Vaginal Misoprostol For Labor Induction Research Articles

Comparing Sublingual and Vaginal Misoprostol for Labor Induction in Full-term Pregnant Women: A Comprehensive Review

Comparing Sublingual and Vaginal Misoprostol for Labor Induction in Full-term Pregnant Women: A Comprehensive Review

Simultaneous use of high-volume Foley catheter (60ml) and misoprostol for labor induction in nulliparous women: Arandomized controlled trial.

To examine the simultaneous effect of high-volume Foley catheter (HVFC) (60ml) and vaginal misoprostol on labor induction in nulliparous women. A randomized, double-blind, controlled trial was conducted among nulliparous post-date (>40weeks) pregnant women between June and December 2019. At enrollment 100 women were randomized into each group (either HVFC and vaginal misoprostol or low-volume Foley catheter [LVFC] [30ml] and vaginal misoprostol), for labor induction. Demographic and clinical data were collected at enrollment and delivery. Women in the HVFC group had statistically significantly shorter induction to delivery interval (median 860min, interquartile range [IQR] 840-940min vs. 1160min, IQR 1080-1320min, P<0.001) and duration of labor (median 615min, IQR 600-680min vs. 750, IQR 692.5-800min, P<0.001). Mode of vaginal delivery (n=94 vs. n=78, P=0.002), number of doses of misoprostol required (median 2, IQR 1-2 vs. 2, IQR 1-3), and need of oxytocin augmentation (n=22 vs. n=39, P=0.014 and P<0.001), was significantly better in the HVFC group. However, there was no significant difference with respect to other maternal or neonatal outcomes. Simultaneous use of HVFC and vaginal misoprostol for labor induction significantly shortens the induction to delivery interval and duration of labor in nulliparous women. Clinical Trial Registry of India CTRI/2019/05/019394 (http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=31554&EncHid=&userName=Foley%20catheter).

52 Vaginal isosorbide mononitrate for labor induction in pregnancies complicated by hypertensive diseases of pregnancy

Pregnancies with hypertensive diseases of pregnancy (HDP) often require induction of labor to minimize maternal and fetal risks. There is no superior method of labor induction and rates of cesarean delivery (CD) range from 15-60% in this population. Nitric oxide donors decrease maternal blood pressure and soften the cervix without inducing uterine contractions. We hypothesized that addition of vaginal isosorbide mononitrate (IMN) to vaginal misoprostol for labor induction may decrease the rate of CD and need for intrapartum emergent antihypertensive therapy in pregnancies complicated by HDP. This was a double-blind, placebo-controlled, randomized trial of women with singleton pregnancy ≥24 weeks gestation with an induction of labor for HDP between 11/2017-2/2020. Participants were eligible if Bishop score less than 6 and cervical dilation ≤2cm. They received up to 3 doses of 40mg IMN and 25mcg vaginal misoprostol in addition to standard interventions for induction - foley and oxytocin. Primary outcome was rate of cesarean delivery. Secondary outcomes included indication for CD, length of labor, use of intrapartum emergent antihypertensives, and maternal and neonatal morbidities. A sample size of 176 women was needed to detect at least a 20% difference in the primary outcome (Power 0.8). 89 women were randomized to the IMN group and 87 to the placebo group. GA at delivery were similar between groups (37 [34-38] vs 37 [35-38]). CD rates were similar with between both (32.6% vs 25.3%; RR, 1.29; 95% CI, 0.81 to 2.06; P=0.39). Neither length of labor nor use of intrapartum emergent antihypertensives was significantly different. Maternal headache was more common in IMN group than placebo group (47.2% vs 27.0%; RR, 1.52; 95% CI, 1.04 to 2.23; P=0.04), whereas clinical chorioamnionitis was less common in the IMN group (0% vs 8%; P=0.02). Adding vaginal IMN to vaginal misoprostol for labor induction in pregnancies complicated by HDP did not result in fewer CD.

