Misoprostol For Labor Induction Research Articles

Effectiveness and Safety of Sublingual versus Vaginal Misoprostol for Induction of Labor for Full Term Pregnant Women in Cha-Am Hospital

Objective: To study the effectiveness and safety of sublingual misoprostol compared with the same dose administered vaginally every four hours for induction of labor at term pregnancy within 24 hours. Materials and Methods: One hundred seventy-six pregnant women of 37 to 42 gestational age fulfilling the study inclusion criteria were recruited and assigned by randomization into two groups. Each group was treated separately by 25-mcg misoprostol sublingually or vaginally every four hours within 24 hours. Results: Mean age of sublingual and vaginal misoprostol group was 25.9±6.9 and 25.5±7.2 years old, respectively, while the mean parity of sublingual and vaginal group was 0.9±1.0 and 1.0±1.0, respectively, which most were first pregnant. Three out of four had no underlying diseases. The initial cervical diameter before receiving misoprostol was 1.7±1.0 and 1.7±0.9 mm, respectively. The total labor time between the two groups was not significantly different. The percentage of success in the sublingual group was more than in the vaginal group, at 79.3 and 74.7, respectively. The side effects of induction were more significantly found in the vaginal group (p<0.05). The pain score was not different, but the satisfactory score was better reported in the sublingual group than in the vaginal one (p<0.05). The Apgar score at 5 minutes of neonates between the two groups were not significantly different (9.8±0.4 and 9.9±0.2). Conclusion: Twenty-five mcg misoprostol administered through sublingual for labor induction in full term pregnant women could not make the total labor time significantly shorter than in the vaginal group. The success rate in the sublingual group was not significantly better than in the vaginal group. The satisfaction was higher in the sublingual group but the pain scores and Apgar score at 5 minutes were not different between the groups.

Effect of Maternal Age and Body Mass Index on Induction of Labor Using Oral Misoprostol in Late-Term Pregnancies: A Retrospective Cross-Sectional Study

Introduction: Several studies have shown that late- and post-term pregnancies are associated with an increased risk of perinatal morbidity and mortality. In this case, induction of labor is the recommended approach. For full-term pregnancies, various methods exist to prepare the cervix and/or commence labor. Prostaglandins serve the dual purpose of cervical ripening and labor induction, blurring the distinction between the two processes. The aim of this research was to evaluate the effect of maternal age and body mass index (BMI) on oral misoprostol induction of labor for late-term pregnancies. Methods: This was a retrospective cross-sectional study (ClinicalTrial ID: NCT06184139), including only late-term pregnancies in healthy nulliparous women carrying a single cephalic fetus with normal birthweight who underwent induction of labor with oral misoprostol. We used the oral misoprostol regimen proposed by the World Health Organization (WHO) for induction of labor in term singleton pregnancies in women who have not had a previous cesarean delivery and a Bishop score <7. The regimen was oral misoprostol in aqueous solution at the low dose of 25 μg every 2 h until a Bishop score ≥7, labor, or for a maximum of 8 doses. Results: One hundred and four pregnant women underwent induction of labor with oral misoprostol for late-term pregnancy on the 290th day of gestation. Study population was divided in two groups based on age (<35 and ≥35 years) and obesity (BMI <30 and ≥30). No statistically significant differences were recorded between younger and older women. Obese women reported a longer time between the last dose of misoprostol and cervical dilation of 6 cm (p = 0.01), a longer time between the last dose of misoprostol and delivery (p = 0.04), and a higher rate of grade II vaginal lacerations (p = 0.02). Conclusions: Maternal BMI is a factor negatively influencing the efficacy of oral misoprostol for induction of labor in late-term pregnancy.

