Misoprostol In Pregnancy Research Articles

The difference of Bishop score change and labor event between oral and vaginal misoprostol in pregnancy beyond 41 weeks

HIGHLIGHTS Oral misoprostol is more effective than vaginal misoprostol in cervical ripening as a part of induction of labor. Oral misoprostol is as safe as vaginal misoprostol. ABSTRACT Objective: To compare Bishop score changes and labor event between oral and vaginal misoprostol in pregnancy beyond 41 weeks. Materials and Methods: A total of 52 pregnant women with more than 41 weeks of gestation, had a Bishop score less than 5, and were undergoing induction labor were randomly divided into two groups: oral and vaginal misoprostol. In the oral misoprostol group, participants were given 25 mg of misoprostol in a solution with a concentration of 1 ug/ml every 2 hours. In the vaginal misoprostol group, a 25 mg misoprostol tablet was inserted into the posterior fornix every 6 hours. The two groups were compared in terms of Bishop score during the first 6 hours, changes in Bishop score, labor at term events, neonatal outcomes, complications, and side effects after the administration of misoprostol. Results: The oral group showed significantly higher changes in Bishop score compared to the vaginal group (5.5 vs 3.6; p=0.0001). The median interval times for induction of labor at term, induction at stage II, and induction at birth were found to be shorter in the oral misoprostol group compared to the vaginal group (7.3 hours vs 10.6 hours, 14.0 hours vs 16.8 hours, and 14.6 hours vs 17.6 hours; p=0.002, 0.003, 0.002). Labor at term occurred much more frequently in the oral group (53.8% vs 15.4%). Additionally, the oral misoprostol group had a 3.5 times higher likelihood of experiencing labor at term within the first 6 hours after the initial administration compared to the vaginal group (OR 3.5, 95% CI 1.33-9.23). Conclusion: Oral administration of misoprostol for cervical ripening has been demonstrated to be more effective than vaginal administration, greater bishop score changes while maintaining an equivalent level of safety.

Comparative Study of the Effect of Vaginal use of Primrose Oil with Misoprostol on Cervical Preparation of Prim Gravid Women: A Double-blind Clinical Trial.

This study compares the effect of vaginal administration of evening primrose oil with misoprostol on cervical preparation in prim gravid women at ≥40 weeks gestation. This was a double-blind randomized clinical trial conducted in Isfahan, Iran during 2019-2020 on 110 prim gravid pregnant women with a gestational age of 40 weeks and more and cephalic presentation of the fetus with the obstetrical indication for pregnancy termination. After obstetric examinations to rule out cephalo pelvic disproportion and calculation of the Bishop score by the researcher, patients were randomized to receive 25 μg misoprostol tablets (n = 55) or 1000 mg evening primrose oil Pearls (n = 55) administrated vaginally by a midwife. We compared Bishop's score before and after the intervention, time of cervical ripening, a dose of intervention for cervical ripening, need to induce labor, the interval between cervical preparation and induction of labor, duration of oxytocin use, need for cesarean section, and its cause, Apgar score at 5 and 10 minutes, neonatal birth weight. Mean baseline Bishop Score was not significant between the groups (P = 0.45); after the intervention, it was significantly higher in the primrose oil group (P < .001). Significantly fewer patients required cesarean sections in the primrose oil group (P = 0.03). The other outcomes were. not significant between the groups (P > 0.05). Misoprostol and primrose oil administration appear to positively affect cervical readiness. Primrose oil resulted in significantly better Bishop Scores and fewer cesarean sections compared to misoprostol in pregnancy 40 weeks and more.