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

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

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

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

Titrated oral misoprostol solution versus vaginal misoprostol for labor induction in primi gravid ladies

Abstract Background It is now generally accepted that the uterine cervix plays an important role during pregnancy and labor and that it depends on an active ripening process within the cervix; which is necessary for successful labor induction. Aim of the Work to test the safety and efficacy of titrated oral misoprostol compared to vaginal misoprostol for labor induction in term gravid ladies. Patients and Methods This prospective, single-blinded randomized controlled clinical trial was conducted at Ain-Shams University Maternity Hospital during the period between August 2017 and August 2018. 120 pregnant women planned for induction of labor were recruited in the study according to the inclusion / exclusion criteria. Subjects included in the study were randomized into two groups: patients who received oral 200 ug misoprostol in 200 ml water titrated over 24 hours and placebo tablets vaginally which resemble vagiprost tablets (25 microgram misoprostol) and the second group contained pients who received vaginal misoprostol 25microg maximum four doses, and placebo solution of 200 ml of tap water. Results titrated oral misoprostol is as effective in promoting cervical ripening and inducing labor as intravaginal misoprostol, oral Misoprostol has a similar maternal and perinatal safety profile to vaginal misoprostol. Conclusion This new approach to oral misoprostol administration was successful in minimizing the risk of uterine hyper-stimulation, which has been a feature of misoprostol use for induction of labor, at the expense of a somewhat slower response. Oral Misoprostol has a similar maternal and perinatal safety profile compared to vaginal misoprostol.

Randomized Double-Blinded Comparison of Titrated Oral Versus Vaginal Misoprostol for Labor Induction [24N

INTRODUCTION: For labor induction of an unfavorable cervix, we propose oral misoprostol, titrated to uterine response, to maximize safety and efficacy, based upon past studies. METHODS: Randomized double-blinded study. Identically appearing oral and vaginal study dosages were prepared containing either 25mcg misoprostol or placebo. The pharmacist randomized the study participants to receive either an “oral packet” (oral misoprostol, vaginal placebo) or a “vaginal packet” (opposite). Patients received both an oral protocol (quantity of capsules titrated to uterine contractions, every 2hrs) and vaginal protocol (25mcg/placebo every 4hrs) simultaneously. Providers and patients were blinded. RESULTS: Un-blinding revealed 28 oral and 22 vaginal participants, with four oral, and five vaginal participants removed (imperfect consent forms, missing data). Confounding variables had no statistical significance. Primary outcomes: 1) Time to Bishop Score &gt; 7: Titrated oral route was 9.94 hours (Standard Deviation 5.149, 95%CI 6.82-13.05). Vaginal route was 6.59 hours (SD 1.826, 95%CI 5.06-8.11). 2) Time to NSVD: Titrated oral route was 15.52 hours (SD 5.862, 95%CI 11.98-19.06). Vaginal route was 12.74 hours (SD 4.790, 95%CI 8.74-16.74). 3) Change in Bishop score: Titrated oral route was 3.39; Vaginal route was 5.25. Several safety parameters and side effects were evaluated, showing a trend towards the oral route being safer. Approximately 25% of the oral route participants reached the maximum oral dose of 75 mcg, and none needed dosage reduction. Approximately 80% of all participants preferred oral administration because they disliked vaginal placement, while 20% preferred the vaginal administration because it “worked better” and they “dislike pills.” CONCLUSION: Results suggest our oral titrated protocol has less efficacy and side effects, although numbers didn’t reach statistical significance. Patients had strong preferences for the oral route. There is potential for future studies based upon our study. With a thorough review of recent studies, we can redesign our study in many ways, including a higher dose of oral misoprostol.

Neonatal outcome with 0ral versus Vaginal Misoprostol for Labour Induction

Background : Misoprostol is being used widely through different routes for induction of labour. Neonatal outcome may be different with using different routes.Objective : To see the neonatal outcome for induction of labour by misoprostol in oral versus vaginal route.Materials and Methods : This prospective and comparative study was carried out in the dept. of Obstetrics and Gynecology of Jalalabad Ragib- Rabeya Medical College and Hospital, Sylhetfrom July 2008 to June 2009.A total 200 pregnant women completed 28 weeks pregnancy upto 42 weeks were selected for the study.Out of which 100 pregnant women were includedin oral misoprostol group and 100 in vaginal misoprostol groupby simple randomization. Inclusion criteria were single live fetus with cephalic presentation, normal fetal heart rate, adequate pelvis and Bishop score &lt;5. Exclusion criteria were previous uterine scar, estimated fetal weight &gt;4 kg, parity more than 3 and history of hypersensitivity to misoprostol. Neonatal outcome in terms of Apgar Score, passage of meconium, perinatal depression and admission to Neonatal Intensive Care Unit (NICU) compared between two groups.Results : Most of the neonate in vaginal group had low Apgar score. Two percent neonate had Apgar score 2 and 86% had 4-6 in 1 minute in vaginal group whereas in oral group it was 4-6 in 88%.Perinatal depression more in vaginal group 18(18%) than oral group 8(8%). More neonate need admission to Neonatal Intensive Care Unit (NICU) in vaginal group 4(4%) than oral group 2(2%). Only 1% neonate passed meconium in vaginal group.Conclusion : This study concluded that neonatal outcome was better and safe with oral misoprostol than vaginal route.Northern International Medical College Journal Vol.8(2) January 2017: 228-230

