Abstract
Background
It is now generally accepted that the uterine cervix plays an important role during pregnancy and labor and that it depends on an active ripening process within the cervix; which is necessary for successful labor induction.
Aim of the Work
to test the safety and efficacy of titrated oral misoprostol compared to vaginal misoprostol for labor induction in term gravid ladies.
Patients and Methods
This prospective, single-blinded randomized controlled clinical trial was conducted at Ain-Shams University Maternity Hospital during the period between August 2017 and August 2018. 120 pregnant women planned for induction of labor were recruited in the study according to the inclusion / exclusion criteria. Subjects included in the study were randomized into two groups: patients who received oral 200 ug misoprostol in 200 ml water titrated over 24 hours and placebo tablets vaginally which resemble vagiprost tablets (25 microgram misoprostol) and the second group contained pients who received vaginal misoprostol 25microg maximum four doses, and placebo solution of 200 ml of tap water.
Results
titrated oral misoprostol is as effective in promoting cervical ripening and inducing labor as intravaginal misoprostol, oral Misoprostol has a similar maternal and perinatal safety profile to vaginal misoprostol.
Conclusion
This new approach to oral misoprostol administration was successful in minimizing the risk of uterine hyper-stimulation, which has been a feature of misoprostol use for induction of labor, at the expense of a somewhat slower response. Oral Misoprostol has a similar maternal and perinatal safety profile compared to vaginal misoprostol.
Background: Induction of labour is a therapeutic option when the benefits of delivery outweigh risks of continuing pregnancy. There are several agents for induction of labour to achieve better outcome of labour. Acceptable methods for induction are oxytocin infusion, dinoprostone gel, misoprostol and mechanical cervical dilators. Prostaglandins are the preferred choice in unripened cervix. To study the neonatal outcome in induction of labour with low dose oral misoprostol compared with intracervical dinoprostone gel and also to assess occurrence of meconium staining liquor.Methods: One hundred women with single live fetus, term gestation, cephalic presentation, reactive fetal heart pattern and Bishops score <6 were included in the study. They were randomized to receive either 6 doses of 25ug oral misoprostol every 3rd hourly or 0.5ug intracervical dinoprostone every 6th hourly for a maximum of 3 doses. Oxytocin was administered. Fetal outcome was assessed in terms of APGAR score, meconium staining and need for NICU.Results: Meconium stained amniotic fluid was high in misoprostol group (16%) compared to dinoprostone group (8%). NICU admissions were seen in 7 neonates in both groups.Conclusions: Low dose oral misoprostol is a safe method of labour induction. APGAR and NICU admission rates were comparable in both groups. Meconium staining was more in misoprostol group compared to dinoprostone group.
Background: Misoprostol is the latest drug for induction of labour which is cheap and stable at room temperature. Our study was conducted to test the efficacy of misoprostol for labor induction through oral and vaginal route.Methods: 250 women who required induction of labor at Govt. Medical College, Kottayam was included in this study. Both oral misoprostol 50µg and vaginal misoprostol 25µg 4 hourly upto maximum of four doses were used for induction of labor as per consultant’s preference. Out of these 125 patients were selected for study in both groups. Singleton term pregnancies with cephalic presentation were selected. The mean induction pain interval, induction delivery interval, mode of delivery, maternal complications like uterine contraction abnormalities, neonatal complications were observed.Results: Induction to pain interval was shorter in oral misoprostol group compared to vaginal misoprostol group (2.48+1.3 hours vs. 3.91+2.17 hours P ≤0.001). But the mean induction to delivery interval was comparable in both groups (12.98±3.04hrs vs. 12.59±3.28 hrs.) Vaginal delivery and cesarean section rate in both groups were comparable. The oral group required more number of misoprostol (>2 misoprostol 38.4% in oral 25.6% in vaginal p=0.030). There was insignificant increased incidence of uterine hyperstimulation in vaginal group. The neonatal outcome was comparable.Conclusions: Misoprostol administered either by oral or vaginal route was equally effective in induction of labor and found to be safe.
Oral misoprostol, low dose vaginal misoprostol, and vaginal dinoprostone for labor induction: Randomized controlled trial