Routes Of Misoprostol Administration Research Articles

Comparison of the effect of oral and vaginal misoprostol on labor induction: updating a systematic review and meta-analysis of interventional studies

ObjectivesThis study is aimed to compare the effect of oral misoprostol with vaginal misoprostol to induce labor as a systematic review and meta-analysis.MethodsElectronic databases including PubMed [Medline], Scopus, Web of science, Embase, Ovid, Cochrane library, and ClinicalTrials.gov were searched using the relevant keywords. All RCTs comparing the effect of oral vs vaginal misoprostol on labor induction were considered. The Cochrane Risk of Bias checklist was used for assessing quality of included RCTs. All statistical analyses were completed using STATA (Version 16) and Revman (Version 5).ResultsThirty-three RCTs with 5162 patients (1560 in oral and 2602 in vaginal groups) were included in this meta-analysis. Labor induction length did differ significantly between the two routes of misoprostol administration [Standardized Mean Difference: 0.40 h, 95% confidence interval (CI) 0.34, 0.46; I2: 66.35%; P = 0.04]. In addition, the risk of neonatal death, tachysystole, uterine hyperstimulation, preeclampsia, non-FHR and abortion was lower in the oral misoprostol group and the risk of hypertonus, PROM, oxytocin need and cesarean fever was higher in this group than the vaginal misoprostol group.ConclusionsBased on results of this meta-analysis, it can be inferred that currently, clinical specialists can decide to use this drug orally or vaginally on a case-by-case basis, depending on the condition of the pregnant mother and the baby.

114 Early versus delayed amniotomy following combination foley catheter-misoprostol for term labor induction

We sought to assess whether early amniotomy reduces the duration of labor or increases the proportion of women delivered within 24 hours among patients undergoing combined Foley Catheter-Misoprostol (FC-M) labor induction at term. This was a planned secondary analysis of a randomized controlled trial. Women with a term (≥37 weeks), singleton pregnancy undergoing FC-M cervical ripening were included. Early amniotomy was defined as artificial rupture of membranes prior to or at 4cm cervical dilation. Amniotomy beyond 4cm was categorized as delayed. Our primary outcome was time from induction initiation to delivery. Cox proportional hazard models were used, accounting for maternal age, race, gestational age, and route of misoprostol administration. 215 women were included: 116 (54%) in the early amniotomy group and 99 (46%) in the delayed group. Demographic and clinical characteristics were similar between the two groups. Delayed amniotomy was associated with shorter time to delivery after adjusting for confounders (hazard ratio [HR] 1.43, 95% confidence interval [CI] 1.09-1.89; p=0.01). Women in the delayed group spent a significantly shorter time in labor (20.4 hours vs 23.1 hours, p=0.03). There was no difference in the proportion of women who delivered within 12 or 24 hours. We found no difference in the rate of cesarean delivery between the two groups (19.8% vs 19.2%, p=1.0). There were no significant differences in maternal and neonatal outcomes. Delayed amniotomy was associated with shorter length of labor without increasing maternal or neonatal adverse events. Delaying amniotomy beyond 4cm dilation should be preferred in women undergoing term labor induction with FC-M.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Medical termination for pregnancy in early first trimester (\u2264 63 days) using combination of mifepristone and misoprostol or misoprostol alone: a systematic review

BackgroundA wide range of drugs have been studied for first trimester medical abortion. Studies evaluating different regimens, including combination mifepristone and misoprostol and misoprostol alone regimens, show varying results related to safety, efficacy and other outcomes. Thus, the objectives of this systematic review were to compare the safety, effectiveness and acceptability of medical abortion and to compare medical with surgical methods of abortion ≤63 days of gestation.MethodsPubmed and EMBASE were systematically searched from database inception through January 2019 using a combination of MeSH, keywords and text words.Randomized controlled trials on induced abortion at ≤63 days that compared different regimens of medical abortion using mifepristone and/or misoprostol and trials that compared medical with surgical methods of abortion were included.We extracted data into a pre-designed form, calculated effect estimates, and performed meta-analyses where possible. The primary outcomes were ongoing pregnancy and successful abortion.ResultsThirty-three studies composed of 22,275 participants were included in this review. Combined regimens using mifepristone and misoprostol had lower rates of ongoing pregnancy, higher rates of successful abortion and satisfaction compared to misoprostol only regimens. In combined regimens, misoprostol 800 μg was more effective than 400 μg. There was no significant difference in dosing intervals between mifepristone and misoprostol and routes of misoprostol administration in combination or misoprostol alone regimens. The rate of serious adverse events was generally low.ConclusionIn this systematic review, we find that medical methods of abortion utilizing combination mifepristone and misoprostol or misoprostol alone are effective, safe and acceptable. More robust studies evaluating both the different combination and misoprostol alone regimens are needed to strengthen existing evidence as well as assess patient perspectives towards a particular regimen.