Titrated oral misoprostol as a safe route for induction of labour at term (a clinical trial)

Objective:To assess safety and efficacy of induction of labour at term by low doses of oral misoprostol in the form of titration versus the standard regimen of vaginal misoprostol in the term of induction delivery interval, operative interventions and fetal outcome. Methods:Clinical comparative study was carried out for a period of one year from November 2008 to October 2009 at Zagazig university hospital. The study protocol was approved by the ethics committee of our hospital. One hundred women at term with indication of labour and Bishop score less than or equal 5, no either Obstetric or maternal contraindications for induction of labour were randomly assigned to receive oral (titrated) or vaginal misoprostol for induction of labour. The oral group received a basal of 20ml misoprostol solution (1mcg/ml) every hour for four doses and then were titrated according uterine response individually, the vaginal group received 25 mcg every 4 hours(maximum number of doses limited to six) until cervix became more favorable. The induction delivery interval, oxytocin need, mode of delivery, frequency of side effects and neonatal and maternal outcome were assessed. Chi-square or Fisher exact test, Student's T-test and Wilcoxon rank sum test were used for analysis the data statistically. Results:The oral misoprostol group had 50 women (50%) and was given it in the form of titrated oral solution and vaginal misoprostol group had 50 women (50%). Vaginal delivery occurred within 12 hours in 38 women (76%) in oral group and in 12 women (24%) in vaginal group. The median interval from starting induction by misoprostol to vaginal delivery was significantly shorter in oral titrated misoprostol group (7.5 h) compared with vaginal misoprostol group (16.1h) with P value <0.01.The incidence of hyper-stimulation in oral group was 0.0% compared with 12% in vaginal group with P value <0.01 which is significantly different. More women had nausea 8% in oral group but fewer infants had Apgar score less than 7 at 1 minute in oral group than in vaginal group. Conclusion:Oral misoprostol in the form of titration is associated with lower incidence of uterine hyper-stimulation and lower cesarean delivery rate, better fetal outcome than vaginal misoprostol for labour induction at term in patients with unripe cervix.

Foley Catheter versus Vaginal Misoprostol for Labour Induction.

Objectives. To compare the efficacy and safety of intravaginal misoprostol with transcervical Foley catheter for labour induction. Material and Methods. One hundred and four women with term gestation, with Bishop score < 4, and with various indications for labour induction were randomly divided into two groups. In Group I, 25 μg of misoprostol tablet was placed intravaginally, 4 hourly up to maximum 6 doses. In Group II, Foley catheter 16F was placed through the internal os of the cervix under aseptic condition and then inflated with 50 cc of sterile saline. Statistical analysis was done using SPSS software. Results. The induction to delivery interval was 14.03 ± 7.61 hours versus 18.40 ± 8.02 hours (p < 0.01). The rate of vaginal delivery was 76.7% versus 56.8% in misoprostol and transcervical Foley catheter group, respectively. Uterine hyperstimulation was more common with misoprostol. Neonatal outcome was similar in both the groups. Conclusion. Intravaginal misoprostol is associated with a shorter induction to delivery interval as compared to Foley's catheter and it increases the rate of vaginal delivery in cases of unripe cervix at term. Transcervical Foley catheter is associated with a lower incidence of uterine hyperstimulation during labour.