A Comparative Study of Vaginal, Sublingual, and Buccal Misoprostol in Induction of Labor in Term Pregnancy

A Comparative Study of Vaginal, Sublingual, and Buccal Misoprostol in Induction of Labor in Term Pregnancy

Comparative Study Between Oral and Vaginal Misoprostol for Induction of Labor in Nulliparous Pregnant Women at or Beyond Completed 41 Weeks

Comparative Study Between Oral and Vaginal Misoprostol for Induction of Labor in Nulliparous Pregnant Women at or Beyond Completed 41 Weeks

Efficacy and safety of oral and vaginal administration of misoprostol for induction of labor in high-risk obese pregnant women with hypertension or diabetes mellitus

Objective This study aims to compare the safety and efficacy of misoprostol administered orally and vaginally in obese pregnant women at term with either gestational hypertension or diabetes. Methods A total of 264 pregnant women were enrolled and categorized into two groups based on their primary condition: hypertension (134 cases) or diabetes mellitus (130 cases) and were further divided into subgroups for misoprostol administration: orally (Oral group) or vaginally (Vaginal group). The primary outcomes measured were changes in the Bishop score following treatment, induction of labor (IOL) success rates, requirement for oxytocin augmentation, duration of labor, mode of delivery, and cesarean section rates. Results Significant enhancements in Bishop scores, decreased cesarean section rates and increased success rates of IOL were noted in both administration groups. The incidence of vaginal delivery within 24 h was significantly higher in the Vaginal group compared to the Oral group. Adverse effects, including nausea, uterine overcontraction, hyperfrequency of uterine contraction and uterine hyperstimulation without fetal heart rate deceleration, were significantly more prevalent in the Vaginal group than in the Oral group. Conclusion Misoprostol administration, both orally and vaginally, proves effective for labor induction in obese pregnant women with hypertension or diabetes. However, the oral route presents a lower risk of adverse maternal and neonatal outcomes, suggesting its preference for safer labor induction in this demographic.

Comparison of 25 microgram of sublingual misoprostol with 25 micrograms of vaginal misoprostol for induction of labour at term

Comparison of 25 microgram of sublingual misoprostol with 25 micrograms of vaginal misoprostol for induction of labour at term

Comparison of the Efficacy and Safety of Sublingual Versus Oral Misoprostol for the Induction of Labor: A Randomized Open-Label Study.

Introduction Misoprostol (prostaglandin E1 analog) is being used for the induction of labor by vaginal, oral, and sublingual routes. Oral misoprostol is the preferred route for induction of labor, but the use of sublingual misoprostol appears promising due to a faster onset of action. This study was done to compare the efficacy and safety of oral and sublingual misoprostol for induction of labor in term pregnancy. Materials and methods One hundred and sixty patients were randomly allocated to one of the two groups to receive 50 micrograms oforal and sublingual misoprostol four hourly for a maximum of six doses. Primigravida at 37-42 weeks of gestation with singleton pregnancy, cephalic presentation, Bishop score (<5), and reassuring fetal heart rate were included in the study. Misoprostol dose was withheldif the active phase of labor was reached or if the cervixwas favorable for amniotomy (Bishop score greater than or equal to eight). The change in the Bishop score with misoprostol was studied along with adverse effects and neonatal outcomes. Results The mean number of 50 mcg misoprostol doses required was significantly less in the sublingual group (2.94±0.97 versus 2.13±0.92; p<0.0001). The rate of change of the mean Bishop score was faster in the sublingual group. After four hours of the first dose, the mean Bishop score changed to 3.52±2.14 versus 4.68±2.34 (p=0.001), and, similarly, after eight hours, it was 10.48±2.59 versus 11.39±2.06, and this difference was statistically significant (p=0.015). The mean induction delivery interval was significantly lower in the sublingual group. The need for labor augmentation, mode of delivery, andadverse effects were similar in both groups. The incidence of meconium-stained liquor and NICU admission was also similar in both groups. Conclusion Sublingmisoprostolstol has a short induction delivery interval and comparable side effects when compared to omisoprostolstol. Sublingmisoprostolstol is recommended for induction of labor at term.

