Term Labor Induction Research Articles

The association between the regular use of preventive labour induction and improved term birth outcomes: findings of a systematic review and meta-analysis.

Despite a lack of high-quality evidence, the use of 'non-indicated' term labour induction is increasingly restricted throughout the world. To assess published associations between the regular use of modelled risk-based 'non-indicated' term labour induction (hereinafter 'preventive induction') and rates of common adverse birth outcomes. MEDLINE and PUBMED databases were searched electronically. Studies were identified that compared term birth outcomes following either the current standard approach with its emphasis on the expectant management of intermediate-level risk or the regular use of preventive induction. Four studies from four unique databases were identified. A meta-analysis was performed using STATA IC12. Pregnancies exposed to the regular use of preventive induction (n = 1153), as compared with pregnancies receiving the current standard approach (n = 1865), experienced a lower caesarean delivery rate (5.7% versus 14.4%; relative risk 0.39, 95% CI 0.31-0.50; I(2) P = 0.21), a lower neonatal intensive care unit admission rate (2.9% versus 6.5%; relative risk 0.45, 95% CI 0.31-0.65; I(2) P = 0.57), and a lower weighted adverse outcome index score (2.8 versus 6.1). The regular use of preventive induction, as compared with the current standard approach, was associated with a more favourable pattern of birth outcomes. Other recently published meta-analyses have also determined that certain types of 'non-indicated' labour induction are beneficial. Accordingly, the current broad restrictions on 'non-indicated' labour induction should be reconsidered. Adequately powered multi-site randomised clinical trials are needed to definitively study the risks and benefits of modelled risk-based 'non-indicated' (i.e. 'preventive') term labour induction.

Oxytocin utilization for labor induction in obese and lean women.

To determine if oxytocin dosage used for labor induction differed in obese and lean women, we analyzed records of patients who underwent term labor induction and delivered vaginally. Each of a cohort of 27 patients with a body mass index (BMI) >40 kg/m2 was matched with a patient with a BMI <28 kg/m2 for gestational age, for birth weight, and for cervical dilatation and fetal station at admission. The oxytocin dose administered during first stage labor was calculated for each patient. In addition to the matched characteristics, there was no difference between groups in parity, frequency of diabetes, epidural anesthesia use, or pharmacologic cervical ripening. Oxytocin utilization was significantly greater in obese women than in lean women. The maximum administration rate was 17.7±4.7 and 13.1±5.0 mU/min, respectively (P=0.001). Oxytocin administered per minute during the first stage of labor was greater in the obese group (11.6±4.8 vs. 8.6±4.1 mU/min; P=0.020). Neither active phase duration nor the maximum rate of dilatation differed significantly between the groups. That obese parturients required more oxytocin than lean women during the first stage of successful labor induction could not be explained by group differences in parity, birth weight, dysfunctional labor, pre-induction dilatation and station, or epidural use.

PLD.47 Term Induction of Labour and Delivery Outcomes: Data from an East of England Hospital

BackgroundInduction of labour (IOL) is indicated when the perceived benefits of delivery outweigh the potential risks of continuing the pregnancy. At term, the risk to the fetus is minimal. However,...

