Misoprostol For Labor Induction Research Articles

Comparative Evaluation of 25µg and 50µg of travaginal Misoprostol for Induction of Labor


 Introduction: To compare the efficacy and safety of 25g vs. 50g of intravaginal (Posterior fornix) misoprostol for induction of labor in 100 patient from Jan 2012 to Dec 2012 at Lumbini Medical College.
 
 Methods: One hundred pregnant lady requiring induction were randomly assigned to receive either 25 g (group A=50) or 50 g (group B=50) of intra vaginal misoprostol every 4 hrs till adequate contractions were achieved or maximum dose of 150 g was used.
 
 Results: The onset of contraction was earlier in group B in 34 cases as compared to group A, where only 25 cases had earlier contraction ( P> 0.05). 38 cases (76%) in Group B and 35 cases (70%) in Group A delivered vaginally. Induction to delivery interval was shorter(<12hrs) in group B in 15 cases and in 10 cases in group A. Mean dose of Misoprostol (94micrograms) for successful induction in group B was high compared to Group A (75.5 microgram). Requirement for oxytocin infusion was higher in group A, 26% vs. 15%. Abnormal contractility pattern was seen in B group 24% cases compared to 14% cases in Group A. APGAR score < 7 at 1 min was seen in 26% neonates in Group B and in only 10% neonates in Group A. Ruptured uterus did not occur in any group.
 
 Conclusion: 50 g dose of misoprostol is more efficacious than 25 g dose as seen in our study. However it appears to be less safe both for mother and baby due to the high incidence of tachysystole, hyperstimulation and intrauterine passage of meconium.

Comparative Evaluation of 50 Microgram Oral Misoprostol and 25 Microgram Intravaginal Misoprostol for Induction of Labour at Term: A Randomized Trial

ObjectivesTo assess and compare the efficacy and safety of 50 μg oral misoprostol and 25 μg intravaginal misoprostol for induction of labour at term. MethodsThis non-blinded, randomized clinical trial included 228 pregnant women at term with obstetric or medical indications for induction of labour. Women either took 50 μg misoprostol orally (two 25 μg tablets) or had one 25 μg tablet of misoprostol inserted in the posterior vaginal fornix. In each group, misoprostol administration was repeated every four hours in the same dose until regular uterine contractions were established or to a maximum of five doses. Time to delivery and outcome data for each group were compared. ResultsOf the 228 women, eight (3.5%) were excluded from the analysis as they withdrew their consent after randomization. Mean induction-to-delivery interval was similar in both groups (21.22 hours in the oral group vs. 20.15 hours in the vaginal group; P = 0.58). There was no significant difference between the groups with respect to the number of women who delivered within 24 hours or who required oxytocin augmentation of labour, the mode of delivery, and neonatal outcomes (P > 0.05). Uterine hyperstimulation occurred in two women who received misoprostol vaginally, but not in any of the women in the oral misoprostol group. ConclusionOral misoprostol in a dose of 50 μg every four hours, to a maximum of five doses, has the potential to induce labour as safely and effectively as 25 μg misoprostol administered vaginally every four hours.

Early amniotomy after vaginal misoprostol for induction of labor: a randomized clinical trial

To test the effectiveness and safety of early amniotomy after vaginal misoprostol for the induction of labor. A randomized clinical trial that included 320 women with medical or obstetric indication for labor induction. They were randomly assigned into two equal groups, amniotomy group and control group. Each participant received vaginal misoprostol 50 μg every 6 h for induction of labor. In amniotomy group, amniotomy was done in the early active phase of labor while in the control group, the membranes were left to rupture spontaneously or as judged by the senior resident in the duty. More subjects in the amniotomy group achieved vaginal delivery within 24 h than in the control group [117 (73.13 %) vs. 105 (65.63 %)]. Subjects in the amniotomy group reported shorter induction to delivery interval (09.72 ± 4.61 h vs. 13.61 ± 5.61, P = .002), and better neonatal outcome compared to the control group. There were no statistically significant differences between both group with regard to number of doses of misoprostol, need for oxytocin, Cesarean Section indication and maternal side effects. Early amniotomy after vaginal misoprostol for labor induction is associated with higher successful vaginal delivery rate, shorter labor duration and better neonatal outcome.