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)

Effect of cardiotocographic monitoring prior to induction of labor

Aim: To assess the role of intermittent cardiotocographic monitoring of induction of labor while using misoprostol in pregnancy of 41 weeks or more.&#x0D; Methods: This is hospital based descriptive study conducted from December 2017 to March 2018. CTG was done before each transvaginal administration of misoprostol in 113 primigravida patients at Paropakar Maternity Women’s Hospital in Kathmandu. Variables studied were indications of induction, mode of delivery, Apgar score and neonatal admissions.&#x0D; Results: 11.5% of CTGs were non-reassuring who underwent Cesarean Section and had significantly low Apgar at 1 minute but only 46% of neonates required resuscitation. Liquor was thick meconium in 61.5% of non-reassuring CTGs. Total twelve (10.6%) of neonate needed resuscitation of which six (6%) neonate in reassuring CTG where as 46.1% of neonate needed resuscitation in non-reassuring. NICU admission rate was 7.96% in total and 33.3% of neonate with non-reassuring CTG who needed resuscitation. However there was no neonatal mortality during this period.&#x0D; Conclusions: Intrapartum cardiotocography can prevent fetal compromise early.&#x0D; Keywords: Apgar score, caesarean section, cardiotocography, induction, resuscitation

Mifepristone With Buccal Misoprostol for Medical Abortion: A Systematic Review.

To summarize clinical outcomes and adverse effects of medical abortion regimens consisting of mifepristone followed by buccal misoprostol in pregnancies through 70 days of gestation. We used PubMed, ClinicalTrials.gov, and reference lists from published reports to identify relevant studies published between November 2005 and January 2015 using the search terms "mifepristone and medical abortion" and "buccal and misoprostol." Studies were included if they presented clinical outcomes of medical abortion using mifepristone and buccal misoprostol through 70 days of gestation. Studies with duplicate data were excluded. We included 20 studies with a total of 33,846 women through 70 days of gestation. We abstracted efficacy and ongoing pregnancy rates as an overall rate and by gestational age in days in reference to completed weeks (eg, 49 days or less, 50-56 days, 57-63 days, 64-70 days) and adverse effects when reported. The overall efficacy of mifepristone followed by buccal misoprostol is 96.7% (95% confidence interval [CI] 96.5-96.8%) and the continuing pregnancy rate is 0.8% (95% CI 0.7-0.9%) in approximately 33,000 pregnancies through 63 days of gestation. Only 332 women with pregnancies between 64 and 70 days of gestation are reported in the literature with an overall efficacy of 93.1% (95% CI 89.6-95.5%) and a continuing pregnancy rate of 2.9% (95% CI 1.4-5.7%). Currently available data suggest that regimens with a 24-hour time interval between mifepristone and buccal misoprostol administration are slightly less effective than those with a 24- to 48-hour interval. Rates of surgical evacuation for reasons other than ongoing pregnancy range from 1.8% to 4.2%. Severe adverse events like blood transfusion (0.03-0.6%) and hospitalization (0.04-0.9%) are uncommon. Outpatient medical abortion regimens with mifepristone followed in 24-48 hours by buccal misoprostol are highly effective for pregnancy termination through 63 days of gestation. More data are needed to evaluate clinical outcomes with regimens containing mifepristone followed in 24 hours by buccal misoprostol and in pregnancies beyond 63 days of gestation.

Use of Misoprostol in Pregnancy- A Review Article

Prostaglandins are the pharmacological agents used for induction of labour and augmentation of labour. Prostaglandin E2 gel is used for cervical ripening and induction of labour. These are however, costly and need to be stored in a refrigerator at a temperature of 2 - 8°C, half life 18 months. The Tablet form of prostaglandin E2 is not available in Bangladesh. Misoprostol, a synthetic prostaglandin (PG) E1 analogue is used orally for the treatment of gastric and duodenal ulcer and used as a cytoprotective agent. It was first used for labour induction in 1987. Prostaglandin can be used in several gynaecological and obstetric conditions. It can be given through several routes. This article will elaborately delinate the role of misoprostol, a prostaglandin in obstetrics and gynaecological conditions. Medicine Today 2010 Volume 22 Number 02 Page 94-98 DOI: http://dx.doi.org/10.3329/medtoday.v22i2.12443

The extended gestational age medical abortion study: the effectiveness of medical abortion with mifepristone and misoprostol at 57–63 days versus 64–70 days gestation

Medical abortion with in-patient regimens is safe and effective through late first trimester, yet women who narrowly pass the 63-day LMP limit are denied out-patient medical abortion because data on out-patient regimens are lacking. We compared the effectiveness and acceptability of early medical abortion protocols with home administration of misoprostol in pregnancies 64���70 and 57���63 days of gestation.