Cervical osmotic dilator is noninferior to oral misoprostol for induction of labor at term

University of Pennsylvania Saint Margaret, Pittsburgh, PA The corresponding author is Yufei Ge, MD; [email protected] The authors declare no conflicts of interest.

Oxytocin Versus Oral Misoprostol for Induction of Labor in Pregnant Women with Term Prelabor Rupture of Membranes: a Randomized Clinical Trial

This study compares the effectiveness and safety of oxytocin infusion against oral misoprostol for inducing labour in pregnant women with term prelabor membrane rupture. We randomized 173 pregnant women presenting with term prelabor rupture of membranes (PROM) at Ain Shams University Maternity Hospital into Group A (underwent induction of labor (IOL) by 25μg misoprostol oral tablet every 4 h, for maximum 5 doses) and an identical Group B: (underwent IOL by oxytocin infusion according to the hospital protocol). Our primary outcome was rate of vaginal delivery within 24 h, while the secondary outcomes included the time till active phase, induction to delivery interval, maternal pyrexia, nausea and vomiting, fetal distress, Apgar score, birth weight, and neonatal intensive care unit admission. Both groups showed high rates of vaginal delivery (82.4% & 87.1% for misoprostol group and oxytocin group respectively) with no significant difference between the two groups (p=0.394). However, patients induced by misoprostol took significantly less time to reach active phase with a shorter induction to delivery interval as compared to patients induced with oxytocin. This difference was clear in multiparous women, but not observed in primiparous women when subgroup analysis was done. No significant difference was found as regards other outcomes. Our study showed that both oral misoprostol and oxytocin are effective and safe for IOL in patients with PROM, with shorter induction-delivery interval in patients induced by oral misoprostol, an effect that is clear in multiparous but not primiparous women.Trial registrationNCT05215873, on 31/01/2022, “retrospectively registered”.

Maternal and fetal outcomes in women undergoing induction of labor with low dose vaginal misoprostol.

To determine Maternal and Fetal outcome in women undergoing induction of labour with low dose misoprostol. A cross-sectional study was carried out to determine the efficacy of Misoprostol for induction of labor (IOL) in MTI, Lady Reading Hospital (LRH), Peshawar from 21st January to 31st December 2021. All pregnant women with singleton pregnancy and cephalic presentation admitted for Induction of Labor were included in the study. Maternal and Fetal outcome was noted. Induction of labor was started with 25 micrograms of Misoprostol, repeated every six hours depending on Bishop Score. Three hundred and thirty-seven women were included in this study. The majority of females (76%) were in 18-35 years age group. In 92.3% of females, the Bishop score was less than six. The maximum number of females (33.5%) delivered after eight hours of IOL. Sixty-six (66.46%) of females had gestational age of 37-40 weeks. Premature rupture of membranes was the most common indication (32.9%). Three doses of misoprostol were required in 31.2% of females. Only 5.6% of females required six doses of misoprostol for induction. With Misoprostol 85.1% of females delivered spontaneously, 2.37% required forceps delivery, 1.7% required vacuum delivery, and 10.68% delivered by Caesarean Section. APGAR score was 8 /10 in 84% of neonates at birth. Eighty-seven %(87.8%) of neonates did not require NICU admission. Misoprostol is a safe medicine to be used to induce labor in females. It can help shorten the duration of labor, with good fetomaternal outcome.