A Comparative Study of 25 mcg vs 50 mcg of Vaginal Misoprostol for Induction of Labor

ABSTRACT Objectives To compare the efficacy and safety of 25 mcg intravaginal misoprostol vs 50 mcg misoprostol for induction of labor. Material and methods This study group consisted of 100 cases of low-risk singleton pregnancies attending the antenatal clinic of SAH and RC, or admitted to the antenatal ward. Study group included singleton pregnancy, Over 37 weeks of gestation with Vertex presentation, with unfavorable cervix (bishop score <4) and patients not in labor with reactive fetal heart rate pattern with intact membranes. Women were randomized to either 25 mcg (n = 50) or 50 mcg (n = 50) of intravaginal misoprostol. The dose was repeated every 4 hours (maximum number of doses limited to 3 doses). The main outcome was induction vaginal delivery interval. Results Induction delivery interval was significantly less with 50 mcg misoprostol —9.45 hours in comparison to 25 mcg 14.2 hours (p-value <0.001), most cases delivered vaginally with 25 mcg misoprostol p value < 0.013, cesarean section rates were high in 50 mcg misoprostol group p-value <0.007, the proportion of women delivering vaginally with single dose of vaginal misoprostol was high in 50 mcg group, i.e. 64%, incidence of maternal complications like tachysystole and hyperstimulation was more with 50 mcg group. Conclusion In the present study, it is concluded that 25 mcg of misoprostol is safe and effective for labor induction. How to cite this article Bharathi A, Kumar KA, Ganga AP. A Comparative Study of 25 mcg vs 50 mcg of vaginal Misoprostol for Induction of Labor. J South Asian Feder Obst Gynae 2013;5(3):111-115.

Comparative Study of Oral and Vaginal Misoprostol for Induction of Labour, Maternal and Foetal Outcome

Misoprostol is a new promising agent for cervical ripening and induction of labour .The ideal dose, route and frequency of administration of misoprostol are still under investigation. Although, vaginal application of misoprostol has been validated as a reasonable mean of induction, there is a patient resistance to digital examination and there is a risk of ascending infection. For this reason, oral administration of misoprostol for cervical ripening and labour induction has been tried. To compare 50μg of oral misoprostol versus 25μg of intravaginal misoprostol for induction of labour at term and maternal, foetal outcomes. Two hundred women who were at term, with indication for induction of labour and Bishop scores of ≤5 were randomly assigned to receive misoprostol 50μg or 25μg intravaginal, every 4-6 hours, for a maximum of 5 doses. In either group, pregnant females with inadequate uterine contractions despite being given maximum 5 doses of misoprostol, were augmented using oxytocin. The primary outcome measure was time-interval from induction to vaginal delivery and vaginal delivery rate within 24 hours. The median induction to vaginal delivery time in oral group (12.92h) and vaginal group (14.04 h) was not significant. Oral misoprostol resulted in more number of vaginal deliveries as compared to vaginal misoprostol (94% as compared to 86%), which was not significant. There was a significantly higher incidence of uterine tachysystole in the vaginal group, as compared to oral group. There were no significant differences between the groups with respect to oxytocin augmentation, caesarean section rate, analgesic requirement and neonatal outcome. Oral misoprostol is as efficacious as vaginal misoprostol because of shorter induction delivery interval, lower caesarean section rates, and lower incidence of failed induction rates. Lower incidence of foetal distress and easy intake are observed if the drug is administered orally.