Comparison of the efficacy of sublingual, oral, and vaginal administration of misoprostol in the medical treatment of missed abortion during first trimester of pregnancy: A randomized clinical trial study.

Background:This study was aimed at comparing the efficacy of different routes of misoprostol administration, including sublingual, oral, and vaginal, on the induction of medical abortion in the first trimester of pregnancy.Materials and Methods:This open-label, randomized clinical trial study was performed on 172 individuals in three parallel groups of vaginal, sublingual, and oral administration of misoprostol. The participants were randomized using permuted blocks of six. A dose of 600 μg of misoprostol every 6 h (maximum of 4 doses) was administrated to each group. Higham chart and demographic questionnaires were completed by the investigator. Data were analyzed using Stata software version 12.Results:The mean age of the participants was 29.81 ± 6.7 years, and the mean gestational age was 8.45 ± 2.32 weeks. We found a significant difference regarding the abortion success rate and the time interval between the administration of the drug among three groups (P = 0.036 and < 0.001 in turn). There was no statistically significant difference between the three groups in terms of severity and duration of vaginal bleeding until day 7 after induction (P = 0.091 and 0.143, respectively). Furthermore, we found statistically significant differences in some drugs, which induced side effects namely vomiting and headache, between the three groups (P = 0.032 and 0.028 in turn).Conclusion:The findings suggest that vaginal administration of misoprostol is more successful than the sublingual and oral route for complete abortion; vaginal administration of misoprostol is an appropriate alternative to curettage.

Is vaginal misoprostol more effective than oral misoprostol for cervical ripening in obese women?

Objective: To determine if vaginal misoprostol is more effective than oral misoprostol for cervical ripening in obese women.Study design: A retrospective cohort study of obese women undergoing induction of labor from Jan 2013 to Dec 2016 with singleton, viable pregnancies beyond 37 completed weeks of gestational age. Women with an initial Bishop score of 7 or less, with a cervical dilatation of less than 2 cm, who received either vaginal or oral misoprostol as a cervical ripening agent, were included. Primary outcome was interval from the start of induction to the attainment of 3 cm cervical dilatation. Secondary outcomes included the interval from the start of induction to delivery and the rate of cesarean delivery (CD).Result: Of women who met the inclusion criteria, 966 (75.5%) women received oral misoprostol and 314 (24.5%) received vaginal misoprostol. The mean time-interval from the start of induction to attainment of 3-cm dilatation was shorter in the vaginal group (10.5 ± 10.4 h) compared to the oral group (17.2 ± 11.5 h), (p < .0001). Significantly shorter times to delivery were also noted in the vaginal group (17.4 h for vaginal vs. 24.8 h for oral, p < .0001). In the subgroup analysis of nulliparous women, shorter time intervals from the start of induction to attainment of 3-cm dilatation, as well as to delivery, were noted in the vaginal misoprostol group (p < .0001 for both). Multiple linear regression model confirmed route of misoprostol administration as an independent variable in predicting the outcomes (time from start of induction to 3 cm as well as to delivery). Significant findings amongst neonatal outcomes included lower umbilical artery pH and higher rates of neonatal jaundice in the oral misoprostol group.Conclusion: In a population of obese women undergoing induction of labor, vaginal administration of misoprostol was associated shorter time intervals from the start of induction to the attainment of 3 cm of dilatation, as well as to delivery, without increasing the rate of cesarean deliveries or the incidence of adverse maternal and neonatal outcomes.

A randomized comparison of patient satisfaction with oral and vaginal misoprostol for induction of labor at term

Background: Induction of labor has the potentials for preventing maternal complications and improving pregnancy outcome especially in low-resource settings like Nigeria. The various routes of administration of misoprostol have been proven to affect the safety and efficacy of the drug. However, there is paucity of studies that compared the satisfaction of women regarding the oral and vaginal routes. The aim of this study is to compare patient satisfaction with administration of oral and vaginal misoprostol for induction of labor at term. Patients and Methods: A randomized comparative study, where 169 women admitted for induction of labor at the delivery suite of Ahmadu Bello University Teaching Hospital were assessed for their satisfaction with regard to the oral and vaginal routes of misoprostol administration using the 5-point Likert scale. Data were analyzed using SPSS version 20. Results: The request for analgesia was similar in both groups [17.9% vs 17.9%, relative risk (RR); 1.00 95% confidence interval (CI) 0.5–1.9]. However, more women in the oral group were very satisfied compared with the vaginal group (57.6% vs 33.3%), and a significant proportion of women in the oral group expressed their willingness to use the same route of labor induction in subsequent pregnancies (RR 1.1, 95% CI 1.0–1.3, P = 0.04). There was no difference in terms of maternal and neonatal outcomes for both routes. Conclusion: Women had higher satisfaction with oral misoprostol and preferred the oral route compared with the vaginal route.