Induction of labor with misoprostol in pregnancies with advanced maternal age

Objective The objective was to compare the efficacy and complications of intravaginal misoprostol application with oxytocin infusion for induction of labor in advanced aged pregnancies with a Bishop score of <6. Study design A hundred advanced aged (≥35 years) pregnant patients with a Bishop score of <6 were randomized into two groups. The first group (50 patients) received 50 μg intravaginal misoprostol four times with 4 h intervals and the second group received oxytocin infusion for induction of labor starting from 2 mIU/min and was increased every 30 min with 2 mIU/min increments up to a maximum of 40 mIU/min. The time from induction to delivery, the route of delivery, fetal outcome, and maternal complications were recorded. Statistical analyses were performed using the Mann–Whitney U, Chi-squared and t tests to determine differences between the two groups. A p value ≤0.05 was considered significant. Results Misoprostol was superior for induction of labor in advanced aged pregnancies with Bishop score of <6, as the mean time from induction to delivery was 9.61 ± 4.12 h and 11.46 ± 4.86 h in the misoprostol and oxytocin groups respectively, with a significant difference between the groups ( p = 0.04). The rate of vaginal delivery was higher in the misoprostol group (84.0%) than in the oxytocin group (80.0%), but the difference did not reach significance ( p = 0.60). The rates of placental abruption and postpartum hemorrhage were similar in both groups and no cases of uterine rupture occurred. The 1- and 5-min mean Apgar scores were 6.98 ± 1.17 to 9.08 ± 0.99 and 6.88 ± 1.81 to 9.00 ± 1.35 in the misoprostol and oxytocin groups respectively, with no significant differences between the groups ( p = 0.74, p = 0.83). No cases of asphyxia were present. The rate of admission to the neonatal intensive care unit was similar in both groups. Conclusion Intravaginal misoprostol seems to be an alternative method to oxytocin in the induction of labor in advanced aged pregnant women with low Bishop scores, as it is efficacious, cheap, and easy to use. But large studies are necessary to clarify safety with regard to the rare complications such as uterine rupture.

Misoprostol and pregnancy: ever-increasing indications of effective usage.

The subject of misoprostol in the field of reproductive health care has courted much controversy. The aim of this review is to survey the literature published in this field over the past year, and to evaluate developments in this area. This article will cover termination of pregnancy, induction of labor and the issue of postpartum hemorrhage. The use of misoprostol as a single agent remains of clinical value when mifepristone is unavailable. The sublingual and rectal routes are alternative modes of administration. For induction of labor, the optimum dose and route of misoprostol is still undetermined. Lower doses of between 20 microg to 40 microg may increase the safety profile for labor induction. Misoprostol may be a useful adjunct to the therapeutic options available for the prevention and treatment of postpartum hemorrhage. There are many potential uses for misoprostol in pregnancy. However clinicians must judge the evidence and the emotive debate surrounding this field and decide how it will influence their clinical practice depending on the priorities of their own clinical circumstances.

