Oral Misoprostol For Labor Induction Research Articles

Mode of delivery after labor induction with vaginal dinoprostone versus oral misoprostol for women with unfavorable cervix at term

ObjectiveTo compare the delivery mode after labor induction with 10 mg vaginal dinoprostone insert versus oral misoprostol 50 µg/4 h for women with an unfavorable cervix. Material and methodsThis is a retrospective observational study comparing the before/after introduction of oral misoprostol for labor induction, conducted at the Saint-Étienne University Hospital on a cohort of 396 women with a Bishop score <6. One hundred and twelve women (28.3%) were treated with a 10 mg vaginal dinoprostone insert versus 284 (71.7%) with oral misoprostol 50 µg/4 h. The primary outcome was the cesarean section rate. ResultsLabor induction with vaginal dinoprostone was independently associated with an increased rate of cesarean sections compared to oral misoprostol (aOR = 2.44; CI95% from 1.35 to 4.40; p = 0.003). The use of vaginal dinoprostone increased the induction rate during more than 48 h (18.8% versus 9.9%; p = 0.02), and the occurrence of fetal heart rate changes (34.8% versus 21.1%; p = 0.005). The maternofetal morbidity was similar. ConclusionLabor induction with vaginal dinoprostone was independently associated with an increased rate of cesarean sections compared to oral misoprostol in women with an unfavorable cervix.

Cochrane Review Summaries-October 2021.

In this month's issue, the journal continues to bring new insights from Cochrane Systematic Reviews to the readers of Obstetrics & Gynecology. This month, we highlight a review of low-dose oral misoprostol for labor induction, strategies to increase continuation of shorter-term hormonal contraception, and early postnatal discharge. The summaries are published below. The complete references with hyperlinks are listed in Box 1.

Oral Misoprostol 2 Hourly for Labor Induction

The objective of this study was to assess the efficacy and safety of the 2 hourly oral misoprostol for labor induction. Between May and November 2013, the hospital records of 83 women who were induced for labor and met the eligibility criteria were retrospectively reviewed. Eligibility criteria were singleton pregnancy of at least 34 weeks’ gestation and a baseline Bishop score 6. Women with a previous cesarean section or other uterine surgery, severe pregnancy-induced hypertension, and parity of 4 or more were excluded. Oral misoprostol was administered as 20 μg 2 hourly unless active labor. A maximum of 12 doses was allowed. The age of the women was 27.9 ± 5.3 years (mean ± SD). Vaginal delivery within 24 hours occurred in 38 (45.8%) women. Cesarean delivery occurred in 17 (20.5%) women. Although more parous women achieved vaginal delivery within 24 hours (52.6%) compared with nulliparous women (40.0%), the difference was not significant (P = .35). Uterine tachysystole occurred in 12 (14.5%) women. No perinatal deaths or neonatal intensive care unit admission occurred in the study group. Evidence supporting an optimal regimen is lacking, and additional research is warranted to optimize the use of oral misoprostol for the induction of labor.

Timing of sequential use of double-balloon catheter and oral misoprostol for induction of labor.

The best time to commence cervical ripening with a balloon catheter is unknown. The aim of this study was to evaluate whether application of a balloon catheter in the morning or in the evening is better when sequential prostaglandin application is planned. This multicenter historical cohort study included 415 women with an unfavorable cervix undergoing labor induction at term. Labor was induced with a double-balloon catheter and the sequential use of oral misoprostol if necessary. The balloon catheter was placed in the morning group between 02:00-15:00 and in the evening group between 15:00-02:00. The primary outcome measure was the cesarean section rate. Secondary outcome measures included failed labor induction (no vaginal delivery within 72 h). The cesarean section rate did not differ between the groups (morning 26.9%, evening 24.3%; P = 0.5553); however, more women in the morning group did not deliver within 72 h (8.8% vs 3.1%; P = 0.0138). In nulliparous women, labor induction failed more often in the morning group (12% vs. 4%, P = 0.043). In parous women, the induction-to-delivery interval was longer in the morning group (1756 vs. 1349 min; P = 0.046), and there were fewer deliveries within 24 h (35% vs. 56%, P = 0.016). When sequential use of a double-balloon catheter and oral misoprostol for labor induction is planned, the preferable time for catheter placement is in the evening. This resulted in fewer failed inductions in nulliparous women and a shorter induction-to-delivery interval and more deliveries within 24 h in parous women.