Comparison of the efficacy and safety of sublingual misoprostol with that of vaginal misoprostol for labour induction at term

Objective To compare the efficacy and safety of 50 mcg of sublingual misoprostol with 25 mcg of vaginal misoprostol for induction of labour at term. Method Non blinded randomized prospective control study. 200 women with singleton term pregnancy, admitted for induction of labour, were randomized to receive either 25 mcg of vaginal misoprostol or 50 mcg of sublingual misoprostol. Outcome measures compared were the number of vaginal deliveries, induction-delivery interval, caesarean section for foetal distress, oxytocin for acceleration, number of doses required, side effects and neonatal outcome. Result Mean dose was smaller and induction to delivery interval was significantly shorter in the sublingual group (13.1 ± 4.1 h) compared with the vaginal group (17.9 ± 5.4 h), p value 0.001. There were no statistically significant differences in the other secondary outcome measures. Conclusion 50 mcg of sublingual misoprostol was more effective than and as safe as 25 mcg vaginal misoprostol for labour induction at term.

Sublingual versus vaginal misoprostol for labor induction at term: a prospective randomized trial

Sublingual versus vaginal misoprostol for labor induction at term: a prospective randomized trial

Early amniotomy after vaginal misoprostol for induction of labor: a randomized clinical trial

To test the effectiveness and safety of early amniotomy after vaginal misoprostol for the induction of labor. A randomized clinical trial that included 320 women with medical or obstetric indication for labor induction. They were randomly assigned into two equal groups, amniotomy group and control group. Each participant received vaginal misoprostol 50 μg every 6 h for induction of labor. In amniotomy group, amniotomy was done in the early active phase of labor while in the control group, the membranes were left to rupture spontaneously or as judged by the senior resident in the duty. More subjects in the amniotomy group achieved vaginal delivery within 24 h than in the control group [117 (73.13 %) vs. 105 (65.63 %)]. Subjects in the amniotomy group reported shorter induction to delivery interval (09.72 ± 4.61 h vs. 13.61 ± 5.61, P = .002), and better neonatal outcome compared to the control group. There were no statistically significant differences between both group with regard to number of doses of misoprostol, need for oxytocin, Cesarean Section indication and maternal side effects. Early amniotomy after vaginal misoprostol for labor induction is associated with higher successful vaginal delivery rate, shorter labor duration and better neonatal outcome.

Sublingual vs Vaginal Misoprostol for Labor Induction

ABSTRACT Background This study is a randomized controlled trial comparing the efficacy and safety of sublingual vs vaginal misoprostol for induction of labor. Materials and methods A total of 160 women admitted for induction of labor at the PGIMER, Chandigarh, India were randomized to receive 25 μg of vaginal or sublingual misoprostol for labor induction. The two groups were compared for mode of delivery, induction delivery interval, misoprostol dose required, uterine contraction abnormalities and neonatal outcomes. Results Majority of women in both groups delivered vaginally (91 and 89% in vaginal and sublingual misoprostol groups respectively). Mean number of doses of misoprostol required for induction of labor was similar in vaginal misoprostol group and sublingual misoprostol group (1.81 ± 0.84 vs 2.05 ± 0.98). The occurrence of uterine contraction abnormalities and neonatal outcome was similar in both groups. Conclusion The low dose of 25 μg is equally efficacious and safe by both vaginal and sublingual routes. How to cite this article Siwatch S, Kalra J, Bagga R, Jain V. Sublingual vs Vaginal Misoprostol for Labor Induction. J Postgrad Med Edu Res 2012;46(3):138-143.

Titrated Oral Compared With Vaginal Misoprostol for Labor Induction: a Randomized Controlled Trial

Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon Financial Disclosure The authors have no potential conflicts of interest to disclose.

Titrated Oral Compared With Vaginal Misoprostol for Labor Induction: a Randomized Controlled Trial

Department of Obstetrics and Gynecology, China Medical University Beigang Hospital, Beigang, Yun Lin, Taiwan, Republic of China