Foley catheter (80 vs 60 mL) and misoprostol for labor induction in nulliparous women: a randomized controlled trial

Induction of labor is a common intervention in obstetrics worldwide. Foley catheter is a commonly used mechanical method for labor induction in nulliparous women with an unfavorable cervix at term. We hypothesize that a higher volume of Foley catheter (80 mL vs 60 mL) will shorten the induction-delivery interval for labor induction in nulliparous women at term with an unfavorable cervix with simultaneous use of vaginal misoprostol. This study aimed to evaluate the effect of transcervical Foley catheter (80 mL vs 60 mL) with simultaneous use of vaginal misoprostol on the induction-delivery interval in nulliparous women at term with an unfavorable cervix for induction of labor. In this double-blind, single-center, randomized controlled trial, nulliparous women with a term singleton gestation with unfavorable cervix were randomized to either group 1 (Foley catheter [80 mL] simultaneously with vaginal misoprostol 25 µg every 4h) or group 2 (Foley catheter [60 mL] with vaginal misoprostol 25 µg every 4h). The primary outcome was induction-delivery interval. Secondary outcomes were duration of the latent phase of labor, number of doses of vaginal misoprostol required, mode of delivery, as well as maternal and neonatal morbidity. Analyses were based on the intention-to-treat method. A sample size of 100 women per group (N=200) was selected. Between September 2021 to September 2022, 200 nulliparous women at term with an unfavorable cervix were randomized to labor induction with either FC (80 mL vs 60 mL) and vaginal misoprostol. Induction delivery interval (in minutes) was statistically significantly shorter in Foley catheter (80 mL) (median [interquartile range], 604 [524-719] vs 846 [596-990]; [P<.001]). Median time to labor onset (in minutes) (240 [120-300] vs 360 [180-600]; P<.001) was also shorter in group 1 (80 mL). The number of doses of misoprostol required for labor induction was statistically significantly less than with 80 mL (mean±standard deviation, 1.4±0.7 vs 2.4±1.3; P<.001). There was no statistically significant difference in the mode of delivery (vaginal delivery: 69 vs 80; odds ratio, 0.55 [1.1-0.3]; P=.104 and cesarean delivery: 29 vs 17; odds ratio, 0.99 [0.9-1.1]; P=.063, respectively). The relative risk of delivery within 12 hours with 80 mL was 2.4 [95% confidence interval, 1.68-3.43], P<.001. Maternal and neonatal morbidity were similar across the 2 groups. FC (80 mL) simultaneously with vaginal misoprostol significantly shortens the induction-delivery interval (P<.001) in nulliparous women at term with an unfavorable cervix, as compared with Foley catheter 60 mL and vaginal misoprostol.

Role of Misoprostol in Induction of Labor: Sublingual versus Vaginal in Tikrit City

A successful induction of labor leads to vaginal delivery of a healthy baby, in an acceptable time frame with minimum maternal discomfort or side effects. To compare the efficacy and safety of sublingual and per vaginal 25µg misoprostol for labor induction. Primary outcome measures were the number of cases delivering vaginally, Secondary requirement, the incidence of meconium-stained liquor, number of cesarean deliveries, the incidence of hyperstimulation/tachysystole, maternal adverse effects and neonatal outcomes. A prospective study was conducted in Tikrit Teaching Hospital. Indications were reviewed; 416 women randomly received misoprostol 25 µg vaginally and sublingually every three hourly for maximum three doses. Outcomes were analyzed accordingly. The number of the cases who successfully delivered vaginally was greater in the sublingual group. The induction to vaginal delivery interval was significantly shorter in sublingual group. The incidence of tachysystole and meconium-stained liquor were more in the vaginal than in the sublingual group. The mean doses, mode of delivery, oxytocin augmentation and maternal outcomes were significantly favorable in sublingual group. No significant difference is seen in neonatal outcome. Sublingual misoprostol 25 µg administered three hourly for labor induction has better effficacy as compared to 25 µg of vaginal misoprostol.

