Efficacy and safety of oral misoprostol solution compared to sublingual misoprostol for induction of labor at term pregnancy
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20254261Keywords:
Efficacy, Induction, Labor, Misoprostol, SafetyAbstract
Background: Induction of labor (IOL) is the artificial stimulation of uterine contractions at term to achieve vaginal delivery. This study aimed to compare the efficacy and safety of 25 μg oral versus sublingual misoprostol for labor induction at term pregnancy. The aim of the study was to compare the efficacy and safety of oral misoprostol solution versus sublingual misoprostol for induction of labor in term pregnancies.
Methods: This randomized controlled trial was conducted at the Department of Obstetrics and Gynecology, Institute of Child and Mother Health (ICMH), Matuail, Dhaka, Bangladesh, from July 2023 to June 2024, including 66 term pregnant women with a singleton cephalic fetus and unfavorable cervix (Bishop score <6). Participants were randomized to oral misoprostol solution (Group A, n=33) or sublingual misoprostol (Group B, n=33), with labor progress, maternal, and neonatal outcomes monitored. Data were analyzed using SPSS v26, with P<0.05 considered significant.
Results: Among 66 term women (33 oral, 33 sublingual), most were 20-30 years, housewives, with normal BMI and primigravida. Indications and gestational age were similar. Oral group required higher misoprostol doses (3.6±1.1 vs. 3±1.9, p=0.010), but labor times, oxytocin use, Bishop score improvement, delivery mode (vaginal 72.7% vs. 75.8%), neonatal outcomes, and adverse effects were comparable. Success rates were 84.8% vs. 90.9%.
Conclusions: Both oral and sublingual misoprostol are similarly effective for labor induction, with oral misoprostol showing a slightly safer profile.
References
Tadesse T, Assefa N, Roba HS, Baye Y. Failed induction of labor and associated factors among women undergoing induction at University of Gondar Specialized Hospital, Northwest Ethiopia. BMC Pregn Childb. 2022;22(1):175.
Marconi AM. Recent advances in the induction of labor. F1000Research. 2019;8:F1000.
Hu T, Du S, Li X, Yang F, Zhang S, Yi J, et al. Establishment of a model for predicting the outcome of induced labor in full-term pregnancy based on machine learning algorithm. Sci Rep. 2022;12(1):19063.
American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 107: induction of labor. Obstet Gynecol. 2009;114:386-97.
Chatsis V, Frey N. Misoprostol for cervical ripening and induction of labour: A review of clinical effectiveness, cost-effectiveness and guidelines.
Senanayake H, Mariani I, Valente EP, Piccoli M, Armocida B, Businelli C, et al. Outcomes of induction versus spontaneous onset of labour at 40 and 41 GW: findings from a prospective database, Sri Lanka. BMC Pregn Childb. 2022;22(1):518.
Vogel JP, Souza JP, Gülmezoglu AM. Patterns and outcomes of induction of labour in Africa and Asia: a secondary analysis of the WHO global survey on maternal and neonatal health. PloS one. 2013;8(6):e65612.
Braund S, Deneux‐Tharaux C, Sentilhes L, Seco A, Rozenberg P, Goffinet F. Induction of labor and risk of postpartum hemorrhage in women with vaginal delivery: A propensity score analysis. Int J Gynecol Obstetr. 2024;164(2):732-40.
Sharda P, Agrawal NR. Various modalities of induction of labour and its feto-maternal outcomes: An observational study. Ind J Obstetr Gynecol Res. 2021;8(3):334-8.
AlKhalifa MA, Hsu S, ElHassan N, AlAnsari B, Ismael R, Raza G, et al. Induction of Labor: a comparison of guidelines. Obstetr Gynecol Res. 2022;5(1):81-106.
Tehseen S, Chughtai F, Riffat N. Predictability of successful induction of labour with poor bishop score. Pak J Medi Heal Sci. 2022;16(02):111-.
Mozurkewich EL, Chilimigras JL, Berman DR, Perni UC, Romero VC, King VJ, et al. Methods of induction of labour: a systematic review. BMC Pregn Childb. 2011;11(1):84.
Alfirevic Z, Weeks A. Oral misoprostol for induction of labour. Cochrane database of systematic reviews. 2006(2).
Mackenzie IZ. Induction of labour at the start of the new millennium. Reproduct. 2006;131(6):989-98.
Leduc D, Biringer A, Lee L, Dy J, Corbett T, Duperron L. Induction of labour. J Obstetr Gynaecol Canada. 2013;35(9):840-57.
Iftikhar B, Baqai SM. Dinoprostone and misoprostol for induction of labour at term pregnancy. Pak Arm For Medi J. 2016;1(5):631.
Bartusevicius A, Barcaite E, Krikstolaitis R, Gintautas V, Nadisauskiene R. Sublingual compared with vaginal misoprostol for labour induction at term: a randomised controlled trial. BJOG: Int J Obstetr Gynaecol. 2006;113(12):1431-7.
Sheir EM, El-Feky AE, El-Sayed AA. Randomized controlled trial between sublingual and vaginal misoprostol for induction of labour at term. Evidence Based Wom Heal J. 2019;9(2):407-15.
Handal-Orefice RC, Friedman AM, Chouinard SM, Eke AC, Feinberg B, Politch J, et al. Oral or vaginal misoprostol for labor induction and cesarean delivery risk. Obstetr Gynecol. 2019;134(1):10-6.
Siwatch S, Kalra J. Sublingual vs oral misoprostol for labor induction. J Postgrad Medi Educat Res. 2014;48(1):33-6.
Datta MR, Ghosh MD, Kharodiya ZA, Kharodiya Sr ZA. Comparison of the efficacy and safety of sublingual versus oral misoprostol for the induction of labor: a randomized open-label study. Cureus. 2023;15(11).
Shetty J, Upadhya R, Rajendran R. Oral misoprostol solution more effective than a sublingual route for induction of labor: a prospective comparative trial at tertiary care center. J South Asian Federat Obstetr Gynaecol. 2023;15(2):165-9.
Amini M, Reis M, Wide-Swensson D. A relative bioavailability study of two misoprostol formulations following a single oral or sublingual administration. Fronti Pharmacol. 2020;11:50.
Amini M, Wide-Swensson D, Herbst A. Sublingual misoprostol vs. oral misoprostol solution for induction of labor: A retrospective study. Fronti Surg. 2022;9:968372.
Ahmad B, Shekhar C, Jindal S, Gupta S. Misoprostol for induction of labour: a comparative study of various routes of administration. Int J Reprod Contracept Obstet Gynecol. 2017;6(10):4583-8.
Parimkayala R, Shetty S. Effectiveness of sublingual versus oral misoprostol for induction of labour at term. Ind J Public Health Res Dev. 2020;11:840-4.
Downloads
Published
How to Cite
Issue
Section