132-POS

Objectives To determine the factors associated with vaginal delivery in hypertensive and normotensive pregnant women submitted to induction of labor with misoprostol. Methods We conducted a cohort study, with pregnant women submitted to induction of labor with misoprostol, evaluating normotensive and hypertensive gestation. All pregnancies had a live fetus. The main outcomes analyzed were: age, parity, number of pregnancies, gestational age, index of amniotic fluid, Bishop score, fetus weight estimated by ultrasound, premature rupture of membranes, diabetes, peridural analgesia, presence of meconium in the amniotic liquid, cervical modifications, time of induction, time of labor and time between induction and labor, need of oxytocin, route of misoprostol administration and size of cervix by ultrasound. For statistical analysis we used the chi-square test or Fisher’s exact test, as appropriate, at a significance level of 5%. We also calculated the risk ratio (RR) and its confidence interval 95% (95% CI). Results We evaluated 410 pregnant women submitted to induction of labor with misoprostol, 227 in normotensive and 183 in hypertensive gestation. The frequency of vaginal delivery was similar in both groups, with 61,2% in normotensive pregnant women and 57.4% in hypertensive (p = 0.43). The risk factors associated with vaginal delivery in both women were, respectively: Bishop score ⩾ 4 (OR = 1.87; 95%CI: 1.06–3.29; p = 0.03) and (OR = 2.31; 95%CI: 1.25–4.28; p = 0.008) and parity ⩾ 1 (OR = 4.36; 95%CI: 2.16–8.80; p 0.0001) and (OR = 2.61; 95%CI: 1.36–5.04; p = 0.004). Conclusions The main factors associated with progression to vaginal delivery in pregnant women undergoing induction of labor were Bishop score ⩾ 4 and higher parity ⩾ 1, regardless of the occurrence of gestational hypertension. Disclosures N.V. Leal: None. A.S. Souza: None. L. Katz: None. C. Noronha-Neto: None. S.B. Maia: None. A.H. Franca-Neto: None. M.M. Amorim: None.

Optimal route of misoprostol administration for the prevention of postpartum hemorrhage

Optimal route of misoprostol administration for the prevention of postpartum hemorrhage

Effectiveness of different routes of misoprostol administration before operative hysteroscopy: a randomized, controlled trial

To compare the effectiveness and patient preference of different routes of misoprostol administration before operative hysteroscopy in premenopausal women. Randomized, controlled trial. University hospital. One hundred sixty women undergoing operative hysteroscopy. Patients were randomly assigned to receive 400 μg misoprostol orally (n=40), sublingually (n=40), or vaginally (n=40) before operative hysteroscopy; the control group (n=40) did not receive any cervical priming agent. Preoperative cervical width, adverse effects, and patient preference. The mean (±SD) cervical widths for the oral, sublingual, vaginal, and control groups were 7.62±1.81 mm, 7.58±1.77 mm, 7.60±2.15 mm, and 5.65±2.12 mm, respectively, which was statistically significant. Time to cervical dilatation was also significantly longer in the control group than in the other three groups. Misoprostol-related adverse effects and hysteroscopy-related complications were comparable among the four study groups. Of all 160 subjects, 132 (82%) preferred the oral route for misoprostol administration to the sublingual or vaginal routes, or had no preference. All orally, sublingually, and vaginally administrated misoprostol is equally effective in inducing proper cervical priming before operative hysteroscopy. Considering patient preference, oral administration may be the optimal route for misoprostol administration. NCT01805115.

Acceptability and feasibility of the use of 400 μg of sublingual misoprostol after mifepristone for medical abortion up to 63 days since the last menstrual period: Evidence from Uzbekistan

ABSTRACTObjective To examine the efficacy, acceptability and feasibility of early medical abortion, with the option of home administration of misoprostol, in Uzbekistan.Methods A total of 450 women were enrolled at national, municipal and private facilities in Tashkent, Uzbekistan. Women who presented for termination of pregnancy with gestations up to 63 days were recruited to participate in the study. All eligible pregnant women who consented to participate swallowed a 200 mg mifepristone pill in the clinic and were given the option of taking 400 μg misoprostol sublingually either at the clinic or at home 24–48 hours after mifepristone administration. Abortion status was determined two weeks later.Results Almost all women (99.5%) chose home administration of misoprostol. The sublingual route of misoprostol administration was acceptable or very acceptable to 89% of participants. Ninety-five percent of women had complete abortions after mifepristone and misoprostol. Almost all participants preferred a medical abortion to surgery for a future procedure (95%).Conclusions Mifepristone medical abortion with home administration of misoprostol is an acceptable and feasible option for women in Uzbekistan. The method worked well at all three facility types.