A pilot study to compare propranolol and misoprostol versus misoprostol and placebo for induction of labor in primigravidae; a randomized, single-blinded, placebo-controlled trial

BackgroundThe Induction of labor is the most common obstetric procedure in daily practice. Introducing propranolol as a new drug to augment the action of prostaglandins will help in the induction process and decrease CS rates. Several researchers have used propranolol in the augmentation of labor.AimThis pilot study compares propranolol and misoprostol versus misoprostol alone for labor induction in primigravids.MethodsThis is a Randomized clinical trial, single-blinded, placebo-controlled trial at Ain Shams University Maternity hospital. This study included 128 pregnant full-term primigravid women candidates for labor induction, randomized into two groups. All candidates underwent labor induction with 25 µg of vaginal misoprostol. Group I received 20 mg of oral propranolol tablets, while group II received sugary pills as a placebo. Candidates who responded successfully to induction were assessed for possible augmentation of labor by amniotomy or oxytocin infusion. The Primary outcome was induction to delivery interval, while the secondary outcomes were the duration of the latent phase, mode of delivery, and APGAR score of the neonate.ResultsThe induction-delivery time was (11.8 ± 8.1 h. vs. 12.6 ± 8.9 h., P value = 0.027) and the duration of the latent phase of labor (7.9 ± 5.6 h. vs. 9.2 ± 6.03 h., P value = 0.017) were significantly shorter in the group of misoprostol and propranolol compared to the group of misoprostol and placebo. There was no statistically significant difference between both groups’ mode of delivery, indications for cesarean section, misoprostol, and oxytocin doses, or neonatal outcome. (P value > 0.05).ConclusionPropranolol, when used with misoprostol for induction of labor, results in augmentation of action of misoprostol and a significantly shorter induction-delivery interval.Trial registrationWe retrospectively registered this trial in clinicaltrial.gov on 01/09/2020 (NCT04533841). https://clinicaltrials.gov/ct2/show/NCT04533841

Pharmacokinetics of oral misoprostol for induction of labor in pregnancies complicated by obesity

Birthing parents with obesity have increased risk of medical and obstetric complications during pregnancy, often leading to a recommendation for induction of labor (IOL). Misoprostol is commonly used for IOL, however there is limited data on whether it’s pharmacokinetics (PK) are altered by body size. The objective of this study is to evaluate PK parameters of oral misoprostol in pregnancies complicated by obesity. Pilot, single-center, observational study of non-fasting, term, singleton pregnancies with body mass index (BMI) > 30.0 kg/m2 at time of IOL with 50 mcg oral misoprostol. Plasma concentrations of active metabolite misoprostol acid (MPA) were measured at four time points using liquid chromatography mass spectrometry. Plasma MPA-time data analyzed using a non-compartmental PK model to derive the area under the curve from the first time point to the last measured concentration (AUC0-t) using the trapezoidal rule. Terminal slope (λz) used to extrapolate plasma concentration to infinity (AUC0-∞). Maximum serum concentration (Cmax) and time to maximum plasma concentration (Tmax) also described. 26 plasma observations from 7 subjects were included (Table 1). Observed plasma concentrations over time (Figure 1) demonstrate median(range) Cmax 26.63 (7.18-56.24) pg/mL, AUC0-t 10.93 (2.43-24.64) pg-h/mL, λz 2.68 (2.00-3.07) h-1, AUC0-∞ 22.67 (12.09-30.60) pg-h/mL. Tmax observed at 0.25 hours. Prior study evaluating 50 mcg oral misoprostol in 12 subjects with normal BMI (mean 28.6 kg/m2) reports mean±SD Cmax 53.97±23.79 pg/mL, AUC0-t 55.02±28.80 pg-h/mL, λz 1.05±0.86 h-1, AUC0-∞ 66.63±33.22 pg-h/mL, Tmax 0.23±0.14 hours. To our knowledge, this study is the first examination of 50 mcg oral misoprostol PK parameters among parturients with obesity undergoing term IOL. Data show decreases in PK parameters in this population, however some results are still within reported margin of error and there is marked variance between subjects. A future, powered, comparative trial is necessary to confirm these findings as well as further investigate clinically relevant outcomes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Induction of labour with misoprostol in premature rupture of membranes after 34 weeks: Which route is better and at what dose a randomized control trial in a tertiary care hospital

