Misoprostol For Labor Induction Research Articles

Misoprostol for labour induction.

Oral and vaginal misoprostol are effective induction methods, but there is a delicate balance between a quicker labour and avoiding side effects. In randomised comparisons with balloon catheters, oral misoprostol resulted in more vaginal births in the first 24h as well as fewer caesarean sections without an increase in hyperstimulation events. Vaginal misoprostol was most effective when used concurrently with a balloon catheter. In comparison with dinoprostone, oral misoprostol had lower rates of caesarean section and uterine hyperstimulation with foetal heart rate changes, but fewer babies were born vaginally within 24h. In contrast, vaginal misoprostol resulted in more vaginal births within 24h, with no significant differences in caesarean section rates. There were no differences in perinatal adverse events with either route. When oral and vaginal misoprostol were compared, vaginal misoprostol resulted in more vaginal births in the first 24h, but with more maternal and neonatal complications.

Efficacy Study of Mifepristone in Pre-induction Cervical Ripening and Induction of Labour

This study was carried out to see the safety and efficacy of mifepristine as pre-induction cervical ripening agent along with misoprostol in induction of labour. It was a study done from January to June 2020 in Department of Obstetrics and Gynecology, Nepal Medical College Teaching Hospital. Total 120 patients were included in this study. Out of which, 60 women were be kept in test group who were induced by mifepristone and misoprostol and 60 women were kept in control group induced by misoprostol only. Patient characteristics, improvement of bishop score, maternal and neonatal outcome was recorded. Chi- square and T- Test were used to compare the result. Patient characteristics and the Bishop score at zero-hour of both the groups were similar. The mean bishop score 48 hours after use of mifepristine in test group was significantly increased in test group vs control group (P<0.0001). There were total 12(20%) patient who went in to labour with mifepristone only without the use of misoprostol. Total number of normal delivery was more (p value=0.003) and cesarean was less (p=0.013) in test group than in control group. The instrumental delivery in both test and control group were same. The adverse effect and neonatal outcome was similar in both the regime. Thus mifepristone as pre-induction cervical ripening agent is a safe and efficient drug

Combined Use of Vaginal Misoprostol with Intracervical Foley Catheter Versus Vaginal Misoprostol alone in Induction of Labor at Term Pregnancy

Abstract Background Induction of labor should be used in the most efficient way possible that will result in a favorable obstetric outcome with minimum fetal morbidity. Objectives The aim of this study is to compare the efficacy and safety of intravaginal misoprostol alone versus intra cervical Foley catheter combined with vaginal misoprostol in induction of labor at term pregnancy. Methods This study was conducted at Obstetrics & Gynecology Department; Ain Shams University, Maternity Hospital in the period between May 2017 to October 2017. The total number of patients studied was 120 patients, divided into two groups; the first group (A) included 60 patients who received vaginal misoprostol, the second group (B) included 60 patients who received vaginal misoprostol combined with trans cervical Foley catheter. Results The current study found that the combined group has a better chance for NVD 88.3% versus 78.3% in misoprostol alone group, a lesser probability to CS 11.7% in combined group versus 21.7% in misoprostol alone group and a shorter induction delivery interval within 12 hours after induction (81.6% in combined group versus 59.5% in misoprostol group). Regarding the effect of both methods on fetal safety, we found that non reassuring FHR was more common in combined group 8.3% than misoprostol alone group 1.7% but it’s statistically non-significant. There was statistically significant increase in tachysystole in combined group 28.3% versus 13.3% in misoprostol alone group. However, dystocia was more common in misoprostol group 15% than combined group 3.3% that is also statistically significant. Conclusion Both methods can be used in induction of labor at term pregnancy without forgetting the precautions and close observation to the mother and the fetus. Combined method results in a shorter induction-to delivery time, but misoprostol alone was safer for the mother and the fetus.

How does low-dose oral misoprostol compare with vaginal misoprostol for induction of labor?