O645 COMPARATIVE EVALUATION OF 25 μG AND 50 μGOF INTRAVAGINAL MISOPROSTOL FOR INDUCTION OF LABOUR

International Journal of Gynecology & ObstetricsVolume 119, Issue S3 p. S488-S488 Free communication (oral) presentations O645 COMPARATIVE EVALUATION OF 25 μG AND 50 μGOF INTRAVAGINAL MISOPROSTOL FOR INDUCTION OF LABOUR U. Singh, Search for more papers by this authorH. Gupta, Search for more papers by this authorS. Mehrotra, Search for more papers by this author U. Singh, Search for more papers by this authorH. Gupta, Search for more papers by this authorS. Mehrotra, Search for more papers by this author First published: 22 October 2012 https://doi.org/10.1016/S0020-7292(12)61075-3AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume119, IssueS3Abstracts of XX FIGO World Congress of Gynecology and ObstetricsOctober 2012Pages S488-S488 RelatedInformation

986 A Comparison Between Effects of Vaginal Misoprostol and Oxytocin in Successful Induction of Labor: A Double Blind Clinical Trial

Aimand Background: Labor induction for Prepare the cervix to active phase of labor, is now one of the most common methods in the field of Obstetrics and Gynecology. This study...

Foley catheter versus intra-vaginal misoprostol for induction of labor in post-term gestations

To investigate whether a fluid filled intra-uterine extra-amniotic Foley catheter is an effective alternative to vaginal misoprostol in inducing labor in primigravid women with post-term gestations. A prospective quasi-randomized controlled trial was designed and 100 primigravid women with post-term gestations were enrolled and equally allocated into two groups. A fluid filled intra-uterine extra-amniotic Foley catheter was inserted in women of group I. Women in group II received 25 microgram misoprostol vaginally every 4 h. Artificial rupture of membranes was performed for all women when their cervices reached 3-4 cm dilatation followed by oxytocin infusion if needed. The main primary outcome parameter was the induction to delivery interval. Results were tabulated and statistically analyzed. No significant difference was noted in any of the demographic data between both groups. The induction to delivery interval was shorter in the Foley group (897.36 ± 116.0 vs. 960.98 ± 94.18 min; P = 0.003). There were 34 cases which needed oxytocin augmentation in group I compared to 11 cases in group II (P < 0.01). Abnormal uterine activity occurred in three cases in the misoprostol group, but none in the Foley group. Ominous fetal heart rate was noted in one case in group I but three in group II. Fluid filled Foley catheter seems to be superior to 25 μg vaginal misoprostol regimen, when used to induce labor in primigravidae with post-term gestations with the advantage of having a shorter induction delivery interval, but more need for oxytocin augmentation.

Sublingual vs Vaginal Misoprostol for Labor Induction

ABSTRACT Background This study is a randomized controlled trial comparing the efficacy and safety of sublingual vs vaginal misoprostol for induction of labor. Materials and methods A total of 160 women admitted for induction of labor at the PGIMER, Chandigarh, India were randomized to receive 25 μg of vaginal or sublingual misoprostol for labor induction. The two groups were compared for mode of delivery, induction delivery interval, misoprostol dose required, uterine contraction abnormalities and neonatal outcomes. Results Majority of women in both groups delivered vaginally (91 and 89% in vaginal and sublingual misoprostol groups respectively). Mean number of doses of misoprostol required for induction of labor was similar in vaginal misoprostol group and sublingual misoprostol group (1.81 ± 0.84 vs 2.05 ± 0.98). The occurrence of uterine contraction abnormalities and neonatal outcome was similar in both groups. Conclusion The low dose of 25 μg is equally efficacious and safe by both vaginal and sublingual routes. How to cite this article Siwatch S, Kalra J, Bagga R, Jain V. Sublingual vs Vaginal Misoprostol for Labor Induction. J Postgrad Med Edu Res 2012;46(3):138-143.

