A comparative study of oral, sublingual and vaginal route of misoprostol as cervical ripening agent before surgical method of termination of first-trimester pregnancy

Background: Cervical ripening is a critical step for surgical method of termination of first trimester of pregnancy. Misoprostol, PGE1 analogue have promising role as cervical ripening agent. The present study aimed to compare the efficacy and side effects of oral, sublingual and vaginal misoprostol at dosage of 400mcg for cervical priming before surgical method of termination in first-trimester pregnancy.Methods: It was a prospective hospital based randamosied study. Total 150 patients at 6-12 weeks gestation requesting for medical termination of pregnancy were divided equally in to 3 groups. Every group was advised to have single dose of 400 mcg misoprostol either oral, sublingual or vaginal route respectively 4 hour before suction and evacuation.Results: The sublingual group had highly significant cervical dilatation (P<0.001) and the duration of suction and evacuation was less as compared to the vaginal and oral routes (p<0.000). However, the mean intraoperative blood loss was more in sublingual as compared to the vaginal and oral groups. Loose motions and nausea/vomiting were more with oral routes while blood loss was more in the vaginal route.Conclusions: Thus, it can be concluded from present study that sublingual route of misoprostol is more preferable than oral or vaginal route as pro-abortion cervical ripening agent.

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To compare the Effectiveness and Tolerability of Misoprostol as a Cervical Ripening Agent in the First Trimester Abortion through Sublingual and Vaginal Routes of Administration

Bangladesh Journal of Obstetrics & Gynaecology ◽

10.3329/bjog.v27i2.29920 ◽

2016 ◽

Vol 27 (2) ◽

pp. 63-66 ◽

Cited By ~ 1

Author(s):

Jayati Nath ◽

Maneesha Jain ◽

Rehana Najam ◽

Rina Sharma

Keyword(s):

Blood Loss ◽

First Trimester ◽

Cervical Ripening ◽

Research Centre ◽

Intraoperative Blood Loss ◽

Vaginal Route ◽

Trimester Abortion ◽

Routes Of Administration ◽

The Mean ◽

Group B

Objective: To compare the effectiveness and tolerability of misoprostol as a cervical ripening agent in first trimester abortion through sublingual and vaginal routes of administration.Material and Methods: This study was carried out in the department of Obst. & Gynae Teerthanker Mahaveer Medical College and Research Centre (TMMC&RC). A total of 120 patients were included in the study. They were divided in two groups Group A 60 patients sublingual Group B 60 patients vaginal The drug was administered 3-4 hours before suction and evacuation by sublingual and vaginal routes. Efficacy was assessed on the basis of time taken for ripening, dilatation achieved, duration of the procedure, intraoperative blood loss and pain. The patients tolerability was noted on the basis of side effects.Results: The mean time taken for cervical ripening was more in the sublingual group as compared to the vaginal ( P<0.001).The duration of suction and evacuation was less as compared to the vaginal route. The mean intraoperative blood loss was more in sublingual as compared to the vaginal group. The intraoperative pain score was comparatively lower (P<0.05) as compared to the vaginal route. Side effects like loose motions, nausea vomiting were more with sublingual group.Conclusion: Sublingual Misoprostol is an effective and favourable cervical ripening agent for 1st trimester abortions.Bangladesh J Obstet Gynaecol, 2012; Vol. 27(2) : 63-66

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A randomised comparison between sublingual, oral and vaginal route of misoprostol for pre-abortion cervical ripening in first-trimester pregnancy termination under local anaesthesia

Australian and New Zealand Journal of Obstetrics and Gynaecology ◽

10.1111/j.1479-828x.2007.00809.x ◽

2008 ◽

Vol 48 (1) ◽

pp. 101-106 ◽

Cited By ~ 8

Author(s):

Pikee SAXENA ◽

Nivedita SARDA ◽

Sudha SALHAN ◽

Deoki NANDAN

Keyword(s):

Local Anaesthesia ◽

Pregnancy Termination ◽

First Trimester ◽

Cervical Ripening ◽

Vaginal Route ◽

First Trimester Pregnancy ◽

Trimester Pregnancy

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Comparison between Sublingual and Vaginal Misoprostol for Induction of Labour in Primigravida