How does low-dose oral misoprostol compare with vaginal misoprostol for induction of labor?

Low-dose oral misoprostol for induction of labour.

Low-dose oral misoprostol for induction of labour.

Heterogenous use of misoprostol for induction of labour: results of an online survey among midwives in German-speaking countries

PurposeThis online survey looked at the experiences and general perceptions of midwives concerning induction of labour and the specific use of misoprostol.MethodsWe published an online questionnaire with 24 questions in German on midwives’ experiences and perceptions of different methods of induction of labour.ResultsThe online survey was answered by 412 midwives between February 2016 and February 2017. At least 20% of the 24 questions were answered in 333 questionnaires, which were included in this analysis. Oral misoprostol was the most common induction method for primipara and for women with a previous vaginal birth and an unfavourable cervix. Apart from alternative methods for induction of labour like castor oil and complementary/alternative methods, oral misoprostol was the preferred method of induction of labour by midwives. Midwives described a wide range of dosage schedules concerning application intervals, starting doses, and the maximum daily dose of misoprostol. Approximately 50% of the participants of this study described prescriptions of more than 200 µg misoprostol daily for induction of labour.ConclusionMisoprostol is widely used in Germany and was one of the three preferred methods of induction of labour among midwives in our study next to castor oil and complementary/alternative methods. The preparation and dosage of misoprostol vary significantly among hospitals and do not adhere to international guidelines. Midwives voiced their concerns about inconsistent indications and heterogenous use of different methods and dosages of induction. They wished for more patience with late-term pregnancies and individualized shared decision-making between pregnant women and obstetricians.

What are the effects of misoprostol for induction of labor to terminate a pregnancy in the second or third trimester for women with a fetal anomaly or after intrauterine fetal death?

What are the effects of misoprostol for induction of labor to terminate a pregnancy in the second or third trimester for women with a fetal anomaly or after intrauterine fetal death?

Foley catheter vs oral misoprostol for induction of labor: individual participant data meta-analysis.

To compare the effectiveness and safety of Foley catheter and oral misoprostol for induction of labor (IOL). The Cochrane Review on Mechanical Methods for Induction of Labour and Ovid MEDLINE, EMBASE via Ovid, Ovid Emcare, CINAHL Plus, ClinicalTrials.gov and Scopus, from inception to April 2019, were searched for randomized controlled trials (RCTs) comparing Foley catheter to oral misoprostol for IOL in viable singleton gestations. Eligible trials for which raw data were obtained were included and individual participant data meta-analysis was performed. Primary outcomes were vaginal birth, a composite of adverse perinatal outcome (including stillbirth, neonatal death, neonatal seizures, admission to the neonatal intensive care unit, severe respiratory compromise or meconium aspiration syndrome) and a composite of adverse maternal outcome (including admission to the intensive care unit, maternal infection, severe postpartum hemorrhage, maternal death or uterine rupture). The quality of the included RCTs was assessed using the Cochrane Risk of Bias 2 tool and the certainty of evidence was evaluated using the GRADE approach. A two-stage random-effects model was used for meta-analysis according to the intention-to-treat principle and interactions between treatment and baseline characteristics were assessed. Of seven eligible trials, four provided individual participant data for a total of 2815 participants undergoing IOL, of whom 1399 were assigned to Foley catheter and 1416 to oral misoprostol. All four trials provided data for each of the primary outcomes in all 2815 women. Compared with those receiving oral misoprostol, Foley catheter recipients had a slightly decreased chance of vaginal birth (risk ratio (RR), 0.95 (95% CI, 0.91-0.99); I2 , 2.0%; moderate-certainty evidence). A trend towards a lower rate of composite adverse perinatal outcome was found in women undergoing IOL using a Foley catheter compared with oral misoprostol (RR, 0.71 (95% CI, 0.48-1.05); I2 , 14.9%; low-certainty evidence). Composite adverse maternal outcome did not differ between the groups (RR, 1.00 (95% CI, 0.97-1.03); I2 , 0%; moderate-certainty evidence). Meta-analyses of effect modifications did not show significant interactions between intervention and parity or gestational age for any of the primary outcomes. For women undergoing IOL, Foley catheter is less effective than oral misoprostol, as it was associated with fewer vaginal births. However, while we found no significant difference in maternal safety, Foley catheter induction may reduce adverse perinatal outcomes. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.

