Misoprostol for induction of labour: a comparative study of various routes of administration

Bushra Ahmad, Chandna Shekhar, Sunita Jindal, Sangeeta Gupta


Background: Oxytocin has been used for labor induction since very long, but with high rates of failed induction. The objective of this study is to compare the safety and efficacy of various routes of misoprostol for induction of labor at term. Design: Prospective randomized study was done at the department of obstetrics and Gynecology at the PGIMSR ESI Basaidarapur, New Delhi between August 2009 and July 2011.

Methods: 150 pregnant women were randomized into three groups each to receive 50 mcg of Misoprostol via oral, sublingual and vaginal routes respectively. Doses were repeated 6 hourly for a maximum of 3 doses till the patient entered active stage of labor (clinically adequate contractions of 3/10 min of >40 s duration, and cervical dilatation of with 4 cm). Statistical analysis was done using chi-square test and ANOVA (one-way analysis of variance).

Results: Mean number of dosage required for successful induction were significantly less in the vaginal group than oral and sublingual groups (in oral groups A were 2.1±0.42, sublingual 1.4±0.34, vaginal 1.1±0.29). The induction to delivery interval was significantly less in vaginal group than oral and sublingual groups (Group A oral 21.06±9.22 h, group B sublingual 16.81±8.08 h, group C vaginal 12.9±5.16 h 0.016 significant). Rate of caesarean was least in the vaginal group 12% vs 20% in oral and 26% in sublingual. All the three groups showed satisfactory neonatal outcomes.

Conclusions: This study shows that vaginal route of administration of misoprostol is preferable to oral route and sublingual route for induction of labor when used in equivalent dosage of 50 mcg 6 hourly, however all three routes are well tolerated with favorable neonatal outcomes.


Induction of labour, Induction delivery interval, Misoprostol

Full Text:



Rayburn COF. Pre-induction cervical ripening: Basis and methods of current practice. Obstet Gynaecol Survey. 2002;67:683-92.

Sanchez- Ramos L, Kuntiz AM, Wears RL. Misoprostol for cervical ripening and labor induction: A meta-analysis. Obstet Gynaecol. 1997;89:633-42

Pollnovv DM, BroeKhuizen FF. Randomized double blind trial of prostaglandin E2 intravaginal gel versus low dose Oxytocin for cervical ripening before induction of labor. Am J Obstet Gynaecol. 1996;174:1910-6.

Alfirevic Z, Keeney E, Dowswell T, Welton NJ, Dias S, Jones LV, et al. Labour induction with prostaglandins: a systematic review and network meta-analysis. BMJ. 2015;350:h217:350.

Fletcher HM, Mitchell S, Simeon D, Freidrick J, Brown D: Misoprostol for labor induction at term. Br J Obstet Gynaecol. 1993;100:641-4.

Carlan SJ, Bouldin S, Biust Danielle, O’ Brien WF. Safety and efficacy of misoprostol for labor induction. A randomized controlled trial. Obstet Gynaecol. 2001;98:107-12.

Jahromi BN, Poorgholam F, Yousefi G, Salarian L. Sublingual versus vaginal misoprostol for the induction of labor at term: a randomized, triple-blind, placebo-controlled clinical trial. Iranian J Med sci. 2016;41(2):79.

Rezaie M, Farhadifar F, Sadegh SM, Nayebi M. Comparison of Vaginal and Oral Doses of Misoprostol for Labour Induction in Post-Term Pregnancies. Journal of clinical and diagnostic research: JCDR. 2016;10(3):QC08.

Zhang Y, Zhu HP, Fan JX, Yu H, Sun LZ, Chen L, et al. Intravaginal Misoprostol for Cervical Ripening and Labor Induction in Nulliparous Women: A Double-blinded, Prospective Randomized Controlled Study. Chinese Medic J. 2015;128(20):2736.

Hall R, Duarte-Gardea M, Harlass F. Oral versus vaginal misoprostol for labor induction. Obstetr Gynecol. 2002;99(6):1044-8.

Jindal P, Avasthi K, Kaur M. A Comparison of Vaginal vs. Oral Misoprostol for Induction of Labor–Double Blind Randomized Trial. J Obstetr Gynecol Ind. 2011;61(5):538-42.

Shetty A, Danilien P, Templeton A. A comparison of oral and vaginal misoprostol in induction of labor at term. Br J Obstet Gynaecol. 2001;108:218-24.

Fletcher HM, Mitchell S, Simeon D, Freidrick J, Brown D. Intravaginal misoprostol versus dinoprostone as cervical ripening and labor inducing agents. Obstet Gynaecol. 1993;83:244-7.

Caliskan E, Bodur H, Ozeren S, Lorakei A, Ozkan, Yucesoy I. Misoprostol 50µg sublingually versus vaginally for labor induction at term : A randomized study. Gynaecol Obstet Invest. 2005;59:155-61.

Adair CD, Weeks JW, Edwards M. Oral or vaginal misoprostol for induction of labor. A randomized double blind trial. Obstet Gynaecol. 1998;92:810-3.

Benett KA, EL More L, Feischman S, Jones D, Lopel JA. Prostaglandin induction in women with prior cesarean delivery increases induction time and risk of uterine rupture. Am J Obstet Gynecol. 2000;182:S130.