Nepal Journal of Obstetrics and Gynaecology ◽

10.3126/njog.v13i3.23509 ◽

2018 ◽

Vol 13 (3) ◽

pp. 51-55

Author(s):

Sailaja Ghimire ◽

Deepanjali Sharma ◽

Samjhana Dhakal ◽

Gehanath Baral

Keyword(s):

Fetal Distress ◽

Fetal Outcome ◽

Induction Of Labour ◽

Cervical Ripening ◽

P Value ◽

Time Interval ◽

Vaginal Route ◽

Sublingual Misoprostol ◽

The Mean ◽

Vaginal Misoprostol

Aims: To compare the outcome and side effects of administration of sublingual misoprostol with vaginal misoprostol for induction of labour and cervical ripening. Methods: It was a hospital based comparative study which was carried out in 120 patients in each group of sublingual and vaginal route of misoprostol induction from August 2016 to February 2017 at Paropakar Maternity and Women’s Hospital, Thapathali, Kathmandu. Patients with Bishops score <6 were subjected for Misoprostol 25 μg (for maximum 2 doses) 6 hours apart. Results were analyzed using SPSS 21 taking p-value <0.05 as statistically significant. Results: The mean change in Bishops score after 6 hours of misoprostol was statistically signifi cantly (p=0.001) in sublingual group in comparison to vaginal group. The diff erence in augmentation rate was not statistically signifi cant (p= 0.811). The mean time interval from drug administration to delivery was almost similar in both groups. The indications for cesarean section were similar in both the groups, the most common being fetal distress, (67.33% in sublingual and 58.065% in vaginal group). In terms of maternal and neonatal outcome there was no difference. Conclusions: Sublingual route results in significant changes of Bishop’s score as compared to vaginal route. It was also significantly better in terms of fetal outcome. However, both routes appeared similar in terms of maternal outcome.

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Comparison of oral and vaginal misoprostol for cervical ripening before manual vacuum aspiration of first trimester pregnancy under local anesthesia: a randomized placebo-controlled study

Contraception ◽

10.1016/j.contraception.2004.11.009 ◽

2005 ◽

Vol 71 (5) ◽

pp. 337-342 ◽

Cited By ~ 15

Author(s):

Leyla Cakir ◽

Berna Dilbaz ◽

Eray Caliskan ◽

F. Suat Dede ◽

Serdar Dilbaz ◽

...

Keyword(s):

Local Anesthesia ◽

First Trimester ◽

Cervical Ripening ◽

Controlled Study ◽

Vacuum Aspiration ◽

First Trimester Pregnancy ◽

Trimester Pregnancy ◽

Manual Vacuum Aspiration ◽

Vaginal Misoprostol

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Correlations Between the Values of Maternal Glycemia from the Last Trimester of Pregnancy and Fetal Birth Weight

Romanian Journal of Diabetes Nutrition and Metabolic Diseases ◽

10.2478/rjdnmd-2013-0024 ◽

2013 ◽

Vol 20 (3) ◽

pp. 259-265

Author(s):

Monica Vereş ◽

Aurel Babeş ◽

Szidonia Lacziko

Keyword(s):

First Trimester ◽

Mean Value ◽

Fetal Macrosomia ◽

Entire Group ◽

Third Trimester ◽

The Third ◽

Group I ◽

Fetal Birth Weight ◽

First Trimester Of Pregnancy ◽

The Mean

Abstract Background and aims: Gestational diabetes represents a form of diabetes diagnosed during pregnancy that is not clearly overt diabetes. In the last trimester of gestation the growth of fetoplacental unit takes place, thus maternal hyperglycemia will determine an increased transplacental passage, hyperinsulinemia and fetal macrosomia. The aim of our study was that o analyzing the effect of maternal glycemia from the last trimester of pregnancy over fetal weight. Material and method: We run an observational study on a group of 46 pregnant women taken into evidence from the first trimester of pregnancy, separated in two groups according to blood glucose determined in the third trimester (before birth): group I normoglycemic and group II with hyperglycemia (>92mg/dl). Results: The mean value of third trimester glycemia for the entire group was of 87.13±22.03. The mean value of the glycemia determined in the third trimester of pregnancy was higher in the second group (109.17 mg/dl) in comparison to the first group (74.,21 mg/dl). The ROC curve for third trimester glycemia as fetal macrosomia appreciation test has an AUC of 0.517. Conclusions: Glycemia determined in the last trimester of pregnancy cannot be used alone as the predictive factor for fetal macrosomia.