Comparative study of labour outcome in foley bulb and vaginal misoprostol versus vaginal misoprostol for induction of labour at a teaching hospital

Comparative study of labour outcome in foley bulb and vaginal misoprostol versus vaginal misoprostol for induction of labour at a teaching hospital

Comparative study of dinoprostone pessary and misoprostol for induction of labour

Comparative study of dinoprostone pessary and misoprostol for induction of labour

A comparative evaluation of 25 mcg versus 50 mcg vaginal misoprostol for induction of labour at term in a Tertiary Care Hospital

Misoprostol is a synthetic PGE1 used for cervical ripening and induction of labour. However, the optimal dose of misoprostol to be used is a controversial issue. of the study was to determine the efficacy and safety of 25 mcg versus 50 mcg vaginal misoprostol for induction of labour at term based on maternal and fetal outcomes. This prospective cross-sectional study was carried out in the Department of Obstetrics and gynecology, Prathima Institue of Medical Sciences, Naganoor, Karimnagar. The patients were randomly allotted to either receive misoprostol 25 μg (Group I) or misoprostol 50 μg (Group II) respectively. The patient's group was recorded in the case file. After the confirmation of Bishop's score to be less than 6 the choosen dose of misoprostol was kept in the posterior fornix under aseptic conditions. The doses were repeated after 6 hours with a maximum of 4 doses till the patients get adequate uterine contractions which are defined as three contractions per 10 minutes or cervical dilatation of > 3cms. Group I received 25μg of misoprostol intravaginally and Group II received 50μg of intravaginal misoprostol. The majority of women in this study n = 85 out of n=120 were primigravida. The distribution of primigravida in group I was n=48 and group II was n=37. The maternal complications were recorded in n=2(3.33%) of group II and n=1(1.67%) of group I patients. It appears that the higher doses of misoprostol used in group II is one of the cause although the values were statistically insignificant. In conclusion, we found that the efficacy of 25µg of intravaginal misoprostol is comparable to 50 µg of intravaginal misoprostol for induction of labour. The advantages of 50µg of intravaginal misoprostol were it expedited vaginal deliveries. However, it also resulted in greater frequencies of complications to mother and fetus. Therefore we recommend the use of 25µg routinely and 50µg intravaginal misoprostol may be reserved for those with lower Bishop's scores.

Oral Misoprostol Solution In Comparison To Vaginal misoprostol for Induction of Labour in a Randomized controlled trial

Background: With more than 15% of all gravid women requiring prostaglandins in cervical ripening and labour induction. However, evidence is not clear about the preferred route or dose of the drug. So this study was designed with objectives to compare the induction delivery interval and safety of titrated oral misoprostol solution with vaginal misoprostol for labour induction in term primigravida women. Methods: This randomized controlled clinical trial was conducted on a total of 100 patients randomly selected among primigravida at term women undergoing induction of labour for obstetric or medical indication for labour induction in Ain Shams University Maternity Hospital. They were divided into two Groups: Group I: patients undergoing induction of labour using misoprostol oral solution and Group II: patients undergoing induction of labour using vaginal misoprostol. Results: Oral misoprostol solution has less induction delivery duration and less side effects than vaginal misoprostol. The induction-delivery time with the oral route compared to the vaginal one (15.2 vs. 20.3 hours respectively) with significant p-value (

Foley's Catheter with or without Misoprostol in Induction of labor: (Randomised Double Blind Control Study)