Induction of Labor for Term Small-for-Gestational-Age Fetuses

Induction of labor (IOL) when the fetus appears small for gestational age (SGA) toward term may improve perinatal outcomes and prevent fetal death. If these fetuses are small as a variant of the normal spectrum, early induction may not improve outcomes and may cause obstetric complications. This study was undertaken to determine the impact of early IOL on neonatal outcomes and rates of maternal obstetric interventions in SGA term infants. The cohort included all term singleton deliveries and their neonatal outcomes occurring in 2004 to 2008. Maternal and neonatal outcomes of term (37–42 weeks) growth-restricted singleton deliveries were analyzed. Small for gestational age was defined as birth weight lower than the 10th percentile adjusted for gestational age and sex. The exposed group, termed early-induction SGA group, included women giving birth after IOL for suspected intrauterine growth restriction (IUGR) of a singleton SGA neonate at 37 to 39 weeks. The unexposed group, or no-early-induction SGA group, included women giving birth at 40 weeks of gestation or later and those who gave birth spontaneously to term SGA neonates at 37 to 39 weeks. Maternal characteristics, pregnancy and neonatal complications, and obstetric interventions were compared to evaluate benefits/drawbacks of early term IOL for IUGR. Of 37,342 women who had a singleton neonate at 37 weeks of gestation or later, 2378 (6.36%) neonates were born SGA. The early-induction and no-early-induction SGA groups included 445 and 1933 neonates, respectively. Most obstetric complications were similar in the 2 groups. Women in the early-induction group had significantly more hypertensive complications and a higher rate of cesarean deliveries compared with the unexposed group, and only 65.5% reached noninstrumental vaginal delivery (P < 0.0001). Neonatal Apgar scores at 1 and 5 minutes and sex were similar between the 2 groups. Compared with the unexposed group, the early-induction group had higher rates of hyperbilirubinemia necessitating phototherapy (odds ratio [OR], 1.75; 95% confidence interval [CI], 1.21–2.53) and hypoglycemia (OR, 2.38; 95% CI, 1.56–3.62). Two neonates in the early-induction group had respiratory complications. Necrotizing enterocolitis, sepsis, adverse neurologic outcomes, and need for resuscitation were rare and similar in both groups. No neonates died. The risk for any adverse neonatal outcome was ~2 times higher for the early-induction compared with the unexposed group (OR, 1.95; 95% CI, 1.46–2.61; P < 0.0001). The most significant danger in abstaining from IOL for IUGR at term is intrauterine fetal death. Of 37,342 singleton deliveries, 33 fetal deaths occurred at 37 to 42 weeks, 0.88 cases per 1000 live births at term; only 1 was an SGA fetus at 37 weeks. The risk for intrauterine fetal demise at term for non–early-induction SGA was 0.52 cases per 1000 live births, similar to that of the general term population (OR, 0.57; 95% CI, 0.08–3.85; P = 0.99). For suspected IUGR at term, awaiting spontaneous labor risks fetal decompensation, yet active IOL might increase rates of obstetric interventions and neonatal complications of early term delivery. This study found no apparent neonatal benefit for early term IOL for SGA neonates.

305: Timing of term induction of labor among women with chronic hypertension

305: Timing of term induction of labor among women with chronic hypertension

Term induction of labor and subsequent preterm birth

Although the rate of inductions continues to rise, there is a paucity of data investigating subsequent pregnancy outcomes after induction. Our objective was to compare term inductions with term spontaneous labor and evaluate the rate of subsequent spontaneous preterm birth (sPTB). A retrospective cohort study of women with 2 consecutive deliveries from 2005 through 2010 was performed. Term inductions or term spontaneous labor in the index pregnancy was included, and those with a prior sPTB were excluded. Data were obtained through chart abstraction. The primary outcome was sPTB (<37 weeks) in a subsequent pregnancy. Categorical variables were compared with χ(2) analyses, and logistic regression was used to calculate odds. Eight hundred eighty-seven women were included (622 inductions, 265 spontaneous labor). The overall subsequent sPTB rate was 7.2%. Term inductions were less likely to have a subsequent sPTB compared with term spontaneous labor (6% vs 11%; odds ratio [OR], 0.49; 95% confidence interval, 0.29-0.81; P = .005). This remained after adjusting for confounders (adjusted OR, 0.55; P = .04). The sPTB risk depended on gestational age of index delivery. At 37-38.9 weeks, the sPTB rate after spontaneous labor was 24% vs 9% after induction (OR, 3.0; 95% confidence interval, 1.44-6.16; P = .003). This was not significant for 39-39.9 weeks (P = .2) or 40 weeks or longer (P = .8). Induction is not a risk factor for subsequent sPTB. Spontaneous labor, however, in the early term period is associated with subsequent sPTB. Further investigation among early term deliveries is warranted to evaluate the risk of sPTB and target interventions in this cohort.