Oral misoprostol is an effective and acceptable alternative to vaginal administration for cervical priming before first trimester pregnancy termination

BackgroundCervical priming agents mainly prostaglandins in different doses and routes are used during first trimester vaccum aspiration to prevent cervical injury and shorten the abortion procedure. This study was carried out to assess women's acceptability, the efficacy and side effects of oral versus vaginal administration of misoprostol in facilitating cervical dilatation prior to first trimester vaccum aspiration. MethodsA randomised control study where 120 women were divided in oral (51) and vaginal (69) group. Each group received 400 mcg of misoprostol either orally or vaginally 04 h prior to first trimester pregnancy termination. Baseline cervical dilatation, women's acceptability and side effects and complications were noted in both the groups. ResultsThere was no difference between the oral and vaginal misoprostol groups with respect to mean cervical dilatation (5.53 mm vs 5.43 mm; p > 0.05). A total of 88% of women in the oral group expressed satisfaction with the route of misoprostol administration as compared to 74% in the vaginal route. The women in the vaginal group were experienced more preoperative vaginal bleeding (43% vs 25%). ConclusionOral administration of misoprostol is an effective alternative to vaginal administration in preinduction cervical ripening prior to first trimester pregnancy termination.

I081 DOES ROUTE MATTER? WHAT WE KNOW ABOUT FIRST TRIMESTER MEDICAL ABORTION OUTCOMES WITH REGIMENS USING VARIOUS ROUTES OF MISOPROSTOL ADMINISTRATION

International Journal of Gynecology & ObstetricsVolume 119, Issue S3 p. S180-S180 Invited presentations and presentations by organisations and societies I081 DOES ROUTE MATTER? WHAT WE KNOW ABOUT FIRST TRIMESTER MEDICAL ABORTION OUTCOMES WITH REGIMENS USING VARIOUS ROUTES OF MISOPROSTOL ADMINISTRATION R. Dabash, R. DabashSearch for more papers by this author R. Dabash, R. DabashSearch for more papers by this author First published: 22 October 2012 https://doi.org/10.1016/S0020-7292(12)60111-8AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume119, IssueS3Abstracts of XX FIGO World Congress of Gynecology and ObstetricsOctober 2012Pages S180-S180 RelatedInformation

Sublingual versus vaginal misoprostol for the management of missed abortion

To evaluate the efficacy of two routes of misoprostol administration (sublingual and vaginal) for the treatment of missed abortion. Two hundred and twenty women with confirmed missed abortion who received 400 microg/6 h misoprostol either sublingually or vaginally, were included in this randomized control trial. All women were admitted to hospital for follow-up care for 2 days. If the pregnancy was not completely evacuated during this time, the patient underwent immediate surgical completion. Efficacy was defined as the percentage of women discharged from the study without the need for surgical intervention. The effectiveness was high in the sublingual group and statistically different (sublingual 84.5%, vaginal 46.4% P = 0.000 RR = 0.54 95%CI = 0.442-0.681). The groups differed in terms of complications like bleeding (88.2% vs 65.5%), pain (85.5% vs 56.4%), diarrhea (69.1% vs 36.4%) and fever (23.6% vs 13.3%) in the sublingual group versus the vaginal group, but the mean time to expulsion was shorter (9.68 h SD = 5.51 95%CI = 8.61-10.57) in the sublingual group than the vaginal group (16.64 h SD = 14.01 95%CI = 13.8-19.48), P = 0.000. Women in the sublingual group were highly satisfied with the method. Sublingual misoprostol for the medical management of missed abortion is more effective and more acceptable than the vaginal route. However, it showed more adverse effects.