Comparison of Oral and Vaginal Administration of Low-dose Misoprostol for Labor Induction

ABSTRACT Objective Comparison of oral and vaginal administration of lowdose misoprostol for induction of labor at term. Materials and methods Two hundred pregnant women after 37 weeks of gestation with an indication for induction were given 25 μg of misoprostol orally (study group) or vaginally (control group), every 3 hours to a maximum of 8 doses. The induction to delivery interval, requirement of oxytocin, dose of misoprostol used, maternal and neonatal outcome were analyzed statistically. Results The median induction to delivery interval was significantly shorter in those induced with vaginal misoprostol (p = 0.06). The median induction to delivery interval was 21.35 ± 7.44 hours in study group and 14.64 ± 5.49 hours in control group. Eighty-two percent women in study group and 84% women in control group had vaginal delivery. Cesarean section rate was lower in control group, 16% vs 18% in study group, but the difference was not statistically significant (p = 0.790). Oxytocin augmentation was needed for 80% cases in the study group and 54% cases in control group, which was statistically significant (p = 0.006). The incidence of abnormal FHR was more in control group as compared to study group (30 vs 14%). Hyperstimulation syndrome was observed in 4% cases in control group and 2% cases in study group. Neonatal outcome was found to be similar in both groups. Conclusion Vaginal misoprostol achieved higher success rate within a short induction interval but was associated with increase in abnormal FHR pattern and abnormal uterine activity as compared to the oral route. Oral route had comparable efficacy, was safe and well-tolerated route of misoprostol administration for induction of labor at term. How to cite this article Mahajan M, Gupta KB, Sharma R, Jyoti R. Comparison of Oral and Vaginal Administration of Low-dose Misoprostol for Labor Induction. J South Asian Feder Obst Gynae 2012;4(3):137-140.

Induction of Labor With Vaginal Misoprostol Plus Oxytocin Versus Oxytocin Alone

Abstract Objective To compare the effect of an oxytocin infusion alone or preceded by an intravaginal application of misoprostol for labor induction in women with term pregnancies and a low Bishop score. Methods This study randomized 100 multiparous women with singleton pregnancies over 38 weeks and a Bishop score less than 6 to receive either a single 50-µg dose of misoprostol intravaginally 3 hours before initiation of the oxytocin infusion or only an oxytocin infusion. The time from induction to delivery, the route of delivery, and maternal and fetal outcomes were analyzed. Results The mean time from induction to delivery was 9.36 ± 1.97 hours in the misoprostol plus oxytocin group and 11.08 ± 3.23 in the oxytocin alone group ( P = 0.002). The rates of vaginal delivery, 1- and 5-minute Agpar scores, placental abruption, and postpartum hemorrhage were similar between the 2 groups, as were the rates of admission to the neonatal intensive care unit. There were no cases of perinatal asphyxia. Conclusion A 50-µg intravaginal application of misoprostol before starting the oxytocin infusion is a more effective method of labor induction than an oxytocin infusion alone for our study population.

Pregnancy outcome following induction of labor with intravaginal misoprostol for decreased fetal movements at term

Objective. To determine the outcome of labor induction with intravaginal misoprostol among women with perception of persistent decrease in fetal movements at term.Method. The study group comprising 107 women who had induction of labor at term for primary complaint of decreased fetal movements (DFM) were compared with equal number of women who had induction for prolong pregnancy in a university teaching hospital.Results. Caesarean section rate (39.3% vs. 22.4%, P < 0.001) and birthweight less than 2500 g (11.2% vs. 2.8%, P = 0.02) were significantly higher in the DFM group with the leading indication for caesarean delivery being nonreassuring fetal heart rate. Also, the incidence of 5-min Apgar score <7 were significantly lower among women in the DFM group. However, there was no difference in neonatal unit admission. There was no case of early neonatal death in both groups of women.Conclusion. Intravaginal misoprostol for labor induction is a safe delivery option for women with perception of DFM with reassuring nonstress test. Since all cases with persistent decrease in fetal movements had reassuring nonstress test, the reduction in fetal movements was most likely due to altered perception.