Induction of labor for term small-for-gestational-age fetuses: what are the consequences?

ObjectiveTo evaluate whether early term labor induction for suspected intrauterine growth restriction (weeks 37–39) improves neonatal outcome for small-for-gestational-age (SGA) neonates. Study designDelivery room data for 2004–2008 from a single tertiary medical center were linked to neonatal discharge data from the same institution. Data were limited to all singleton, liveborn SGA neonates born at 37–42 weeks of gestation and their mothers. Births with known congenital anomalies were excluded. Women undergoing induction of labor for suspected growth restriction between 37 and 39 weeks’ gestation (early induction SGA) were compared with women who gave birth to term SGA neonates without early induction. SGA (<10th percentile for gestational age and gender) was used as a surrogate for intrauterine growth restriction. Associations between early term labor induction and neonatal morbidities were estimated using logistic regression. ResultsA total of 2378 SGA neonates meeting study criteria were identified. Of these, 445 underwent early term induction and 1933 were in the non-early induction SGA group. Intrauterine demise among term (37–42 weeks) SGAs occurred in one case at 37 weeks. Early term induction for SGA was associated with an increased risk of cesarean delivery. Several neonatal complications, including hyperbilirubinemia, hypoglycemia and respiratory complications were more prevalent in the early induction SGA group. The increased odds for neonatal complications persisted after controlling for possible confounders. ConclusionsEarly term induction for SGA fetuses results in an increased risk of cesarean deliveries as well as neonatal metabolic and respiratory complications, with no apparent neonatal benefit.

Term and preterm labor: decreased suppressive activity and changes in composition of the regulatory T‐cell pool

Regulatory T cells (Tregs) exert a key role in tolerance induction to the semi-allogeneic fetus. Currently, it is not known whether immunological rejection processes are involved in the induction of normal term or irresistible preterm labor. In this study, we examined whether there were differences in the percentage of the total CD4(+)CD127(low+/-)CD25(+)FoxP3(+)-Treg-cell pool, its suppressive activity and its composition with distinct Treg subsets (HLA-DR(low+)-, HLA-DR(high+)-, HLA-DR(-)- and naive CD45RA(+)-Tregs) between preterm and term laboring women. We found that its percentage was decreased neither in term nor in preterm laboring women. Its suppressive activity was strongly diminished in preterm laboring women and to a lesser extent in spontaneously term laboring women. During the normal course of pregnancy, its composition changed in such a way that the percentage of naive CD45RA(+)-Tregs increased while the percentage of the highly suppressive HLA-DR(low+)- and HLA-DR(high+)-Tregs decreased significantly until term. With the onset of spontaneous term labor this phenomenon was reversed and reached significant values postpartum. In addition, we confirmed that both the decreased percentage of HLA-DR(+)-Tregs within the total Treg-cell pool and their decreased level of HLA-DR expression (depending on the percentage of HLA-DR(low+)- and HLA-DR(high+)-Tregs) had a reducing effect on the suppressive activity of the total Treg cell pool in preterm laboring women. However, spontaneous term delivery was associated with increasing percentages of HLA-DR(+)-Tregs and increasing HLA-DR expression of this Treg subset. Therefore, it becomes apparent that the mechanisms inducing term or preterm labor may be completely different.

302: Term induction of labor: a possible cause for subsequent preterm birth?