Background: The idea of this study was to evaluate the efficacy and safety of different routes of administration of misoprostol - 50µg oral, 25µg vaginal and 50µg sublingual for induction of labour in women with premature rupture of membranes after 34 weeks of gestation.Design: Randomized controlled trial.Sample: A total of 252 women with premature rupture of membranes after 34 weeks of gestation with indications of induction of labour.Methods: Study was conducted from 01/02/2022 to 31/11/2022, Women admitted to ward with premature rupture of membranes (PROM) after 34 weeks of gestation and requiring induction of labour were randomized into three groups. A total of 252 women participated in the study and were assigned to three groups to receive either 50µg oral misoprostol (n=82) or 25µg vaginal misoprostol (n=85) or 50µg sublingual misoprostol (n=85). The doses were repeated 4 hourly till active labour was established or up to a maximum of 4 doses.Major outcomes: 1.Induction to active labour 2.induction to delivery intervals 3.Delivery modes and 4.fetal outcomes were noted.Results: The mean induction to active labour interval was not significantly different in the three groups (oral vs vaginal vs sublingual- 7.54±4.8 vs 7.77±4.1 h vs 7.68±5.1 h; p=0.92). There was no significant difference in the induction to delivery time interval among the three misoprostol groups (oral vs vaginal vs sublingual – 10.7± 5.5 h vs 11.2±5.0 h vs 11.2±6.4 h; p= 0.88). Spontaneous vaginal delivery rate, instrumental delivery rate and lower segment caesarean section rates were comparable among the three groups. The spontaneous vaginal delivery is more in vaginal group and least in the sublingual group. The oral group is almost equal to the sublingual group in spontaneous delivery. The number of neonates with APGAR score <7 (low APGAR) at 1 minute of birth was highest in sublingual group and lowest in vaginal group which was statistically significant (oral vs vaginal vs sublingual, 16.8% vs 9.4% vs 20%; p= 0. 04). APGAR score <7 at 5 minutes was not significantly different among the three groups (oral vs vaginal vs sublingual, 6.02% vs 3.5% vs 7.05%; p=0.2). This implies that the need for immediate resuscitation was more in the sublingual group. Neonatal intensive care admission was least in the vaginal group although the difference was not statistically significant.Conclusion: 50µg oral misoprostol, 25µg vaginal misoprostol or 50µg sublingual misoprostol for induction of labour after 34 weeks of gestation have equal efficacy for induction of labour in women with spontaneous vaginal delivery is highest in vaginal route. The spontaneous vaginal delivery is more in vaginal route. The sublingual route having slightly higher incidence of low APGAR scores at one minute for the neonate.

Oxytocin versus vaginal misoprostol for induction of labour in pregnant women with term pre-labour rupture of membranes

Oxytocin versus vaginal misoprostol for induction of labour in pregnant women with term pre-labour rupture of membranes

Comparative study of dinoprostone and misoprostol for induction of labor in patients with premature rupture of membranes after 35 weeks

The modalities of induction of labor in the event of premature rupture of membranes are controversial. The main purpose of this study was to compare the modalities of delivery after the use of dinoprostone or misoprostol for labor induction in the preterm rupture of membranes after 35 weeks in women with an unfavorable cervix. We then studied maternal and fetal morbidity for the two drugs. Retrospective, single-center, comparative cohort study in a level 3 maternity unit in France from 2009 to 2018 comparing vaginal administration of misoprostol 50 µg every six hours (maximum 150 µg) and administration of dinoprostone 10 mg, a slow-release vaginal insert, for 24 h (maximum 20 mg), for labor induction in the preterm rupture of membranes after 35 weeks in women with an unfavorable cervix (Bishop score < 6). We included 904 patients, 656 in the misoprostol group and 248 in the dinoprostone group. Vaginal delivery rate was significantly higher in the dinoprostone group (89% vs. 82%, p = 0.016). There were more cesarean sections for abnormal fetal heart rate in the misoprostol group (p = 0.005). The time interval from induction to the beginning of the active phase of labor and the duration of labor were shorter in the misoprostol group than in the dinoprostone group (437 min vs. 719 min, p < 0.001 and 335 min vs. 381 min, p = 0.0023, respectively). Maternal and neonatal outcomes were not significantly different in the two groups. Vaginal dinoprostone used for labor induction in preterm rupture of membranes seems to be more effective for vaginal delivery than vaginal misoprostol (50 µg).