The potential of two non-vaginal routes of misoprostol administration following mifepristone for medical abortion up to 63 days gestation

The potential of two non-vaginal routes of misoprostol administration following mifepristone for medical abortion up to 63 days gestation

A randomised controlled trial of mifepristone in combination with misoprostol administered sublingually or vaginally for medical abortion up to 13 weeks of gestation

To assess women's acceptability, the efficacy and side effects of sublingual versus vaginal administration of misoprostol in combination with mifepristone for medical abortion up to 13 weeks of gestation. Randomised controlled trial. Aberdeen Royal Infirmary. Women undergoing medical abortion under the terms of the 1967 Abortion Act. Mifepristone (200 mg) was given orally followed 36-48 hours later by misoprostol administration (sublingual: 600 microg; vaginal: 800 microg). A second dose of misoprostol 400 microg was given 3 hours later (sublingually or vaginally). Women between 9 and 13 weeks of gestation received a further (third) dose of misoprostol 400 microg (sublingually or vaginally), 3 hours later if abortion had not occurred. Women's acceptability, efficacy of the regimen and side effects experienced. A total of 340 women were recruited (171 sublingual and 169 vaginal). A total of 70% of women in the sublingual group expressed satisfaction with the route of misoprostol administration; 18% answered 'Don't know' while 12% were dissatisfied, compared with 68%, 28% and 4%, respectively, in the vaginal group (P= 0.02). There was no significant difference in the need for surgical evacuation for women in the sublingual (3/158, 1.9%) and vaginal groups (4/156, 2.6%) (P= 0.70). Women receiving misoprostol sublingually were more likely to experience diarrhoea (P < 0.01), shivering (P < 0.01) and unpleasant mouth taste (P < 0.01). Sublingual administration of misoprostol is an effective alternative to vaginal administration for medical abortion up to 13 weeks of gestation. The prevalence of prostaglandin-related side effects, however, was higher with this route of administration.

Comparison of misoprostol plasma concentrations following buccal and sublingual administration

Background New indications for misoprostol include medical abortion, cervical softening, induction of labor and treatment of postpartum hemorrhage. Various routes of misoprostol administration under study include oral, vaginal, buccal, sublingual and rectal. Materials and Methods This was an open-label, randomized, cross-over study of the pharmacokinetic differences of buccal vs. sublingual misoprostol 800 μg in 10 healthy women. Results Of the 10 women enrolled, 2 withdrew after experiencing excessive cramping from the sublingual route of misoprostol. The mean misoprostol plasma concentration–time curves at 4 h [area under the curve (AUC) 0–4)] and the maximum concentration ( C max) showed that levels were significantly higher for sublingual administration than the buccal route. Buccal misoprostol administration resulted in fewer symptoms and was found to be more acceptable. Conclusions Sublingual administration of misoprostol had a higher AUC and C max compared with buccal administration. The pharmacokinetics may help to determine the best application of misoprostol depending on the indication.

Medical treatment of missed abortion using misoprostol

Objective: To compare the efficacy of two routes of misoprostol administration (oral and vaginal) for treatment of missed abortion. Methods: Two hundred women with confirmed missed abortion received 800 mcg misoprostol either orally or vaginally. All women returned for follow-up care 2 days later. If the pregnancy was not completely evacuated at this time, women could wait an additional 5 days or undergo immediate surgical completion. Efficacy was defined as the percent of women discharged from the study without need for surgical intervention. Results: Efficacy was high in both groups and not statistically different (oral=89.0%, vaginal=92.9%). While the groups did not differ in terms of the completion rate by day 2 (oral=41.6%, vaginal=52.7%), the mean time to expulsion was longer (21.04 h) in the oral group than the vaginal group (13.47 h), p=0.041. Women in both groups were highly satisfied with the method. Conclusions: Medical management of missed abortion with either oral or vaginal misoprostol is highly effective and highly acceptable.

73. Normalization of rCBF memory activation pattern following treatment with pyrithioxine in SDAT patients

Cervical priming agents mainly prostaglandins in different doses and routes are used during first trimester vaccum aspiration to prevent cervical injury and shorten the abortion procedure. This study was carried out to assess women's acceptability, the efficacy and side effects of oral versus vaginal administration of misoprostol in facilitating cervical dilatation prior to first trimester vaccum aspiration.A randomised control study where 120 women were divided in oral (51) and vaginal (69) group. Each group received 400 mcg of misoprostol either orally or vaginally 04 h prior to first trimester pregnancy termination. Baseline cervical dilatation, women's acceptability and side effects and complications were noted in both the groups.There was no difference between the oral and vaginal misoprostol groups with respect to mean cervical dilatation (5.53 mm vs 5.43 mm; p > 0.05). A total of 88% of women in the oral group expressed satisfaction with the route of misoprostol administration as compared to 74% in the vaginal route. The women in the vaginal group were experienced more preoperative vaginal bleeding (43% vs 25%).Oral administration of misoprostol is an effective alternative to vaginal administration in preinduction cervical ripening prior to first trimester pregnancy termination.