cause for subsequent preterm birth? Lisa D. Levine, Adi Hirshberg, Stacey Hoffman, Michal A. Elovitz, Sindhu K. Srinivas University of Pennsylvania Perelman School of Medicine, Maternal and Child Health Research Program, Department of Obstetrics and Gynecology, Philadelphia, PA, University of Pennsylvania, Clinical Effectiveness and Quality Improvement, Philadelphia, PA OBJECTIVE: It is estimated that 20% of women undergo induction of labor (IOL), and this continues to rise. Simultaneously, the preterm birth (PTB) rate remains largely unchanged. Previously published work from our institution demonstrates the rate of spontaneous PTB (SPTB) in women with a prior term delivery is 5.7%, which is lower than the national average (Edlow et al. AJOG 2007). The objectives of this study were to 1) determine the rate of SPTB in a subsequent pregnancy among women who previously underwent a term IOL and 2) evaluate the association between different methods of term IOL on subsequent SPTB risk. STUDY DESIGN: A retrospective cohort study of women with 2 deliveries (a term IOL and a subsequent delivery) between 2005 & 2010 at the Hospital of the University of Pennsylvania was performed. Maternal medical, obstetrical, and delivery information for both pregnancies were obtained through chart abstraction. The rate of SPTB among pregnancies following term IOL was calculated. Associations between methods of IOL and SPTB rate were calculated using 2analyses or fishers exact tests. RESULTS: The study included 413 women. For method of IOL, 94 (23%) had a cervical foley, 172 (42%) had only prostaglandin, and 147 (36%) had only pitocin. The overall SPTB rate among subsequent pregnancies after term IOL was 7.5%. The rate of SPTB when cervical foley was used vs. medical IOL agents was 9.6% vs. 6.9% (RR 1.39[0.66-2.91], p 0.39). When analyses were restricted to women whose first pregnancy was a term IOL (N 278), the SPTB rate in subsequent pregnancies was 6.5%. Among these women, the SPTB rates were 8.9% vs. 5.5% (RR 1.60[0.64-3.99], p 0.31) for those who had a cervical foley vs. medical IOL agents respectively. CONCLUSION: The observed SPTB rate of 7.5% in women who had a term IOL is higher than the previously published 5.7%. Interestingly, the risk is differentially increased when comparing mechanical vs. medical IOL agents. Further research is needed to evaluate the impact of IOL and methods of IOL on subsequent PTB risk in order to ensure the increasing IOL rate is not causing unnecessary harm.

Cervical ripening with foley balloon plus fixed versus incremental low-dose oxytocin: a randomized controlled trial

Objective: To evaluate cervical ripening with foley balloon combined with a fixed vs. incremental low-dose oxytocin infusion. Methods: Women presenting for term labor induction were randomized to fixed low-dose or standard incremental low-dose oxytocin infusion following foley balloon placement. The primary outcome was time from foley balloon placement to delivery. Results: Among 116 subjects, there was no difference in median time to delivery among subjects receiving fixed low-dose vs. standard incremental low-dose oxytocin during induction of labor with a foley balloon (23.7 vs. 19.2 hours). There were no differences between the two groups in median time to foley bulb extrusion, active labor and second stage of labor or incidence of uterine tachysystole, fetal heart rate abnormalities, mode of delivery or maternal hemorrhage. Conclusions: There is no difference in median time to delivery in women undergoing cervical ripening with a foley balloon combined with a fixed low-dose or standard incremental low-dose oxytocin.

P16.11: Bishop score and transvaginal sonography of cervical length as predictors of successful induction of term labor: the effect of parity

P16.11: Bishop score and transvaginal sonography of cervical length as predictors of successful induction of term labor: the effect of parity

Misoprostol for term labor induction: A randomized controlled trial

Objectives The aim of this study was to compare the efficacy of vaginal misoprostol with vaginal dinoprostone for term labor induction. Material and Methods It was a randomized controlled trial done in the Obstetrics Department, Shifa Community Health Centre, Shifa International Hospital (Teaching Hospital of Shifa College of Medicine, Islamabad). All pregnant women at term pregnancy coming for induction of labor were enrolled. 246 women fulfilled the inclusion criteria. Out of them 208 women consented to be part of the study. These women were then randomized to receive either Treatment A (vaginal misoprostol) or Treatment B (vaginal dinoprostone). Data were completed for 200 women. These included induction labor and induction-delivery interval, fetal and maternal complications, and baby apgar score. Results Out of 200 women in the study, 100 were in Group A and 100 in Group B. Labor commenced in a mean of 6.67 hours (±3.63) in Group A whereas it took a mean of 8.41 hours (±5.13) in Group B ( p = 0.00). Actual induction to delivery (of the baby) interval was a mean of 11.68 hours (±4.55) for misoprostol and 15.37 hours (±5.30) for dinoprostone group ( p = 0.00). There were no cases of uterine rupture in both groups; however, there were 10 cases of uterine hyperstimulation in Group A and 4 in Group B ( p = 0.09). Conclusions It is time to re-evaluate the role of misoprostol for term labor induction. It is an efficacious and cost-effective alternative to the presently licensed treatment.