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VAGINAL AND ORAL MISOPROSTOL FOLLOWING MIFEPRISTONE ADMINISTRATION IN MEDICAL TERMINATION OF PREGNANCY UP TO 49 DAYS: A COMPARATIVE STUDY

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2020.v13i2.36162 ◽

2019 ◽

pp. 1-3

Author(s):

DIVYA VARDAINI

Keyword(s):

Comparative Study ◽

Termination Of Pregnancy ◽

Vaginal Route ◽

Control Groups ◽

Routes Of Administration ◽

Medical Termination Of Pregnancy ◽

Oral Misoprostol ◽

Medical Termination ◽

Gastrointestinal Side Effects ◽

Vaginal Misoprostol

Objective: The objective of this study was to compare and evaluate the efficacy, safety, adverse effects, and patient compliance of vaginal versus oral misoprostol in medical termination of pregnancy after tablet misoprostol up to 49 days of gestation. Methods: A comparative study of 100 patients divided randomly assigned to two control groups. Results: The study showed that 200 mg mifepristone followed by 800 mcg vaginal misoprostol is more effective for medical termination in gestational age up to 49 days as compared to 200 mg mifepristone followed by 400 mcg oral misoprostol. Conclusion: While both routes of administration are safe, gastrointestinal side effects are more with oral misoprostol. The vaginal route is more acceptable to the patients enrolled in the study.

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Comparison of efficacy of buccal versus vaginal misoprostol in first trimester induced abortion

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20193567 ◽

2019 ◽

Vol 8 (8) ◽

pp. 3368

Author(s):

Nida Khan ◽

Anita M. Kant ◽

Pooja C. Thukral ◽

Mohammad Saquib

Keyword(s):

Side Effects ◽

Group Versus ◽

First Trimester ◽

Comparable Efficacy ◽

P Value ◽

Vaginal Route ◽

Trimester Abortion ◽

Group A ◽

Vaginal Misoprostol ◽

Group B

Background: To compare the effectiveness, side effects, and patient satisfaction of buccal versus vaginal misoprostol administration in first trimester abortions.Methods: Women opting for first trimester abortion received oral Mifepristone followed 48 hours latermisoprostol. Group A received Misoprostol via buccal route whereas group B received Misoprostol vaginally. A comparative analysis using SPSS was done.Results: Giving 800µg Misoprostol by either buccal or vaginal route after oral Mifepristone have comparable efficacy in terms of complete abortion rate (96% in buccal group versus 98% in vaginal group; p value = 0.495), failure rate being statistically similar (4% versus 2%). Drug abortion interval was comparable in the two groups. (11.16 hour in buccal group and 12.32 hours in vaginal group). Few side effects like nausea and vomiting, shivering, diarrohea was significantly higher with vaginal Misoprostol while abdominal cramps, altered taste were found more with the buccal group.Conclusions: Buccal Misoprostol is comfortable and easier to administer when compared to other routes and it has potential to be developed as a self-administered regimen. Buccal Misoprostol is as efficacious as vaginal Misoprostol with significantly lesser side effects up to 7 weeks of period of gestation.

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Comparative study of intra vaginal misoprostol (PGE1) with intracervical dinoprostone (PGE2) gel for induction of labour

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20183792 ◽

2018 ◽

Vol 7 (9) ◽

pp. 3769

Author(s):

Bina M. Raval ◽

Nainesh S. Zalavadiya ◽

Pushpa A. Yadava ◽

Shital T. Mehta

Keyword(s):

