Evaluation of vaginal and sublingual routes of misoprostol in induction of labor

Authors

  • Ishita Mehra Department of Obstetrics and Gynecology, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India
  • Namita Agarwal Department of Obstetrics and Gynecology, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India
  • Jyoti Baghel Department of Obstetrics and Gynecology, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India
  • Shubhangi Gupta Department of Obstetrics and Gynecology, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India
  • Shashi Bala Arya Department of Obstetrics and Gynecology, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20252729

Keywords:

Misoprostol, Induction of labor, Maternal complications, Perinatal complications, Sublingual, Vaginal

Abstract

Background: Labor induction is used to initiate uterine contractions. Various misoprostol administration routes demonstrate differing pharmacokinetics and efficacy. Optimal route is selected considering factors like onset of action, side effects, patient comfort, and neonatal outcomes. Objectives were to study the response of sublingual and vaginal routes of misoprostol for induction of labor and compare both the routes for induction of labor.

Methods: A randomized prospective study was conducted from May 2023 to October 2024 at Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, UP. Participants were assigned to either sublingual or vaginal misoprostol (25 mcg every 4 hours, up to five doses), stopped at 4 cm dilation or if adverse effects occurred. Oxytocin was given if needed. Labor progress, induction-to-delivery time, doses, patient preference, and side effects were recorded.

Results: The present study on labor induction with sublingual and vaginal misoprostol showed no significant differences in demographic factors, gravidity, parity, or gestational period between the groups. Bishop scores improved significantly after three doses of misoprostol. The sublingual group had a shorter labor duration and required fewer doses, supporting its quicker induction efficiency. No significant differences were found in adverse effects, mode of delivery, failure rates, or neonatal outcomes but individualized care is essential.

Conclusions: This study highlighted that both sublingual and vaginal misoprostol are effective for labor induction, with sublingual route offering faster results but higher risks, suggesting that the choice of route should be based on patient-specific factors.

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References

Cunningham FG, Leveno KJ, Bloom SL, Dashe JS, Hoffman BL, Casey BM, et al. Williams Obstetrics. 23rd ed. New York: McGraw-Hill; 2010.

Ramos SL. Induction of labor. Obstet Gynecol Clin North Am. 2005;32:181-200. DOI: https://doi.org/10.1016/j.ogc.2004.12.004

World Health Organization (WHO). Recommendations for induction of labor. Geneva: WHO; 2011.

Margulies M, Campos PG, Voto LS. Misoprostol to induce labor. Lancet. 1992;339:64. DOI: https://doi.org/10.1016/0140-6736(92)90194-8

American College of Obstetricians and Gynecologists (ACOG). Committee opinion on misoprostol use. Washington (DC): ACOG; 2000.

Tang OS, Schweer H, Seyberth HW, Lee SW, Ho PC. Pharmacokinetics of different routes of administration of misoprostol. Hum Reprod. 2002;17(2):332-6. DOI: https://doi.org/10.1093/humrep/17.2.332

Milani F, Sharami SH, Arjmandi S. Comparison of sublingual and vaginal misoprostol for pregnancy terminations. J Fam Reprod Health. 2014;8(1):41-4.

Von Hertzen H, Piaggio G, Wojdyla D, Huong NT, Marions L, Okoev G, et al. Comparison of vaginal and sublingual misoprostol for second trimester abortion: randomized controlled equivalence trial. Hum Reprod. 2009;24(1):106-12. DOI: https://doi.org/10.1093/humrep/den328

Leduc D, Biringer A, Lee L, Dy J, Leduc D. Induction of labour. J Obstet Gynaecol Can. 2013;35(9):840-57. DOI: https://doi.org/10.1016/S1701-2163(15)30842-2

Souza AS, Amorim MM, Feitosa FE. Comparison of sublingual versus vaginal misoprostol for the induction of labour: a systematic review. BJOG. 2008;115:1340-9. DOI: https://doi.org/10.1111/j.1471-0528.2008.01872.x

Feitosa FE, Sampaio ZS, Alencar Jr CA, Amorim MM, Passini Jr R. Sublingual versus vaginal misoprostol for induction of labor. Int J Gynecol Obstet. 2006;94(2):91-5. DOI: https://doi.org/10.1016/j.ijgo.2006.04.031

Zahran KM, Shahin AY, Abdellah MS. Sublingual versus vaginal misoprostol for induction of labor at term: a randomized prospective placebo-controlled study. J Obstet Gynaecol Res. 2009;35(6):1054-60. DOI: https://doi.org/10.1111/j.1447-0756.2009.01030.x

Wolf SB, Sanchez-Ramos L, Kaunitz AM. Sublingual misoprostol for labor induction: a randomized clinical trial. Obstet Gynecol. 2005;105(2):365-71. DOI: https://doi.org/10.1097/01.AOG.0000151992.75614.8d

Hofmeyr GJ, Gülmezoglu AM, Pileggi C. Vaginal misoprostol for cervical ripening and induction of labour. Cochrane Database Syst Rev. 2010;2010(10):941.

Alfirevic Z, Aflaifel N, Weeks A, Cochrane Pregnancy and Childbirth Group. Oral misoprostol for induction of labour. Cochrane Database Syst Rev. 2014;2014(6):1338. DOI: https://doi.org/10.1002/14651858.CD001338.pub3

Kerr RS, Kumar N, Williams MJ, Cuthbert A, Aflaifel N, Haas DM, et al. Low-dose oral misoprostol for induction of labour. Cochrane Database Syst Rev. 1996;2021(6) DOI: https://doi.org/10.1002/14651858.CD014484

Hofmeyr GJ, Gülmezoglu AM, Pileggi C. Vaginal misoprostol for cervical ripening and induction of labour. Cochrane Database Syst Rev. 2010;2010(10):CD000941. DOI: https://doi.org/10.1002/14651858.CD000941.pub2

Nautiyal D, Mukherjee K, Perhar I, Banerjee N. Comparative study of misoprostol in first and second trimester abortions by oral, sublingual, and vaginal routes. J Obstet Gynaecol India. 2015;65(4):246-50. DOI: https://doi.org/10.1007/s13224-014-0587-3

Sunda D, Agrawal S, Jain S, Bhatt M. A comparative study on sublingual versus vaginal misoprostol for induction of labour in women with pre-labour rupture of membranes at term with poor Bishop’s score. Gynaecol J. 2019;3(6):27-31. DOI: https://doi.org/10.33545/gynae.2019.v3.i6a.388

Milani F, Sharami SH, Arjmandi S. Comparison of sublingual and vaginal misoprostol for pregnancy terminations. J Family Reprod Health. 2014;8(1):41-4.

DebBarma AM, Baidya JL, Ray D. A comparative study of misoprostol oral versus vaginal route for induction of labour. Int J Reprod Contracept Obstet Gynecol. 2020;9(5):2048-54. DOI: https://doi.org/10.18203/2320-1770.ijrcog20201778

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Published

2025-08-28

How to Cite

Mehra, I., Agarwal, N., Baghel, J., Gupta, S., & Arya, S. B. (2025). Evaluation of vaginal and sublingual routes of misoprostol in induction of labor. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 14(9), 2986–2992. https://doi.org/10.18203/2320-1770.ijrcog20252729

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Original Research Articles