unfavourable cervix requiring induction of labour were randomised to receive either 25 µm vaginal Misoprostol 4-hourly or 0.5 mg of intracervical dinoprostone 12 hourly. The outcome measured was change in Bishop's score, percentage of women going into labour, induction to delivery interval, need for oxytocin, mode of delivery and complications. The parity, mean period of gestation and Bishop's score were similar in both the groups. The improvement in Bishop's score at 12 h was significantly better in the Misoprostol group. Induction to delivery interval was shorter in the Misoprostol group, 16.59 ± 5.13 h vs 27.77 ± 12.71 h. The rate of complications was comparable. Vaginal Misoprostol 25 µg 4-hourly is safe and effective for induction of labour with shorter induction to delivery interval.

Intravaginal misoprostol in preterm premature rupture of membranes with low Bishop scores

This study was carried out at Akbarabadi Hospital in Tehran Iran from December 2002 to May 2004 to assess the efficacy of intravaginal misoprostol in inducing labor in women having preterm premature rupture of membranes (PPROM) with low Bishop score (BS). During the study period 108 consecutive women with a singleton pregnancy of 29 to 36 weeks duration PPROM and indications for pregnancy termination were admitted to the hospital. Gestational age was determined sonographically before 20 weeks and rupture of membranes was confirmed by observing amniotic fluid leakage on speculum examination. (excerpt)

Misoprostol versus cervagem for the induction of labour to terminate pregnancy in the second and third trimester: A systematic review

Aims to compare the benefits and harms of misoprostol to induce labour in the second and third trimester of pregnancy with cervagem. Methods MEDLINE was searched using the terms abortion, induced; abortifacient agents; pregnancy, second trimester; pregnancy, third trimester; misoprostol; cervagem; and gemeprost to identify randomised controlled trials in which misoprostol was compared with cervagem, for induction of labour to terminate pregnancy in the second or third trimester. Outcomes included vaginal birth not achieved within 24 h; induction to delivery interval; analgesia requirements; blood loss; blood transfusion; surgical evacuation of the uterus; maternal death or serious maternal morbidity; side effects. Results Six randomised trials were included. Five compared vaginal misoprostol with cervagem [el Refaey H, Hinshaw K, Templeton A. The abortifacient effect of misoprostol in the second trimester: a randomized comparison with gemeprost in patients pre-treated with mifepristone (RU486). Hum Reprod 1993;8(10):1744–6; Ho PC, Chan YF, Lau W. Misoprostol is as effective as gemeprost in termination of second trimester pregnancy when combined with mifepristone: a randomised comparative trial. Contraception 1996;53(5):281–3; Nuutila M, Toivonen J, Ylikorkala O, Halmesmaki E. A comparison between two doses of intravaginal misoprostol and gemeprost for induction of second trimester abortion. Obstetr Gynecol 1997;90(6):896–900; Wong KS, Ngai CS, Wong AY, Tang LC, Ho PC. Vaginal misoprostol compared with vaginal gemeprost in termination of pregnancy: a randomized controlled trial. Contraception 1998;58(4):207–10; Dickinson JE, Godfrey M, Evans SF. Efficacy of intravaginal misoprostol in second trimester termination of pregnancy: a randomized controlled trial. J Mater Fetal Med 1999;7(3):115–9], and one oral misoprostol with gemeprost [Bartley J, Baird DT. A randomised study of misoprostol and gemeprost in combination with mifepristone for induction of abortion in the second trimester of pregnancy. Br J Obstetr Gynaecol 2002;109(11):1290–4]. Vaginal misoprostol compared with cervagem was associated with reduced narcotic analgesia (3 studies, 169 women, RR 0.64 95% CI 0.49–0.84), and surgical evacuation of the uterus (5 studies, 319 women, RR 0.71 95% CI 0.53–0.95). No other statistically significant differences were observed for other outcomes with reported data. In the single trial comparing oral misoprostol with gemeprost, reported outcomes were similar. Conclusions Vaginal misoprostol for the termination of second and third trimester of pregnancy appears as effective as cervagem, but information about maternal safety is limited.

Is misoprostol safe for labor induction in twin gestations?

Objective. To compare the safety and efficacy of intravaginal misoprostol to oxytocin for the induction of labor in twin gestations.Methods. All twin gestations that underwent induction of labor with misoprostol or oxytocin during a 4-year period were identified from the Mount Sinai obstetrical database. Only twins ≥34 weeks with a vertex presenting twin A were included. Labor and delivery characteristics, maternal complications and neonatal outcomes were compared between the two groups.Results. Of 134 patients with twins, 57 initially received misoprostol and 77 received oxytocin. These groups had similar demographics, but women who received misoprostol had less cervical dilation (0.8 vs. 2.2 cm, p < 0.0001) and were less likely to be multiparous (19% vs. 44%, p = 0.003). There was a shorter length of induction to delivery (7.8 hours vs. 15.1 hours, p = 0.001) and a trend toward a lower cesarean section rate (16.9% vs. 31.6%, p = 0.06) in the oxytocin-only group. There were no cases of uterine rupture or maternal mortality in this series. There were no significant differences in neonatal outcomes between the two groups, but the sample size was underpowered to detect significant differences between the groups.Conclusions. Misoprostol and oxytocin both appear to be safe and efficacious for use in inductions of labor in twins in this limited retrospective investigation. The safety of these agents with regard to neonatal outcomes should be confirmed by larger studies.