Caesarean Section Rate ◽

Cost Effective ◽

Active Phase ◽

Cross Sectional Study ◽

Cervical Ripening ◽

Cross Sectional ◽

Misoprostol Group ◽

The Mean ◽

Vaginal Misoprostol ◽

Mean Time

Background: Labour is a final consequence of Pregnancy and is inevitable. The timing of labour may vary widely but it will happen sooner or later. The aim of the present research was to study the safety, efficacy and effect of intra vaginal Misoprostol and intra cervical Dinoprostone gel for induction of labour.Methods: 100 patients who required labour of induction were included in this prospective cross-sectional study from September 2017- March 2018. 50 patients of them received 25mcg tablet misoprostol intravaginal and 50 patients of them required 0.5mg intracervical dinoprostone gel and doses were repeated every 6 hourly for up to maximum 6 doses for Misoprostol and 3 doses for Dinoprostone gel.Results: The majority of patients had gestational age above 40 weeks and between 37-40 weeks in PGE2 and PGE1 group respectively. The mean time taken for the onset of labour was less in Misoprostol than in Dinoprostone group (43.22min v/s 1 hr40 min). The mean time taken for induction to active phase of labour (1hr 42min v/s 4hr 10min) and active phase to delivery (3hr 6min v/s 4hr54min) was less in Misoprostol than Dinoprostone group. The mean time required for induction to delivery was less in Misoprostol group (5hr 2min v/s 11hrs). Requirement of oxytocin for augmentation of labour was almost equal in both groups. Caesarean section rate was less in Misoprostol group (10% v/s 22%). Maternal side effects were minimal in either groups and neonatal outcome was good in both the groups.Conclusions: Both Misoprostol and Dinoprostone gel are safe, effective for cervical ripening and induction but Misoprostol is more cost effective and stable at room temperature.

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Oral and vaginal route of misoprostol for induction of labour: a comparative study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20191950 ◽

2019 ◽

Vol 8 (5) ◽

pp. 1956

Author(s):

Deepti D. Sharma ◽

Kavita A. Chandnani

Keyword(s):

Cesarean Section ◽

Vaginal Delivery ◽

Induction Of Labour ◽

Vaginal Route ◽

Oral Misoprostol ◽

Group A ◽

The Mean ◽

Vaginal Misoprostol ◽

Group B ◽

To Receive

Background: Induction of labour can be defined as “Artificial initiation of uterine contractions before the onset of spontaneous labour, after the period of viability, by any methods, for purpose of vaginal delivery.” The key factor for a successful induction is the status of cervix, its form, consistency and dilatation which is determined by the Bishop score. In case of unfavourable cervix or in the pregnancies remote from the term; prostaglandins are more effective than any other method of induction. Introduction of misoprostol, PGE1 analogue, for the induction of labour in 1993 and its approval for clinical use by ACOG (American College of Obstetrics and Gynecology) in 1999 has been the most significant advancement. It is the latest drug for induction of labour which is cheap and stable at room temperature and is being used worldwide in different doses and by various routes. We compared the most commonly preferred two routes; vaginal and oral in terms of success of induction and noted the adverse events and side effects in both routes.Methods: This was a prospective comparative study carried out at SBKSMIRC (Shrimati Bhikhiben Kanjibhai Shah Medical Institute and Research Centre), Dhiraj general hospital, Vadodara, Gujarat, 200 patients who required induction of labour were recruited after applying inclusion and exclusion criteria and were randomly divided in two groups- Group A meant to receive 50µg oral misoprostol, Group B - meant to receive 25µg vaginal misoprostol repeated 4 hourly up to maximum of five doses. Progress of labour was charted on the partograph. The mean induction delivery interval, mode of delivery, maternal and neonatal outcomes and complications were observed.Results: The mean induction to delivery interval was significantly less in vaginal group than oral (23.3±12.4 hours in oral vs. 17.3±10 hours in vaginal). Vaginal delivery and cesarean section rates were comparable in both groups (76% in Group A vs. 72% in Group B for vaginal delivery, 18% vs. 20% for Cesarean section, respectively). 58% patients in Group A required more than two doses as compared to 39% in group B, though the difference was statistically not significant. Significant number of patients required added oxytocin administration in Group A (72%). No major complications or adverse events were observed. Neonatal hyperbilirubinemia was seen more in Group A.Conclusions: Both Oral misoprostol in a dose of 50μg and vaginal misoprostol 25 μg every four hours, to a maximum of five doses, have the potential to induce labour safely and effectively. The vaginal route however is beneficial in effecting delivery in lesser time with few numbers of doses as compared to oral route.

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