Current Resources for Evidence-Based Practice, July/August 2016

Evidence-Based Use of Oral Misoprostol for Labor Induction In the United States, nearly half of nulliparous women and more than one-third of multiparous women have their labors induced, and more than half of all inductions require cervical ripening (Laughon et al., 2012). These numbers reflect the sharp rise in the rate of induction during the past few decades (Hamilton, Martin, Osterman, Curtin, & Matthews, 2015). However, labor inductions are likely to become even more frequent in the coming years if investigators of ongoing clinical trials such as the ARRIVE study find neonatal or maternal benefits associated with elective induction at 39 weeks gestation (Eunice Kennedy Shriver National Institute of Child Health and Human Development, 2013). When performed incorrectly, labor induction can result in a range of poor maternal and neonatal outcomes, including cesarean birth, uterine tachysystole with fetal heart rate changes, uterine rupture, and postpartum hemorrhage (Stephenson & Wing, 2015). Thus, it is particularly important that practitioners induce labor using the most up-to-date and evidence-based strategies. Unfortunately, the medication that has been used most successfully for labor induction is at the heart of a controversy that has raged for more than 20 years (Goldberg & Wing, 2003).

Sublingual vs Oral Misoprostol for Labor Induction

ABSTRACT Background This study compares the eficacy and safety of sublingual vs oral misoprostol for induction of labor. Materials and methods 160 women admitted for induction of labor at the Postgraduate Institute of Medical Education and Research, Chandigarh were randomized to receive 25 µg misoprostol orally 3 hourly or 25 µg sublingual misoprostol 4 hourly for labor induction. Outcome The two groups were compared for number of women not delivered in 24 hours, misoprostol dose required, induction delivery interval, incidence of uterine contraction abnormalities, mode of delivery, side effects and neonatal outcomes. Results Low dose of misoprostol is eficacious with both routes of administration. Majority women delivered vaginally and of them, comparable numbers in both vaginal and sublingual misoprostol groups delivered within 24 hours of induction (93.1 and 83.7%). The sublingual route is associated with a statistically signiicant lesser induction to delivery interval (14.8 ± 6.2 hours vs 17.67 ± 7.32 hours) and lesser requirement of oxytocin augmentation (62.5 vs 35%). The occurrence of uterine contraction abnormalities and neonatal outcome was similar in both groups. Conclusion The low dose of 25 µg is eficacious and safe by both sublingual and oral routes. Sublingual route has lesser induction to delivery interval and lesser requirement for oxytocin augmentation. How to cite this article Siwatch S, Doke G, Kalra J Bagga R. Sublingual vs Oral Misoprostol for Labor Induction. J Postgrad Med Edu Res 2014;48(1):33-36.

Induction of labor with oral misoprostol for premature rupture of membranes at term in women with unfavorable cervix: a randomized, double-blind, placebo-controlled trial

To evaluate the efficacy and safety of oral misoprostol for labor induction in women with term premature rupture of membranes (PROM) and an unfavorable cervix. We randomized 130 women with PROM of < or =4 h to either oral misoprostol, 50 microg, or a placebo given every 4 h for up to three doses. Intravenous oxytocin was initiated if active labor did not begin within 12 h. Sixty-four women received oral misoprostol and 66 received placebo. The PROM-to-delivery interval was shorter with misoprostol than with placebo (13.7+/-5.8 vs. 20.3+/-6.8 h, respectively, P<0.05). Misoprostol significantly reduced the need for oxytocin (28.1 vs. 72.7%, P<0.001) and antibiotics (25 vs. 69.7%, P<0.001). No significant differences in cesarean section or hyperstimulation rate were noted. Oral misoprostol given to women with unfavorable cervix soon after term PROM significantly reduces the induction-to-delivery time and the need for oxytocin and antibiotics.

Pilot Study of Labor Induction with Titrated oral Misoprostol

To evaluate the safety and efficacy of titrated oral misoprostol for labor induction at term. Seventy-seven pregnant women (37 nullipara and 40 multipara), with medical or obstetric indications for labor induction after 37 weeks of gestation and unfavorable cervices (Bishop's score < 7), were induced according to the principles of titrated oral doses of misoprostol against uterine response. Our primary outcome measurements were the percentage of patients who had a vaginal delivery within 24 hours of induction and the interval from induction to vaginal delivery. Secondary measurements included oxytocin requirement, total misoprostol dosage, number of cesarean deliveries, induction failure, uterine hyperstimulation rates and neonatal outcomes. Seventy-five women (97.4%) experienced active labor within 24 hours, with 72 (93.5%) completing vaginal delivery within 24 hours. The mean interval from induction to vaginal delivery for all the women was 9.7 hours, with a 2.3-hour active phase. The mean misoprostol dosage was 206 microg, with eight women (10.4%) requiring oxytocin augmentation. There was no uterine hyperstimulation or induction failure, except for seven cases of uterine tachysystole (9.1%). Titrated oral misoprostol is a safe and effective method of labor induction because the dosage can be adjusted according to individual response.