The effect of introduction of misoprostol for induction of labour on pregnancy in gravidas with pre-eclampsia

Misoprostol has revolutionized labour induction since the early 1990’s, because it is inexpensive and very effective. Eclampsia is common unless the pregnancy can be terminated by induction or by caesarean section. This study was done to determine the impact of Misoprostol used for induction of labour, on the outcome in patients with pre-eclampsia (PE) at the University of the West Indies Kingston Jamaica. This was a retrospective analysis of pre-eclamptic women who were managed before and after the introduction of misoprostol into routine usage for induction of labour. We compared 793 women (controls) in the pre misoprostol era (1986-1991) with 709 in the misoprostol era (1993-1998). Outcome variables were the frequency of mild and severe PE, eclampsia, misoprostol and syntocinon inductions, foetal complications and use of caesarean section (CS). Analysis of frequency of eclampsia, neonatal admissions and CS, during the misoprostol years, was also done to eliminate other confounding variables because of the influence of each era. Logistic regression was used to determine the impact of all variables. In comparison to controls, patients induced in the misoprostol years had a greater incidence of severe PE (p < 0.05), neonatal admissions (p = 0.007), foetal distress (p < 0.05); a higher CS rate (p < 0.05); but fewer oxytocin inductions (p < 0.05). However, sub group analysis of the misoprostol years alone, showed a reduction in the incidence of CS, eclampsia, and neonatal admissions in women who were induced with misoprostol (p < 0.05). Logistic regression revealed a lower odds of CS delivery (OR 0.867, 95% confidence interval .02, .37) using misoprostol. These findings suggest that in patients with PE, induction of labor with Misoprostol had a beneficial effect on pregnancy outcome with a decreased incidence of CS, eclampsia and neonatal admissions, but it has not had a significant impact on the main problems in these patients between the two eras as other factors may be important in the management of these patients independent of misoprostol induction.

Induction of labour with titrated oral Misoprostol suspension. A comparative study with vaginal Misoprostol

To compare the effectiveness of titrated orally and vaginally administered misoprostol for induction of labour. Unmasked randomized controlled trial. Department of Obstetrics and Gynaecology University of Zimbabwe, Harare. Pregnant women with singleton foetus in cephalic presentation booked for induction of labour, were randomized to receive titrated orally or vaginally administered misoprostol. The main outcomes were the duration of labour and induction to delivery interval. The secondary outcomes were neonatal and maternal complications. 134 women were recruited into the study; 69 and 65 were randomized into orally and vaginally administered misoprostol respectively. The baseline characteristics in the two groups were similar. Women induced with titrated oral misoprostol suspension had a shorter interval from administration of the drug to initiation of uterine contractions (OR = 0.94 .95% CI 0.42 to 2.12) and a longer duration of labour (OR = 0.36; 95% CI 0.16 to 0.79). Labour was augmented with oxytocin in the oral group. The mean drug dose was 28mcg in the oral group. There was no difference in the mode of delivery between the two groups. Hypertonic uterine contractions were not detected. Ruptured uterus did not occur in the study population. There were more neonatal admissions in the vaginal than the oral group (OR = 1.03 .95% CI 0.29 to 1.39). Titrated oral misoprostol suspension is as effective and safe as vaginal misoprostol for induction of labour even in poor resource countries where intrapartum monitoring is inadequate.

Misoprostol for induction of labour to terminate pregnancy in the second or third trimester for women with a fetal anomaly or after intrauterine fetal death.