Term Labor Induction Compared With Expectant Management

Term Labor Induction Compared With Expectant Management

Term Labor Induction Compared With Expectant Management

To determine whether changing the definition of the group to which induction is being compared (ie, noninduced delivering during the same week as those induced compared with two definitions of expectant management) changes the association of labor induction and increased cesarean risk. A New York State birth-certificate database was used to estimate odds ratios for cesarean delivery associated with labor induction at term. The analyses used three definitions of controls: cesarean delivery after induction compared with after spontaneous labor by week (week-to-week), induction at a given gestation age compared with expectant management of all other women after gestational age (all above), or induction at a given gestational age compared with expectant management of all other women at or after that gestational age (at or above). Chi-square logistic regression was used for comparisons and adjustment for possible confounders. All variations of comparison groups were associated with increased unadjusted cesarean risk after induction, although not after 39 weeks in the all-above group. After adjustment, increased risk persisted from 37 to 41 weeks using the week-to-week group and from 38 to 41 weeks in the at-or-above group (odds ratios 1.24 to 1.45) but was no longer significant in the all-above group. The excess cesarean delivery risk associated with labor induction is between 1 and 2 per 25 inductions. Labor induction is associated with increased cesarean risk whether using a week-to-week comparison group or an expectant group that includes women the same week or beyond that of the index induction, even after adjustment for parity, high-risk factors, and demographic variables. Although the magnitude of increased risk for a given woman undergoing induction is not large, women nonetheless should be informed of this increased risk. II.

Antepartum Bleeding of Unknown Origin in the Second Half of Pregnancy and Pregnancy Outcomes

Objective The purpose of our investigation was to evaluate factor(s) associated with unexplained antepartum bleeding of unknown origin (ABUO) after 24 weeks of pregnancy and correlate unexplained haemorrhage with maternal and perinatal outcomes. Design This is a retrospective observational study. Setting King Edward Memorial Hospital (KEMH), Subiaco, Western Australia. Population Singleton pregnancies delivering at KEMH between January 1998 and December 2004. Methods ABUO was defined as bleeding after 20 weeks of gestation but before the onset of labour with no cause detected on vaginal examination or abdominal ultrasound. Outcomes of these pregnancies were collated and compared with those of pregnancies without ABUO. Main outcome measures Antepartum complications assessed included pre-eclampsia/eclampsia, gestational diabetes and preterm birth. Intrapartum evaluations included labour inductions, mode of delivery and gestational age at delivery. Neonatal outcomes evaluated included birthweight, Apgar scores, newborn intensive care unit (NICU) admission, neonatal complications and risk of perinatal/neonatal death. Results Between January 1998 and December 2004, there were 26 583 deliveries without ABUO and 1431 with ABUO. Multivariable analyses of the ABUO effects revealed that ABUO was a simultaneously significant risk factor for term labour inductions (OR = 2.00, 95% CI: 1.72–2.32, P < 0.001), preterm delivery (OR = 4.31, 95% CI: 3.84–4.84, P < 0.001), NICU admission (OR = 1.23, 95% CI: 1.01–1.51, P = 0.042), hyperbilirubinaemia (OR = 1.29, 95% CI: 1.01–1.63, P = 0.041) and reduced birthweight (26 g, 95% CI: 3–50, P = 0.026). Conclusion Women with ABUO are at greater risk of preterm delivery, term labour induction and their neonates are at greater risk for NICU admissions, hyperbilirubinaemia and a reduced birthweight.