Comparing Vaginal and Oral Administration of Misoprostol for Cervical Ripening and Induction of Labour in Prolonged Pregnancies

Background: Dinoprostone (prostaglandin E2), is presently used as the approved standard protocol for cervical ripening and labour induction. In search for a cheaper alternative, misoprostol (prostaglandin E1) has been found to be a good substitute. The ideal dose, route and frequency of administration of misoprostol are, however, still under investigation. Although, vaginal application of misoprostol has been validated as a reasonable means of induction, there is patient resistance to digital vaginal examination and there is a risk of ascending infection. For these reasons, oral administration of misoprostol for cervical ripening and labour induction has been tried.Objective: The efficacy and safety of oral and vaginal misoprostol for the elective induction of labour with prolonged pregnancy and unfavourable cervix was compared through a prospective study over a period of one year at the Military Hospital, Accra. Methods: A prospective, non-blinded randomised study of 148 women with prolonged pregnancy. Data was collected using a prepared structured case record form (data profoma). The study population was randomized into two groups and given 50 μg misoprostol orally in one group and 50 μg vaginally in the other. The main outcomes were measured as induction to delivery time,vaginal delivery achieved within 24 hours and the incidence of uterine hyperstimulation with fetal heart rate (FHR) changes. Results: The mean induction to delivery interval was shorter in vaginal group than oral group but the differences did not reach statistical significance (12.9hrs vs 14.3hrs; mean difference -1.42, P value = 0.24). The shorter duration of vaginal misoprostol, however, was significant for nulliparous women (13.4hrs vs 17.9hrs; mean difference 4.53, p&lt;0.05). There was less failure to achieve vaginal delivery within 24 hours of induction in the vaginal route group, but the differences did not reach statistical significance (6.1% vs. 6.8%; p = 0.81). Fewer women needed oxytocin augmentation in the vaginal group (24.2% vs.17.4%, p = 0.11). There was a higher incidence of uterine hyperstimulation in the vaginal group but not significant (14.7% vs 6.1%, p = 0.10). APGAR scores at 5 minutes showed no difference between the two groups (1.49% vs. 2.99%, p =0.42).Conclusions: Compared with oral misoprostol, vaginal misoprostol for induction of labour at term resulted in a shorter induction-to-delivery time and a lesser need of oxytocin for women to deliver within 24 hours of induction. Both maternal and neonatal safety outcome were comparable in both groups. However, the more frequent occurrence of hyperstimulation in the vaginal group could lessen its preference to the oral route. More trials are needed to determine the right oral dosage that combines efficacy with safety.

Evaluation of Low-dose and High-dose Intravaginal Misoprostol for Induction of Labour: A Randomised, Double-blinded, Single Centre Study