A woman may need to give birth prior to the spontaneous onset of labour in situations where the fetus has died in utero (also called a stillbirth), or for the termination of pregnancy where the fetus, if born alive would not survive or would have a permanent handicap. Misoprostol is a prostaglandin medication that can be used to induce labour in these situations. To compare the benefits and harms of misoprostol to induce labour to terminate pregnancy in the second and third trimester for women with a fetal anomaly or after intrauterine fetal death when compared with other methods of induction of labour. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (November 2009). Randomised controlled trials comparing misoprostol with placebo or no treatment, or any other method of induction of labour, for women undergoing induction of labour to terminate pregnancy in the second and third trimester following an intrauterine fetal death or for fetal anomalies. Both authors independently assessed trial quality and extracted data. We included 38 studies (3679 women).Nine studies included pregnancies after intrauterine deaths, five studies included termination of pregnancies because of fetal anomalies when the fetus was still alive and the rest (24) presented the pooled data for intrauterine deaths, fetal anomalies and social reasons.When compared with agents that have traditionally been used to induce labour in this setting (for example, gemeprost, prostaglandin E(2) and prostaglandin F(2alpha)), vaginal misoprostol is as effective in ensuring vaginal birth within 24 hours, with a similar induction to birth interval. Vaginal misoprostol is associated with a reduction in the occurrence of maternal gastrointestinal side effects such as nausea, vomiting and diarrhoea when compared with other prostaglandin preparations. While the different treatments involving various prostaglandin preparations appear comparable for the reported outcomes, the information available regarding rare maternal complications, such as uterine rupture, is limited. The use of vaginal misoprostol in the termination of second and third trimester of pregnancy is as effective as other prostaglandin preparations (including cervagem, prostaglandin E(2) and prostaglandin F(2alpha)), and more effective than oral administration of misoprostol. However, important information regarding maternal safety, and in particular the occurrence of rare outcomes such as uterine rupture, remains limited. Future research efforts should be directed towards determining the optimal dose and frequency of administration, with particular attention to standardised reporting of all relevant outcomes and assessment of rare adverse events. Further information is required about the use of sublingual misoprostol in this setting.

Sublingual versus oral misoprostol for induction of labour in prelabour rupture of membranes at term.

To compare the efficacy of sublingual with oral misoprostol for induction of labour in primigravida with prelabour rupture of membranes at term. Randomized controlled trial. Department of Obstetrics and Gynaecology Unit-II, Sir Ganga Ram Hospital, Lahore, from June 2004 to January 2006. The study included 100 primigravidas with singleton pregnancy at term, having pre-labour rupture of membranes and unfavourable Bishop score with no contraindication of induction of labour, vaginal delivery or misoprostol use. The cases were randomized into two equal groups, A and B. Women in the group A were given 100 microg of misoprostol orally at an interval of 4 hours to a maximum of 2 doses while patients in the group B were prescribed the medicine sublingually (50 microg, 4 hourly, maximum of 2 doses). Induction to delivery interval, mode of delivery and fetomaternal complications were main outcome measures of the study. In the sublingual misoprostol group (B), 92% women delivered within 12 hours of induction while 84% of subjects delivered in this time period in oral group (A, p < 0.05). There was no failed induction in either group. Regarding dosage, 64% of women delivered with single dose in group B while only 32% delivered with single dose in group A (p < 0.05). The frequency of vaginal delivery was 92% in group B versus 80% in group A, while rate of caesarean section was 8% in the group B and 20% in the group A, which is statistically insignificant. No significant fetomaternal complications were seen in both groups. The efficacy of sublingual misoprostol in the dosage of 50 microg was comparable to 100 microg oral dose for the induction of labour in the primigravidas at term with pre-labour rupture of membranes.

Comparative evaluation of 25 μg and 50 μg of intravaginal misoprostol for induction of labor

Objectives To compare the efficacy and safety of 25 μg vs 50 μg of intravaginal misoprostol for induction of labor

Sublingual versus vaginal misoprostol for induction of labor at term: A randomized prospective placebo‐controlled study

To assess the effectiveness and safety of sublingual misoprostol (50 microg), compared with the same dose administered vaginally every 6 h for cervical ripening and labor induction in women with a viable fetus in the third trimester of pregnancy. This double-blind randomized prospective placebo-controlled trial included 480 women with medical or obstetric indications for labor induction and undilated, uneffaced cervices. The patients were assigned randomly to receive 50 microg of sublingual or 50 microg of vaginal misoprostol every 6 h for 24 h. Maternal and neonatal outcome were analyzed. A total of 169 (70.4%) patients delivered vaginally in the sublingual group compared to 160 (66.7%) in the vaginal group. The main indications for cesarean section in both groups were fetal distress (33/71 [46.4%] vs 38/80 [47.5%]), followed by failure of labor progress. Thirty three (13.8%) patients in the sublingual group had meconium staining of the amniotic fluid compared to 39 (16.3%) in the vaginal group. There was no difference between the groups regarding the induction-to-delivery interval, duration of labor, neonatal outcome or maternal side-effects. Sublingual misoprostol is as effective as vaginal misoprostol for induction of labor at term. Moreover, the sublingual route is associated with a significantly higher patient satisfaction rate than vaginal misoprostol.