Induction of labor with oral misoprostol in nulliparous mothers of twins

The efficacy and safety of oral misoprostol for labor induction of twins is unknown. We conducted a retrospective case-control study to evaluate the use of oral misoprostol in near term (> or =35 weeks) twin pregnancies in nulliparas. Eligible cases were given 100 mcg oral misoprostol, which was repeated after 6 h if labor did not start. Either a third dose or diluted oxytocin infusion were given in intractable cases. Diluted oxytocin infusion was used for augmentation. Controls were nulliparas delivered at > or =35 weeks by elective cesarean section. The two groups were comparable in most aspects, except for fetal malpresentation, which was the major reason for avoiding induction. Of the 69 patients in whom labor was induced, 53 (76.8%) had a vaginal birth, 3 (4.3%) had a combined twin delivery, and 13 (18.8%) had a cesarean during labor. The mean length of stay of the neonates was significantly shorter among study cases, without significant difference in the frequency of delayed discharges as an overall proxy for neonatal complications. Labor induction with oral misoprostol could be offered to patients in whom near term vaginal twin delivery is unequivocally permitted and wish to deliver by the vaginal route.

Ruptured membranes at term: randomized, double-blind trial of oral misoprostol for labor induction

Objective To determine if oral misoprostol can replace oxytocin for labor stimulation in women with ruptured membranes at term and without evidence of labor. Methods Nulliparous women at 36 to 41 weeks with a singleton, cephalic-presenting fetus and ruptured membranes without evidence of labor were randomized to receive oral misoprostol (100 μg) or a placebo every 4 hours for a maximum of two doses. Intravenous oxytocin was initiated if active labor had not ensued within 8 hours of the initial study drug dose. Results Fifty-one women were randomized to oral misoprostol and 51 women to the placebo. Misoprostol reduced the use of oxytocin stimulation of labor from 90% to 37% ( P < .001) and was associated with approximately a 7-hour shorter elapsed time in the labor unit. Uterine hyperactivity, defined as six or more contractions in 10 minutes without fetal heart rate decelerations, occurred in 25% of women randomized to misoprostol. However, uterine hyperactivity associated with fetal heart rate decelerations occurred in only three (6%) women, none of whom required emergency cesarean delivery. Route of delivery and infant outcomes were not related to misoprostol use. Conclusion Oral misoprostol (100 μg) given in a maximum of two doses 4 hours apart significantly reduced the use of oxytocin in the management of women with ruptured membranes without labor at term.

A comparison of two dosage regimens of oral misoprostol for labor induction at term

A comparison of two dosage regimens of oral misoprostol for labor induction at term

Oral or vaginal misoprostol administration for induction of labor: a randomized, double-blind trial

Objective: To compare the efficacy and vaginal birth intervals after intravaginal or oral misoprostol for labor induction. Methods: One hundred seventy-eight women were randomized to one of two double-blind groups: 1) oral misoprostol 200 μg and one-half tablet placebo intravaginal or 2) oral placebo tablet and one-half tablet of a 100-μg misoprostol intravaginal (dose 50 μg). Doses were repeated every 6 hours until labor was established (maximum of three doses). Results: Ninety-three subjects were assigned to oral misoprostol and 85 to intravaginal administration. Oral administration was accompanied by significantly shorter intervals to the onset of uterine contractility (133 ± 78 minutes versus 168 ± 93, P < .01) but a higher incidence of abnormal uterine contractile activity (tachysystole 38.7% versus 20.0%, P < .01; hyperstimulation syndrome 44.1% versus 21.2%, P < .01). No adverse maternal or neonatal outcomes were noted, nor were there differences in cesarean delivery rates or total lengths of labor. Conclusion: Oral administration of 200 μg misoprostol has similar efficacy to intravaginal administration of 50 μg but is associated with more frequent abnormal uterine contractility.