Background: Labor induction is the initiation of labor at a viable pregnancy duration by artificial means, and occurs before the spontaneous onset of labor. The goal of labor induction is to achieve a timely and uncomplicated vaginal delivery with minimal adverse effects on the mother or newborn.Aim: This study aimed to compare the efficacy of the use of Foley’s catheter with either misoprostol or placebo to improve induction to delivery interval in women with unfavorable cervix undergoing induction of labor.Materials and Methods: The present study is a randomized double blind controlled study that that was conducted at Maternity Hospital of Ain-Shams University. The study included 100 candidates on 4 equal goups :50 nulliparas randomized into 2 groups and 50 multiparas randomized into 2 groups. Each group underwent labor induction by Foley's catheter and Misoprostol or placebo.Results: Labor stages were significantly shorter in combined group than in Foley's group, but no significant difference in third stage. Oxytocin duration and total dose were significantly lower in combined group. No significant difference among studied groups regarding mode of delivery or fetal or maternal complications.Conclusion: Combined Foleys catheter and misoprostol provides a shorter duration of cervical ripening, less oxytocin required with no added complications compared to Foley’s catheter alone.

Oxytocin versus sublingual misoprostol for induction of labour in term prelabour rupture of membranes: A randomized controlled trial

Background: Induction of labor is one of the most common interventions practiced in modern obstetrics. In the developedWorld, the ability to induce labor has contributed to the reduction in maternal and perinatal mortality and morbidity.Aim: This study aimed to evaluate the effect of pre-labour administration of sublingual misoprostol versus oxytocin in term PROM on maternal and fetal outcomes. Materials and Methods: In a randomized single-blind controlled trial at department of obstetrics and gynecology, Menoufia University between September 2018 and October 2019. A total of 100 pregnant women who had spontaneous rupture of membrane and unripe cervix were enrolled. The group A underwent Oxytocin infusion according to low-dose standard protocol and the group B received 50 microgram sublingual Misoprostol every 6 hours. Results: There was a significant reduction in induction duration hours between Misoprostol group than Oxytocin group (p < 0.001). Second stage of labour was significantly shorter in misoprostol group. Although, some maternal sideeffects were non-significantly higher in misoprostol group. There was no significant difference between Oxytocin and Misoprostol groups regarding neonatal condition. Conclusion: pre-labour administration of sublingual misoprostol in patients with singleton term pre-labour rupture of membranes shorten duration of both active phase and second stage of labour significantly in comparison with oxytocinadministration.

Comparison of two dosing regimens of vaginally administered misoprostol for cervical ripening and induction of labour at term: A randomized controlled trial

Background: The use of misoprostol in induction of labour has become established, but there exist wide variations in the dosing regimen.Objective: The aim of this study was to compare the efficacy and safety of two regimens of intravaginal misoprostol for cervical ripening and labour induction at term.Method: This prospective randomized clinical trial was conducted on 130 pregnant women at term in Aminu Kano Teaching Hospital, Kano, Nigeria. Those who fulfilled the criteria were randomized into 2 groups to receive intravaginal misoprostol tablets for 24 hours. Study group (A) received 4 hourly 25 µg misoprostol and Control group (B) 6 hourly 50 µg of misoprostol. Student t test, chi-square and Fisher Exact test were used to compare variables. P&lt; 0.05 was considered statistically significant.Results: Both regimens were effective in cervical ripening and induction of labour with 93.8% and 98.5% achieving vaginal deliveries for 25 µg and 50 µg groups respectively. Oxytocin need was significantly higher (p&lt;0.001) in group A (76.9%) compared to group B (23.1%). The Mean induction- delivery interval in hours was significantly shorter (p&lt; 0.001) in group B (19.31±6.91) compared to group A (25.57±7.25). The percentage of women who delivered within 24 hours of commencement of induction was significantly higher (p= 0.002) in group B. There was no difference in the modes of deliveries in both groups (p =0.074). Tachysystole developed in two and three women in group A and B respectively. There were no significant differences between the two groups in neonates with Apgar score &lt; 7 at 1 minute, Apgar score &lt; 7 at 5 minutes, nor the proportion admitted to NICU. There was no difference in the incidence of adverse maternal effects in each group with p- values &gt; 0.05.Conclusion: The mean induction-vaginal delivery interval and the number of women who delivered within 24 hours were better in 50µg group than 25µg group with no statistical significant difference in mode of deliveries, maternal and neonatal outcomes.