Low-dose oral misoprostol for induction of labor: a systematic review.

To estimate the efficacy and safety of low-dose oral misoprostol compared with dinoprostone (PGE2), vaginal misoprostol, and oxytocin for labor induction in women with a viable fetus. We conducted electronic database searches of PubMed, MEDLINE, EMBASE, and the Cochrane Library for articles published before January 2008 using the keywords misoprostol, labor, induction, randomized controlled trials, dinoprostone, oxytocin, pregnancy, and maternal and fetal side effects. We included randomized controlled trials comparing 20-25 micrograms oral misoprostol with vaginal misoprostol, dinoprostone or oxytocin given to women at 32-42 weeks of gestation for labor induction. From 401 citations identified, results from nine studies were finally analyzed using the Review Manager software. Relative risk (RR) and 95% confidence intervals (CIs) were calculated using fixed and random-effects models. Nine articles with 2,937 women met the inclusion criteria. The five trials comparing oral misoprostol and dinoprostone showed significantly fewer women requiring cesarean delivery in the misoprostol group (20% compared with 26%; RR 0.82, 95% CI 0.71-0.96). There were no statistically significant differences in risks of uterine hyperstimulation or need for oxytocin augmentation. Two trials compared oral with vaginal low-dose misoprostol. Women using oral misoprostol were significantly less likely to experience uterine hyperstimulation with fetal heart rate changes (2% compared with 13%; RR 0.19, 95% CI 0.08-0.46), but there were no significant differences in other outcomes. Low-dose oral misoprostol solution (20 micrograms) administered every 2 hours seems at least as effective as both vaginal dinoprostone and vaginal misoprostol, with lower rates of cesarean delivery and uterine hyperstimulation, respectively.

Titrated low‐dose vaginal and/or oral misoprostol to induce labour for prelabour membrane rupture: a randomised trial

To evaluate the clinical effectiveness and safety of titrated low-dose misoprostol for induction of labour (IOL) in the presence of prelabour rupture of membranes (PROM). Randomised controlled trial. Maternity units in the UK (9) and Egypt (1). Women >34 weeks of gestation with PROM, singleton viable fetus and no previous caesarean section. Subjects randomised to IOL with a titrated low-dose misoprostol regimen (oral except if unfavourable cervix, where initial dose vaginal) or a standard induction method, namely vaginal dinoprostone followed by intravenous oxytocin if the cervix was unfavourable or intravenous oxytocin alone if the cervix was favourable. Primary outcome measures were caesarean section and failure to achieve vaginal delivery within 24 hours. Analysis was by intention to treat. The trial did not achieve the planned sample size of 1890 due to failure in obtaining external funding. Seven hundred and fifty-eight women were randomised (375 misoprostol and 383 standard). There were less caesarean section (14 versus 18%, relative risk [RR] 0.79; 95% CI 0.57-1.09) and less women who failed to achieve vaginal delivery within 24 hours in the misoprostol group (24 versus 31%, RR 0.79; 95% CI 0.63-1.00), but the differences were not statistically significant. Subgroup analysis showed that with unfavourable cervix, misoprostol may be more effective than vaginal dinoprostone. There was no difference in hyperstimulation syndrome. There were more maternal adverse effects with misoprostol, but no significant differences in maternal and neonatal complications. Titrated low-dose misoprostol may be a reasonable alternative for IOL in the presence of PROM, particularly in women with an unfavourable cervix. Safety and rare serious adverse events could not be evaluated in a trial of this size.