Cervicovaginal matrix metalloproteinase-9 and cervical ripening in human term parturition

Objective To investigate the changes of matrix metalloproteinase-9 (MMP-9) in cervicovaginal fluid during pregnancy and its association with parturition. Study design A prospective study was conducted on nulliparous women between 16 and 42 weeks with normal singleton pregnancies in the following categories: (1) preterm control ( n = 39); (2) term labor induction without labor or rupture of membranes ( n = 68); (3) term spontaneous labor with intact membranes ( n = 42); (4) term premature rupture of membranes ( n = 24). The MMP-9 concentration in the cervicovaginal fluid was measured by immunoassay. Results (1) Cervicovaginal MMP-9 did not change significantly with advancing gestation until 37 weeks, and significantly increased after 37 weeks. (2) Cervicovaginal MMP-9 levels were similar in women with no labor, spontaneous labor, and premature rupture of membranes at term. (3) For the induced labor group, a high Bishop score (≥4) was significantly correlated with cervicovaginal MMP-9. However, an elevated cervicovaginal MMP-9 did not predict achieving active phase of labor or vaginal delivery after labor induction. Conclusion Cervicovaginal MMP-9 correlated with cervical ripening before labor at term. However, cervicovaginal MMP-9 did not change with spontaneous labor or rupture of membranes at term and did not predict success of labor induction.

Antepartum bleeding of unknown origin in the second half of pregnancy and pregnancy outcomes

The purpose of our investigation was to evaluate factor(s) associated with unexplained antepartum bleeding of unknown origin (ABUO) after 24 weeks of pregnancy and correlate unexplained haemorrhage with maternal and perinatal outcomes. This is a retrospective observational study. King Edward Memorial Hospital (KEMH), Subiaco, Western Australia. Singleton pregnancies delivering at KEMH between January 1998 and December 2004. ABUO was defined as bleeding after 20 weeks of gestation but before the onset of labour with no cause detected on vaginal examination or abdominal ultrasound. Outcomes of these pregnancies were collated and compared with those of pregnancies without ABUO. Antepartum complications assessed included pre-eclampsia/eclampsia, gestational diabetes and preterm birth. Intrapartum evaluations included labour inductions, mode of delivery and gestational age at delivery. Neonatal outcomes evaluated included birthweight, Apgar scores, newborn intensive care unit (NICU) admission, neonatal complications and risk of perinatal/neonatal death. Between January 1998 and December 2004, there were 26 583 deliveries without ABUO and 1431 with ABUO. Multivariable analyses of the ABUO effects revealed that ABUO was a simultaneously significant risk factor for term labour inductions (OR = 2.00, 95% CI: 1.72-2.32, P < 0.001), preterm delivery (OR = 4.31, 95% CI: 3.84-4.84, P < 0.001), NICU admission (OR = 1.23, 95% CI: 1.01-1.51, P = 0.042), hyperbilirubinaemia (OR = 1.29, 95% CI: 1.01-1.63, P = 0.041) and reduced birthweight (26 g, 95% CI: 3-50, P = 0.026). Women with ABUO are at greater risk of preterm delivery, term labour induction and their neonates are at greater risk for NICU admissions, hyperbilirubinaemia and a reduced birthweight.

Trends in twin neonatal mortality rates in the United States, 1989 through 1999: influence of birth registration and obstetric intervention