Labor Induction Using Titrated Oral Doses of Misoprostol in Pregnancy with Myoma

Objective: To avoid uterine hyperstimulation of misoprostol during labor induction, we adopted a new method of repeated smaller doses titrated and used orally in one pregnancy with myoma. In addition, we assessed the effectiveness and safety of this regimen. Case Report(s): A 29-year-old pregnant woman complained of lower abdominal pain at 21 weeks of gestation. At that time, a leiomyoma approximately 8.4 × 7.3 cm in the anterior wall of uterine lower segment was found on a sonogram. There were no abnormal findings except for uterine myoma and high-normal blood pressure without proteinuria and edema in all prenatal examinations. She was admitted to the delivery room for labor induction at 39 weeks of gestation due to grade Ill calcified placenta and oligohydramnios. The principle of the labor induction with misoprostol was according to the titrated oral method. The Bishop score was 3 before labor induction and total dose of misoprostol used was 250μg. No hyperstimulation or no fetal distress was found during the whole labor course. The induction to active phase interval was 14 hours and 45 minutes, while the induction to vaginal delivery interval was 16 hours and 20 minutes. A male newborn that weighed 3050 g was delivered vaginally and the Apgar’s score of 1’/5’ was 9/10. Three tablets of oral misoprostol (600μg) were given 3 hours and 25 minutes after delivery to prevent postpartum hemorrhage due to heavy lochia. Conclusion(s): According to the pharmacokinetics of misoprostol and the patient’s responsiveness, the titrated oral use of misoprostol was effective. In the meantime, the uterine hyperstimulation resulting in acute fetal distress was also avoided. It is worthwhile to conduct a large trial to assess the effectiveness and safety of this regimen.

Confusion concerning the use of misoprostol in pregnancy

Confusion concerning the use of misoprostol in pregnancy

Mifepristone and misoprostol: efficacy and dangers

Unsafe abortion is another major cause of maternal mortality in poorer countries. In the first trimester the standard method of termination of pregnancy is surgical evacuation of the uterus, but this is expensive for countries with constrained health budgets. Medical termination of pregnancy therefore is likely to the preferred method, but only if the costs of this treatment can be kept to a minimum. It was probably this consideration which encouraged the World Health Organisation (pages 524–530) to perform a randomised trial of two doses of mifepristone given two days before misoprostol for termination of pregnancy in the first trimester. This was an equivalence trial, to test the hypothesis that the lower dose of mifepristone was as effective as the higher dose in achieving termination of pregnancy. The trial was placebo-controlled with randomisation from the centre in Geneva, and so two of the main sources of bias in randomised trials were minimised. Furthermore, seventeen centres in several continents participated in the trial, and so the results can be made general. There was no difference in the rates of abortion with the two doses of mifepristone. A secondary analysis showed that women who had a menstrual delay of greater than 21 days had an unacceptably low rate of abortion with either misoprostol, vaginal misoprostol or a more powerful prostaglandin. As the World Health Organisation point out, rigorous follow up of medical termination of pregnancy is necessary in order to detect failures, bearing in mind the teratogenic effects of misoprostol. This is the topic of the case-control study performed by Iêda Orioli and colleagues (pages 519–523), who tested the hypothesis that failed termination of pregnancy with misoprostol bought over the counter was associated with fetal malformations. The authors used the information held by the Latin American Collaborative Study of Congenital Malformations, which has recorded all births in ten Latin American countries since 1967 and includes detailed descriptions of birth defects. There were over four thousand cases of congenital malformation which were each matched with the next normal infant of the same sex born in the same hospital. The limitations of this study are that use of misoprostol may not always be reported; the analysis is by defect and not by infant so that each infant may be counted more than once; statistical significance was sometimes achieved with only small numbers and so the confidence intervals are wide; and there are many comparisons such that statistical significance may have occurred by chance. Nevertheless, there was a strong association between taking misoprostol in pregnancy and constriction defects in the limbs, consistent with the results of smaller case series. The assumption is that misoprostol taken in early pregnancy causes tonic uterine contraction and ischaemia of the distal parts of the limbs. These studies indicate that it may be possible to reduce substantially maternal mortality from unsafe abortion by medical termination of pregnancy. However, since in a significant number of women medical termination may fail, there must be an effective system of follow up so that the harmful consequences of failed medical termination of pregnancy can be avoided.

Overdosage of misoprostol in pregnancy

We report the clinical course of a woman 31 weeks pregnant who ingested misoprostol (a prostaglandin E1 analog, Cytotek, used to prevent gastric ulcer) and trifluoperazine (Stelazine). Manifestations of toxicity included hypertonic uterine contraction with fetal death, hyperthermia, rhabdomyolysis, hypoxemia, respiratory alkalosis, and metabolic acidosis. We are concerned that misoprostol may be used as an llicit abortifacient.