Introduction: Misoprostol is a synthetic prostaglandin E1 analogue widely used for cervical ripening and labour induction. However, misoprostol optimal dose required to induce labour is still controversial. Aim: To determine the efficacy and safety of 25 µg and 50 µg of intravaginal misoprostol for induction of labour at term and to evaluate maternal and neonatal complications. Materials and Methods: The present study was a prospective, randomised, double blind, single centre study carried out during March 2019 to December 2020. All the selected participants were randomised (1:1) to group 1 which received 25 µg of intravaginal misoprostol (n=70) and group 2 received 50 µg of intravaginal misoprostol (n=70). Based on the Bishop’s score, misoprostol was chosen as labour inducing agent. Number of misoprostol doses, mode of delivery, vaginal delivery duration, maternal and neonatal complications was recorded. Statistical significance among study groups were analyzed by using Chi-square test. Results: Postdatism was most frequently reported indication in both the study groups (57.1% and 52.9%). A total of 14 and 4 participants in group 2 and group 1 received only single dose of misoprostol (p&lt;0.01). Participants who received misoprostol 50 µg (n=60, 85.7%) has slightly showed higher vaginal deliveries compared to misoprostol 25 µg (n=57, 81.4%). The mean duration of induction time in group 2 was 10.12 hours and group 1 women showed 13.56 hours (p&lt;0.0001). Maternal and neonatal complications were slightly higher in 50 µg misoprostol group. Maternal complications such as uterine tachysystole (n=4), Postpartum Haemorrhage (PPH) (n=3) and uterine hyperstimulation syndrome (n=2). Neonatal complications with 50 µg misoprostol were Apgar &lt;7 at 1 min (n=4), Apgar &lt;7 at 5 min (n=3), Special Care Baby Unit (SCBU) admissions (n=2) and severe birth asphyxia (n=1). Misoprostol with 25 µg has showed Apgar &lt;7 at 1 min (n=2), Apgar &lt;7 at 5 min (n=2), SCBU admissions (n=1). Conclusion: The efficacy and safety results of 25 µg intravaginal misoprostol were comparable with 50 µg of intravaginal misoprostol for labour induction. The advantages of 50 µg misoprostol were it favours the vaginal deliveries, lesser active induction time and decrease number of misoprostol doses required to induce labour. However, higher dose of misoprostol showed higher frequencies of both maternal and neonatal complications.

Foley Balloon Catheter versus Oral Misoprostol for Induction of Labour after Prelabour Rupture of Membranes: A Retrospective Data Analysis

Objectives: The Foley balloon catheter (FC) is a viable method for cervical ripening, but concerns about infection risk restrict its use in cases of prolonged prelabour rupture of membranes (PROM). This study aims to evaluate the efficacy and safety of the FC compared to oral misoprostol for cervical ripening after PROM. Study Design: A retrospective data-analysis of 128 pregnant women was conducted. Of these, 49 underwent cervical ripening with an FC and 79 with oral misoprostol. We included all women with a vital singleton pregnancy at 37 - 42 weeks of gestation who underwent cervical ripening after ≥ 24 hours of PROM in specific time frames in two Dutchsecondary care and teaching hospitals. The primary outcome was the incidence of intrapartum infection, a composite of maternal and neonatal infection. In addition, we evaluated the mode of delivery, duration of priming and priming-to-delivery interval. Secondary endpoints included uterine hyperstimulation, umbilical cord prolapse, birth weight, Apgar scores, length of admission to the neonatal low dependency unit, admission to the (neonatal) Intensive Care Unit (ICU) and mortality. Statistical analyses included bivariate and multivariate techniques. Results: Cervical ripening with FC, compared with oral misoprostol, showed a higher incidence of intrapartum infection, respectively 32.7% (n = 16) vs. 12.7% (n = 10) (p = 0.006). However, after adjusting for epidural anaesthesia and pregestational BMI, the association was no longer significant. No difference was found in mode of delivery and total priming-to-delivery interval (median 21.3 hours vs. 22.0, p = 0.897). Furthermore, FC, compared with oral misoprostol, showed a longer duration of cervical ripening and hence a shorter duration of active labour (p 0.001). Apart from the 1-min Apgar score, secondary maternal and neonatal outcomes did not differ between the groups. Conclusion: In women who require cervical ripening after prolonged PROM at term, the FC and oral misoprostol are similar in terms of efficacy and safety. Advantages associated with the FC are its safe application in women with a history of caesarean section, although we did not study these women, and an implied shorter duration of active labour. Our study adds to the limited available data on the use of the FC after the rupture of membranes and a large randomized controlled trial is needed to strengthen our findings.