DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20202341

A comparative study of vaginal misoprostol versus oral misoprostol for induction of labour

Raj M. Mehta, Babulal S. Patel, Akshay C. Shah, Shashwat K. Jani, Vismay B. Patel, Adwait B. Patel, Jui Rakesh Shah

Abstract


Background: Induction of labour defined as artificial initiation of uterine contractions before the onset of spontaneous labour, after the period of viability, by any methods. The successful outcome depends on the Bishop Score, maternal age and parity. Authors compared the most preferred two routes; vaginal and oral for induction and outcome, adverse events and side effects were noted.

Methods: This was a prospective comparative study carried out at SVPIMSR, Ahmedabad, from January 2019 to June 2019, Gujarat, 100 patients who required induction were randomly divided in two groups- Group A received 25µg oral misoprostol, Group B - received 25µg vaginal misoprostol repeated 4 hourly up to maximum five doses in both groups. The induction to delivery interval, mode of delivery, maternal and neonatal outcome and complications were observed.

Results: The mean induction to delivery interval was less in vaginal group than oral (18.7 hours in vaginal versus 22.4 hours in oral). Vaginal delivery and caesarean section rates were comparable in both groups. 60% patients in Group A required more than two doses as compared to 36% in Group B. No major complications or adverse events were observed.

Conclusions: Both oral misoprostol in a dose of 25μg and vaginal misoprostol 25μg every four hours, to a maximum of five doses, have safety and efficacy for induction. With The vaginal route, delivery occurs in less time and few doses required as compared to oral.


Keywords


Induction of labour, Misoprostol, Oral route, Uterine contractions, Vaginal route

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References


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

ACOG committee on practice bulletins - Obstetrics. ACOG Practice Bulletin No. 107: Induction of labor. Obstet Gynecol. 2009;114(2, Pt 1):386-97.

Wolf S, Sanchesz Ramos L, Kaunitz A. Sublingual Misoprostol for labour induction: A randomized clinical trial. Obstet Gynecol. 2005;105:365-71.

Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Gilstrap L, Wenstrom KD. William’s obstetrics and gynecology. 25th ed. New York: McGraw-Hill; 2018:503-514.

James DK, Steet PJ, Weiner CP. High risk pregnancymanagement options. 6th ed. Philadelphia: Saunders Co; 2007:333-334.

American College of Obstetrician and Gynecologists. Instruction of labour with misoprostol. Int J Gynecol Obstet. 2000;69:77-8.

Hill JB, Thigpen BD, Bofill JA, Magann E, Moore LE, Martin JN. A randomized clinical trial comparing vaginal misoprostol versus cervical Foleyplus oral misoprostol for cervical ripening and labour induction. Am J Perinatol. 2009;26(1):33-8.

Stovall TG. Break and Novak’s. Gynecology. 14th Ed. Philadelphia: Lipincott, williams and Wilkins. Early pregnancy loss and ectopic pregnancy. In: Berek JS; 2007:601.

Scheepers HCG, Van Erp EJM, Van den Bergh AS. Use of misoprostol in first and second trimester abortion. Obstet Gynecol Surv. 1999;54:592-600.

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

Alfirevic Z, Keeney E, Dowswell T, Welton NJ, Dias S, Jones LV, et al. Labour induction with prostaglandins, a systemic review and network meta-analysis. BMJ. 2015;350:217-350.

Wing DA, Paul RH. A comparison of differing dosing regimens of vaginally administered misoprostol for pre-induction cervical ripening and labour induction. Am J Obstet Gynaecol. 1996;175:158-64.

Kramer RL, Gilson GJ, Morrison DS, Martin D, Gonzales JL, Qualls CR. A randomized trial of misoprostol and oxytocin for induction of labour: safety and efficacy. Obstet Gynaecol. 1997;89:387-91.

Wing DA, Paul RH. Misoprostol for cervical ripening and labour induction: the clinician’s perspective and guide to success. Contem Ob Gyn. 1999;44:46-61.

Hofmeyr GJ. Misoprostol administered vaginally for cervical ripening and labour induction in the third trimester (Cochrane Review on CD-ROM). Oxford, England: Cochrane Library Update Software. 1998;3.

Cheng S, Ming H, Lee J. Titrated oral compared with vaginal misoprostol for labour induction: a randomized controlled trial. Obstet Gynaecol. 2008;111:119-25.

Zieman M, Fong SK, Benowitz NL, Banskter D, Darney PD. Absorption kinetics of misoprostol with oral or vaginal administration. Obstet Gynecol. 1997;90:88-92.

Bebbington MW, Kent N, Lim K, Gagnon A, Delisle MF, Tessier F, et al. A randomized controlled trial comparing two protocols for the use of misoprostol in midtrimester pregnancy termination. Am J Obstet Gynecol. 2002;187:853-7.

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

How HY, Leaseburge L, Khoury JC, Siddiqi TA, Spinnato JA, Sibai BM. A comparison of various routes and dosages of misoprostol for cervical ripening and the induction of labor. Am J Obstet Gynecol. 2001;185(4):911-5.

WHO recommendations for induction of labour, 2011, Included in the WHO Model List of Essential Medicines, if only 200 µg tablets are available, smaller doses can be made by dissolving in water. Available at: www.misoprostol.org. Accessed 12th March 2020.