To compare the efficacy and safety of sublingual and vaginal dose of Misoprostol for induction of labor in term viable pregnancies

To compare the efficacy and safety of sublingual and vaginal dose of Misoprostol for induction of labor in term viable pregnancies

Oral Misoprostol for Induction of Labour in Term PROM: A Systematic Review.

To assess the efficacy of oral misoprostol for induction of labour (IOL) in the context of term pre-labour rupture of membranes (TPROM), and to assess pregnancy outcomes following the administration of oral misoprostol. A systematic literature search was performed using Ovid Medline, Embase, PubMed, and the Cochrane Database of Systematic Reviews. Eligible studies were quasi-experimental trials or randomized controlled trials involving the use of oral misoprostol in singleton cephalic term pregnancies with confirmed rupture of membranes and no spontaneous labour at the time of membranes rupture, in mothers with no contraindications to vaginal delivery. Studies were excluded if they utilized vaginal misoprostol, excluded primigravid participants, or if the full text of the article was not accessible in English. Data were extracted by two reviewers using a standardized data extraction form. Study quality was assessed using the modified Jadad score. Twelve randomized controlled trials that included 1489 singleton pregnancies were included. Doses of oral misoprostol ranged from 20 to 200 μg. The incidence of vaginal birth ranged from 73.0%-95.0% in the oral misoprostol group compared with 52.4%-94% in the control group. Hyperstimulation was infrequent, ranging from 0% to 13.8% in the oral misoprostol group compared with 0%-24% in the control group. Two trials, involving a total of 144 women that compared 50 μg of oral misoprostol every 4 hours versus expectant management followed by PGE2 gel showed a higher incidence of vaginal birth with misoprostol (pooled risk ratio 1.33, 95% confidence interval 1.10-1.61). Oral misoprostol appears to be a safe and effective for IOL in TPROM. However, the varying administration, dose, and frequency reported in the literature highlights the need to develop a standardized protocol for use in Canadian obstetrical practice.

Early versus delayed amniotomy after vaginal misoprostol for labor induction in nulliparous women

Objectives To compare between the effectiveness and safety of early versus delayed amniotomy after vaginal misoprostol for the induction of labor. Background The aim of successful induction of labor is to achieve vaginal delivery when continuation of pregnancy presents a threat to the life or well-being of the mother or fetus. The process of induction of labor should only be considered when vaginal delivery is felt to be the appropriate route of delivery. Patients and methods A randomized, clinical trial that included 80 nulliparous women with medical or obstetric indication for labor induction. They were randomly assigned into two equal groups, the first group for early amniotomy and the second group for late amniotomy after use of vaginal misoprostol. Data were collected and tabulated. Results There was significant difference in the duration of labor between the two groups of early and late amniotomy with aP value of 0.000.There was also no significant difference in the mode of delivery with aP value equal to 0.197. Conclusion In well-selected cases, vaginal misoprostol followed by early intervention with amniotomy for labor induction appears to be associated with higher successful vaginal delivery rate, shorter induction-delivery interval, and better neonatal outcome over standard care.