Objective We sought to evaluate the contributions of changes in birth registration, labor induction, and cesarean delivery on trends in twin neonatal mortality rates. Study design We conducted a population-based, retrospective cohort study of twin live births, using linked birth-infant death data in the United States (1989-1999). Relative risks and 95% confidence intervals that quantified changes in neonatal (0-27 days) mortality rates were derived from ecologic logistic regression models that were fit after aggregation of the data by each state in the United States. Results The frequency of live born twins who weighed <500 g increased 72%, from 0.7% in 1989 to 1.2% in 1999, of live born twins who weighed 500 to 749 g and 750 to 999 g increased by 55% and 28%, respectively, between 1989 and 1999. Preterm birth rates increased by 19%, from 46.2% in 1989 to 57.2% in 1999. The rate of labor induction increased from 5.8% to 13.9%, and the cesarean delivery rate increased from 49.8% to 56.3%. Between 1989 to 1991 and 1997 to 1999, the crude neonatal mortality rates among twins who weighed ≥500 g declined by 37% (95% CI, 35%-40%) from 21.5 to 13.6 per 1000 twin live births. Adjustments for preterm labor induction, preterm cesarean delivery, term labor induction, term cesarean delivery, and sociodemographic factors had little influence on neonatal mortality rate trends. Conclusion Increases in preterm birth because of obstetric intervention among twins have not led to increases in twin neonatal mortality rates in the United States.

Sublingual compared with oral misoprostol in term labour induction: a randomised controlled trial

Objective To compare the efficacy and patient acceptability of 50 μg of sublingual misoprostol with 100 μg of oral misoprostol in the induction of labour at term. Design Non-blinded randomised comparative trial. Setting Tertiary level UK Hospital. Sample Two hundred and fifty women at term with indications for labour induction. Methods Fifty micrograms of sublingual misoprostol or 100 μg of oral misoprostol was administered every four hours after random allocation, to a maximum of five doses. Main outcome measures Number of patients delivering vaginally within 24 hours of the induction, mode of delivery, neonatal outcomes and patient acceptability. Results There was no significant difference in the number of women delivering vaginally within 24 hours of the induction in the sublingual group as compared with the oral group (62.8% vs 59%, RR 1.1, 95% CI 0.6–2.1), or in the mean induction to delivery time (21.8 vs 24.1 h, mean difference 2.3 h 95% CI −2.2 to +6.7). There was no difference in the uterine hyperstimulation rates (1.6% in both groups), operative delivery rates or neonatal outcomes. In the sublingual group, 92.6% found the induction acceptable with 15.8% finding the tablets with an unpleasant taste, while in the oral group it was 96.9% and 4%, respectively. More patients in the oral group thought that they would consider the same method of induction again as compared with the sublingual group (58.6% vs 40%, RR 1.4, 95% CI 1.04–1.9). Conclusion Fifty micrograms of sublingual misoprostol every four hours has the same efficacy and safety profile as compared with 100 μg orally, but the oral route might be preferred by women.

Sublingual compared with oral misoprostol in term labour induction: a randomised controlled trial

To compare the efficacy and patient acceptability of 50 microg of sublingual misoprostol with 100 microg of oral misoprostol in the induction of labour at term. Non-blinded randomised comparative trial. Tertiary level UK Hospital. Two hundred and fifty women at term with indications for labour induction. Fifty micrograms of sublingual misoprostol or 100 microg of oral misoprostol was administered every four hours after random allocation, to a maximum of five doses. Number of patients delivering vaginally within 24 hours of the induction, mode of delivery, neonatal outcomes and patient acceptability. There was no significant difference in the number of women delivering vaginally within 24 hours of the induction in the sublingual group as compared with the oral group (62.8% vs 59%, RR 1.1, 95% CI 0.6-2.1), or in the mean induction to delivery time (21.8 vs 24.1 h, mean difference 2.3 h 95% CI -2.2 to +6.7). There was no difference in the uterine hyperstimulation rates (1.6% in both groups), operative delivery rates or neonatal outcomes. In the sublingual group, 92.6% found the induction acceptable with 15.8% finding the tablets with an unpleasant taste, while in the oral group it was 96.9% and 4%, respectively. More patients in the oral group thought that they would consider the same method of induction again as compared with the sublingual group (58.6% vs 40%, RR 1.4, 95% CI 1.04-1.9). Fifty micrograms of sublingual misoprostol every four hours has the same efficacy and safety profile as compared with 100 microg orally, but the oral route might be preferred by women.