Randomised trial of intravaginal misoprostol and intracervical Foley catheter for cervical ripening and induction of labour

SummaryInduction of labour may be indicated despite an unripe cervix. The purpose of this study was to compare the safety and efficacy of intravaginal misoprostol and an intracervical Foley's balloon catheter for preinduction cervical ripening and labour induction. A total of 120 patients requiring indicated induction of labour with an unfavourable cervix (Bishop's score ≤4) were randomised prospectively to receive either 50 μg intravaginal misoprostol every 6 h for a maximum of two doses, or an intracervical Foley balloon catheter for 12 h followed by an intravenous oxytocin infusion. The two arms of the study were comparable with respect to maternal age, parity, gestational age, indication for induction, and initial Bishop's scores. There were significant change in the Bishop's score in the two groups (5.9 ± 0.2 and 4.0 ± 0.2, respectively, p < 0.001) but no inter group differences. Oxytocin induction or augmentation of labour occurred more in the catheter group (95%) than in the misoprostol group (43.3%) (p < 0.0001). Induction to delivery interval was significantly shorter in the misoprostol group than in the catheter group (8.7 ± 2.4 vs 11.9 ± 2.7 h p < 0.0001). There was no significant difference noted in the caesarean or other operative delivery rates among patients in the two treatment groups. There was a higher incidence of tachysystole and hyperstimulation in the misoprostol group than in the catheter group (p < 0.03). No differences were observed between groups for meconium passage, 1- or 5-min Apgar scores <7 and admission into the neonatal intensive care unit. In conclusion, the maternal and perinatal outcomes in this study have shown no difference confirming the efficacy and safety of both methods, however we observe a decrease in the induction-to-delivery interval when misoprostol is used for this purpose.

Efficacy of intravaginal misoprostol in second-trimester pregnancy termination: A randomized controlled trial

Efficacy of intravaginal misoprostol in second-trimester pregnancy termination: A randomized controlled trial

A double-blind comparison of the safety and efficacy of intravaginal misoprostol and prostaglandin E 2 to induce labor

Objective: Our purpose was to compare the safety and efficacy of intravaginally administered misoprostol versus prostaglandin E 2 for labor induction in a double-blind, randomized trial. Study Design: One hundred three patients with indications for labor induction (including prelabor rupture of membranes) were randomized and received either misoprostol 50 μg or prostaglandin E 2 (dinoprostone) 3 mg intravaginally. The dose was repeated 6, 24, and 30 hours after the first dose until active labor was achieved. For proper blinding, the drugs were prepared as identical-looking vaginal tablets. Results: With use of a random number–generated table 52 patients were allocated to the misoprostol group and 51 to the prostaglandin E 2 group. After exclusion of 3 patients, 50 in each group were evaluated. Delivery within 24 hours after administration occurred more often in the misoprostol group (70% vs 46% in the prostaglandin E 2 group, p = 0.009), and fewer patients in this group needed more than two doses (12% vs 30%, p = 0.027). No difference in cesarean section rate (12% vs 14%, p = 0.67), fetal heart rate anomalies (33% vs 34%, p = 0.89), tachysystole (8% vs 14%, p = 0.37), hyperstimulation syndrome (0% vs 2%, not significant), meconium passage (28% vs 18%, p = 0.22), and fetal outcome (Apgar score at 1 and 5 minutes, arterial and venous umbilical cord blood pH, transfer to neonatal intensive care unit) was noted between the two groups. Conclusion: Intravaginal misoprostol is a safe drug for labor induction with superior effectiveness compared with intravaginal prostaglandin E 2.

Misoprostol for cervical ripening and labor induction: A meta-analysis

To analyze published randomized trials assessing the safety and efficacy of misoprostol for cervical ripening and labor induction. We supplemented a search of entries in electronic data bases with references cited in original studies and review articles to identify randomized trials of misoprostol for cervical ripening and labor induction. Two blinded investigators performed independent trial quality evaluation and data abstraction of randomized clinical trials assessing the efficacy of misoprostol as a cervical ripening and labor-inducing agent. We calculated an estimate of the odds ratio (OR) and risk difference for dichotomous outcomes, using both a random- and fixed-effects model. Continuous outcomes were pooled using a variance-weighted average of the within-study difference in means. Of 16 studies identified, eight met our criteria for meta-analysis. These eight trials included 966 patients (488 received misoprostol and 478 were controls). Women who received misoprostol for cervical ripening and labor induction had a significantly lower overall cesarean rate (OR 0.67, 95% confidence interval [CI] 0.48, 0.93) and a higher incidence of vaginal delivery within 24 hours of misoprostol application (OR 2.64, 95% CI 1.87, 3.71). Use of misoprostol was associated with a higher incidence of tachysystole (OR 2.70, 95% CI 1.80, 4.04) but not hyperstimulation (OR 1.91, 95% CI 0.98, 3.73). The incidences of abnormal 5-minute Apgar scores and admissions to the neonatal intensive care unit were similar in the misoprostol and control groups. The pooled estimate of the mean interval from start of induction to delivery was 4.6 hours fewer (95% CI -3.5, -5.7) in the misoprostol group. Published data confirm the safety and efficacy of intravaginal misoprostol as an agent for cervical ripening and labor induction.