Intravaginal isosorbide mononitrate in addition to misoprostol versus misoprostol only for induction of labor: a randomized controlled trial

Abstract Background Induction of labor is still a controversial obstetric procedure. The need to shorten delivery time has been recognized and practiced for centuries. Although the indications have clearly changed during the past decades from a need to expel a dead fetus to an effective solution to reduce the threat to the mother and her precious fetus, effective and safe methods of achieving delivery must always have been the primary objectives. Induction is indicated when the benefits to either mother or fetus outweigh those of pregnancy continuation. Nitric oxide donors(NO donors) such as isosorbide mononitrate could be of a great use for cervical ripening because of their effect on release of prostaglandins and vasodilation while having no or little effect on uterine activity ; since they are relatively safe and has low number of non-vital adverse effect if used with caution, they could be added to misoprostol to shorten to time needed for cervical ripening thus accelerating the whole process of induction of labor. The Aim of this study was to evaluate safety &amp; efficacy of nitric oxide donors such as intravaginal isosorbide mononitrate in addition to misoprostol versus misoprostol only for the whole process of induction of labor. Patients and Methods in a prospective randomized double-blind placebo-controlled clinical trial which was conducted at Ain Shams Maternity University Hospital in Cairo from January 2018 to June 2018, 50 women were included in induction of labor, they were randomly divided into 2 group: Group I consisted of 25 patients, each patient was given 1 tablet of isosorbide mononitrate 40mg vaginally once and one tablet of misoprostol 25mcg vaginally; Group II consisted of 25 patients, each patient was given 1 tablet of misoprostol 25mcg vaginally. Misoprostol were given for a maximum of 5 doses (one 25mcg vaginal tablet) with interval of 6 hours between each tablet. This clinical trial was registered in clinicaltrial.gov registry with number: NCT03523754. Results there was a statistically significant difference between Isosorbide mononitrate &amp; Misoprostol group versus Misoprostol only group regarding induction to delivery time ( mean 19.55 ± 1.41 to 22.94 ± 1.44 hours respectively, P-value &amp;lt;0.001) , induction to active phase interval (mean 10.67 ± 1.83 to 13.81 ± 0.52 hours respectively, P-value &amp;lt;0.001), maternal headache (36% to 12% respectively, P-value =0.047). Conclusion Isosorbide mononitrate appears to be a safe agent when used with misoprostol for induction of labor. It decreases induction to delivery time and induction to active phase time.

A comparative study of 25mcg of oral and vaginal misoprostol in induction of labour at term gestation in primigravida

Background: Labour induction is one of the common medical procedures in obstetrics. The aim is to end the pregnancy when continuity is a risk to mother or fetus. Prostaglandins have been used successively for cervical ripening and for induction of labour since early 1970’s.This comparative study is undertaken to evaluate the safety and efficacy of oral and vaginal routes of administation of misoprostol for induction of labor. Material and Methods: A prospective randomised controlled trial done on 196 Patients of admitted in Rajkiya Mahila chikitsalaya, JLN Medical College, Ajmer as per inclusion and exclusion criteria, informed consent was taken and randomization into two groups. The women in the oral group were 25 µg of misoprostol with a sip of water, and vaginal group had one 25 µg of misoprostol tablet inserted in the posterior vaginal fornix without use of lubricant (maximum upto 6 doses). Results: Our study showed that Full term (26.5%), followed by severe preeclampsia (24.4%), post-dated (16.3%), Mild PE (12.2%), Antepartum eclampsia (10.2%) and Polyhydramnios (10.2%) were indication for induction of labor. High rate of caesarean section in oral group than vaginal group 32 (32.6%) vs 16(16.3%). The commonest indication of caesarean section was fetal distress in both the groups. Failed induction was also higher in oral group than vaginal group 8(8.1%) vs 4(4%). Conclusion: Our study shows that for induction of labour vaginal route is preferable to oral route when used in equivalent dosage of 25 µg in primigravida. In vaginal route of administration compared to oral route number of dosage required is less, induction delivery interval is less, less incidence of failed induction, less rate of caesarean section, less requirement of oxytocin augmentation, less maternal side effects of the drug. The onset of uterine activity was earlier in oral group. Neonatal outcome is comparable in both groups. The increase efficacy associated with vaginal misoprostol raises the possibility of a local cervical effect with the vaginal administration.