Titrated Oral Compared With Vaginal Misoprostol for Labor Induction

To compare the efficacy and safety of titrated oral misoprostol and vaginal misoprostol for labor induction. Women between 34 and 42 weeks of gestation with an unfavorable cervix (Bishop score less than or equal to 6) and an indication for labor induction were randomLy assigned to receive titrated oral or vaginal misoprostol. The titrated oral misoprostol group received a basal unit of 20 mL misoprostol solution (1 mcg/mL) every 1 hour for four doses and then were titrated against individual uterine response. The vaginal group received 25 mcg every 4 hours until attaining a more favorable cervix. Vaginal delivery within 12 hours was the primary outcome. The data were analyzed by intention-to-treat. Titrated oral misoprostol was given to 101 (48.8%) women and vaginal misoprostol to 106 (51.2%) women. Completed vaginal delivery occurred within 12 hours in 75 (74.3%) women in the titrated oral group and 27 (25.5%) women in the vaginal group (relative risk [RR] 8.44, 95% confidence interval [CI] 4.52-15.76). The incidence of hyperstimulation was 0.0% in the titrated oral group compared with 11.3% in the vaginal group (RR 0.08, 95% CI 0.01-0.61). Although more women experienced nausea (10.9%) in the titrated oral group (RR 27.07, 95% CI 1.57-465.70), fewer infants had Apgar scores of less than 7 at 1 minute in the titrated oral group than in the vaginal group (RR 0.10, 95% CI 0.01-0.76). Titrated oral misoprostol is associated with a lower incidence of uterine hyperstimulation and a lower cesarean delivery rate than vaginal misoprostol for labor induction in patients with unfavorable cervix. ClinicalTrials.gov, www.clinicaltrials.gov, NCT00529295 I.

Sublingual compared with oral and vaginal misoprostol for labor induction

Misoprostol is a synthetic prostaglandin E1 analogue that has been found to be as effective as dinoprostone and oxytocin in inducing labor. Different routes of administration of misoprostol have been tried effectively and recently the sublingual and vaginal routes of administration were compared. However more research is needed in this area. An open randomized controlled clinical trial was conducted at the labor ward of Wad Medani Hospital Sudan to test the outcome of induction of labor using misoprostol administered via different routes. The study received ethical clearance from the Ethical Board of The University of Geizera Sudan. The women admitted from February through November 2006 to the labor ward were asked to participate in the study if they had a singleton pregnancy and a live fetus but an unfavorable cervix (Bishop score 6). The women were assigned toreceive 50 µg of misoprostol orally vaginally or sublingually. Outcome measures were induction to delivery time cesarean section rate Apgar score at 1 min presence of meconium-stained liquor and referral of the newborn to the pediatrician. (excerpt)

Sublingual compared with vaginal misoprostol for labour induction at term: a randomised controlled trial

To compare the efficacy and safety of 50 microg of sublingual misoprostol with 25 microg of vaginal misoprostol administered for labour induction at term. Design Double-blinded, randomised controlled trial. Setting University Hospital, Kaunas, Lithuania. Sample A total of 140 women at term with indications for labour induction. Methods Women were randomised to receive either 50 microg of sublingual misoprostol with vaginal placebo (n = 70) or sublingual placebo with 25 microg of vaginal misoprostol (n = 70) every 4 hours (maximum six doses). Main outcome measures The number of women delivering vaginally within 24 hours of labour induction. Results Fifty-eight women (83%) in the sublingual misoprostol group and 53 (76%) in the vaginal misoprostol group delivered vaginally within 24 hours [relative risk (RR) 1.1, 95% confidential interval (CI) 0.9-1.3]. However, the induction to vaginal delivery time was significantly shorter in the sublingual group (15.0 +/- 3.7 hours) compared with the vaginal group (16.7 +/- 4.1 hours, P = 0.03). The incidence of tachysystole was more than three-fold higher in the sublingual than in the vaginal group (14 versus 4.3%; RR 3.3, 95% CI 0.9-11.6), but this was not statistically significant. There were no significant differences in the incidence of hypertonus or hyperstimulation syndrome, mode of delivery, interventions for fetal distress or neonatal outcomes between the two groups. Conclusion A 50 microg of sublingual misoprostol 4 hourly for labour induction at term seems to have similar efficacy as 25 microg of vaginal misoprostol. Further studies on safety with larger numbers of women need to be conducted before routine sublingual misoprostol use in this setting.

Prediction of Adverse Outcome Associated With Vaginal Misoprostol for Labor Induction

Obstetrical & Gynecological Survey: April 2004 - Volume 59 - Issue 4 - p 247-248 doi: 10.1097/01.OGX.0000119176.81707.2D