Oral misoprostol solution in comparison to vaginal misoprostol for induction of labour in a randomized controlled trial

Authors

  • Ahmed M. Abbas Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
  • Peter R. Thabet Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
  • Amgad E. Abour Gamrah Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
  • Osama S. El-Kady Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20203823

Keywords:

Induction of labour, Oral, Vaginal misoprostol

Abstract

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 versus 20.3 hours respectively) with significant p-value (<0.001).

Conclusions: Titrated oral misoprostol is safe and effective for labour induction in primigravida patients with unfavorable cervix.

References

Mackenzie IZ. Induction of labour at the start of the new millennium. Reprod. 2006;131(6):989-98.

Hofmeyr GJ, Gulmezoglu AM, Pileggi C. Vaginal misoprostol for cervical ripening and induction of labour. Cochrane Database Syst Rev. 2010;6:CD000941.

Deshmukh VL, Rajamanya AV, Yelikar KA. Oral misoprostol solution for induction of labour. J Obstet Gynaecol India. 2017;67(2):98-103.

Goldberg AB, Greenberg MB, Darney PD. Misoprostol and pregnancy. N Engl J Med. 2001;344:38-47.

Sanchez Ramos L, Kauritz AM, Del Valle GO. Labour induction with the prostaglandin. EL methyl analogue misoprostol versus oxytocin, a randomized trial. Obstet Gynaecol. 1993;81:332-6.

Tessier F, Dansereau J. A double-blind randomized controlled trial comparing oral misoprostol to vaginal prostaglandin E2 gel for the induction of labour at or near term. Am J Obstet Gynecol. 1997;176:S111.

Windrim R, Bennett K, Mundle W, Young DC. Oral administration of misoprostol for labour induction: a randomized controlled trial. Obstet Gynecol. 1997;89:392-7.

Adair CD, Weeks JW, Barrilleaux PS, Philibert L, Lewis DF. Labour induction with oral versus vaginal misoprostol: a randomized, double-blind trial. Am J Obstet Gynecol. 1998;178:S93.

Kwon JS, Davies GA, Mackenzie VP. A comparison of oral and vaginal misoprostol for induction of labour at term: a randomised trial. Br J Obstet Gynecol. 2001;108:23-6.

Wing DA, Ham D, Paul RH. A comparison of orally administered misoprostol with vaginally administered misoprostol for cervical ripening and labour induction. Am J Obstet Gynecol. 1999;180:1155-60.

Toppozada MK, Anwar MY, Hassan HA, El-Gazaerly WS. Oral or vaginal misoprostol for induction of labour. Int J Gynecol Obstet. 1997;56:135-9.

Kadanali S, Küçüközkan T, Zor N, Kumtepe Y. Comparison of labor induction with misoprostol vs. oxytocin/prostaglandin E2 in term pregnancy. Int J Gynecol Obstet. 1996;55:99-104.

Antil S, Gupta U. Role of titrated low dose oral misoprostol solution in induction of labour. Int J Reprod Contracept Obstet Gynecol. 2016;5(3):775-82.

Alfirevic Z, Keeney E, Dowswell T. Labour induction with prostaglandins: a systematic review and network meta-analysis. Am Coll Obstet Gynecol. 2015;350:g217.

Sanchez Ramos L, Kauritz AM, Del Valle GO. Labour induction with the prostaglandin. EL methyl analogue misoprostol versus oxytocin, a randomized trial. Obstet Gynaecol. 1993;81:332-6.

Induction of labour (CG70), 2008. Available at: www.nice.org.uk/CG70. Accessed on 12th March 2020.

RCOG response to BMJ study on induction of labour, 2019. Available at: https://www.rcog.org.uk/en/news/rcog-response-to-study-on-induction-of-labour-and-stillbirth-risk/ Accessed on 14th March 2020.

Mahajan P, Popatrao R. Shitole comparison of titrated oral misoprostol solution versus vaginal misoprostol for induction of labour in term obstetric patients for obstetric and neonatal outcomes: a randomized controlled trial. Int J Reprod Contracept Obstet Gynecol. 2018;7(6):2339-46.

Leduc D, Biringer A, Lee L, Dy J. Induction of labour. J Obstet Gynaecol Can. 2013;35(9):840-57.

Osterman MJ, Martin JA. Recent declines in induction of labor by gestational age. NCHS Data Brief. 2014;155:1-8.

Alfirevic Z, Aflaifel N, Weeks A. Oral misoprostol for induction of labour. In: Weeks A, editor. The cochrane database of systematic reviews. Vol 6. Chichester, UK: John Wiley and Sons, Ltd; 2014:CD001338.

Hofmeyr GJ, Gulmezoglu AM, Pileggi C. Vaginal misoprostol for cervical ripening and induction of labour. Cochrane Database Syst Rev. 2010;6:CD000941.

Hokkila E, Kruit H, Rahkonen L, Timonen S, Mattila M, Laatio L, et al. The efficacy of misoprostol vaginal insert compared with oral misoprostol in the induction of labor of nulliparous women: A randomized national multicenter trial. Acta Obstetricia et Gynecologica Scandinavica. 2019;98(8):1032-9.

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. Obstet Gynecol. 2019;134(1):10-6.

Redling K, Schaedelin S, Huhn EA, Hoesli I. Efficacy and safety of misoprostol vaginal insert vs. oral misoprostol for induction of labor. J Perinatal Med. 2018;47(2):176-82.

Rouzi AA, Alsahly N, Alamoudi R, Almansouri N, Alsinani N, Alkafy S, et al. Randomized clinical trial between hourly titrated and 2 hourly static oral misoprostol solution for induction of labor. Am J Obstet Gynecol. 2018;216(4):405.e1-405.e6.

Cheng SY, Ming H, Lee JC. Titrated oral compared with vaginal misoprostol for labour induction. Obstet Gynecol. 2008;111:119-25.

Souza ASR, Feitosa FEL, Costa AA, Pereira AP, Carvalho AS, Paixão RM, et al. Titrated oral misoprostol solution versus vaginal misoprostol for labor induction. Int J Gynecol Obstet. 2013;123:207.

Kafy S. Oral misoprostol 2 hourly for labor induction. Open J Obstet Gynecol. 2018;8(6):553-8.

Yousaf T, Asher Z, Afghan S, Malik K. Comparison of oral (20 µg 2 hourly) versus vaginal (25 µg 6 hourly) misoprostol for induction of labour in term pregnancies. Pak Armed Forces Med J. 2019;69(2):346-50.

Jindal P, Avasthi K, Kaur M. A comparison of vaginal vs. oral misoprostol for induction of labor-double blind randomized trial. J Obstet Gynaecol India. 2011;61:538-42.

Komala K, Reddy M, Quadri IJ. Comparative study of oral and vaginal misoprostol for induction of labour, maternal and foetal outcome. J Clin Diag Res. 2013;7(12):2866-9.

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Published

2020-08-27

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Original Research Articles