Oral Versus Vaginal Misoprostol for Induction of Labour

It is sometimes difficult to select the most effective, easy to use, safest, widely accepted and less expensive method for induction of labour and thereby spontaneous vaginal delivery. Prostaglandin E1 analogue ie misoprostol as a successful method both in oral and vaginal form has been used for induction of labour. The present study was conducted with an aim to compare the efficacy and safety of oral and vaginal administration of misoprostol tablets for cervical ripening and induction of labour in pregnant women using similar dosing regimen in two groups of pregnant women. A prospective randomized trial was done on one hundred pregnant women for the purpose. They were between 37 and 42 weeks of gestation with singleton pregnancy, cephalic presentation and unfavourable cervix (modified Bishops score of 4 or less) in the department of Obstetrics and Gynaecology of Dhaka Medical college Hospital during the period between February 2003 and March 2004. The mode of delivery did not vary significantly between the two groups. Mean induction delivery interval, mean doses of misoprostol, number of women delivered within 24 hours, oxytocin requirement and mean time to delivery were nearly similar in the two groups. Only nulliparous women in oral group took longer time to deliver than vaginal group though it was not statistically significant. The mode of delivery also did not differ significantly. The proportion of emergency caesarean section was high in vaginal group than oral group. Neonatal outcome was satisfactory and the results were comparable. (J Bangladesh Coll Phys Surg 2006; 24: 44-49)

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INDUCTION OF LABOUR

The Professional Medical Journal ◽

10.29309/tpmj/2011.18.02.2049 ◽

2011 ◽

Vol 18 (02) ◽

pp. 181-188

Author(s):

GHAZALA NASREEN ◽

MALIK AMJAD YASIN ◽

ABEERA CHOUDRY

Keyword(s):

Mode Of Delivery ◽

Induction Of Labour ◽

Cervical Ripening ◽

Military Hospital ◽

Oral Misoprostol ◽

Oral Group ◽

Quasi Experimental ◽

Group 2 ◽

Low Incidence ◽

Vaginal Misoprostol

Objective: To determine the efficacy and safety of stepwise oral misoprostol with vaginal misoprostol for cervical ripening for induction of labour. Study design: Interventional Quasi - Experimental study. Setting and duration: The study was of 15 months (April to 30 June) duration conducted at Obstetrics and Gynaecology department Military Hospital Rawalpindi. Subjects and methods: 100 females between 37-42 weeks of gestation were randomly divided into two groups 1and 2. Patients in group -1 assigned to the stepwise oral misoprostol arm received 50 μg initially followed by 100 μg every 04 hours upto maximum 04 doses ; group-2 assigned to the vaginal misoprostol arm received 25 μg every 04 hours up to maximum 04 doses. Subsequent doses of misoprostol were withheld if adequate uterine activity (≥3 contractions in 10 minutes) or a Bishop score ≥ 8 had been achieved, or active labour had begun. The main outcomes were the interval from first misoprostol dose to delivery and mode of delivery. Patients were also monitored for adverse events. Results: There was no difference in the average interval from the first dose of misoprostol to delivery in the oral (21.1 ± 7.9 hrs) and vaginal (21.5 ±11.0 hrs, p = NS) misoprostol groups. 9 patients in the oral group (18%) and 16 patients in the vaginal group (32%) underwent caesarean section (p<0.05). There were no significant differences in the occurrence of tachysystole, hypertonus, hyperstimulation or neonatal outcome between two groups. Conclusions: Oral misoprostol appears to be as effective as vaginal misoprostol for cervical ripening with a low incidence of hyperstimulation, no increase in side effects, and is associated with a lower cesarean section rate.

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A Comparison of Orally Administered Misoprostol With Vaginally Administered Misoprostol For Cervical Ripening And Labour Induction

KYAMC Journal ◽

10.3329/kyamcj.v7i1.33755 ◽

2017 ◽

Vol 7 (1) ◽

pp. 668-672 ◽

Cited By ~ 1

Author(s):

Sohana Siddique ◽

Muhammad Jahangir Howlader ◽

Joysree Saha ◽

Kazi Shahnaz Begum

Keyword(s):

Mode Of Delivery ◽

Cervical Ripening ◽

Labour Induction ◽

Efficacy And Safety ◽

Cross Sectional ◽

Oral Misoprostol ◽

Number Of Patients ◽

Oral Group ◽

Vaginal Misoprostol ◽

Duration Of Pregnancy

Objective: To compare efficacy and safety of oral misoprostol over vaginal misoprostol for labour induction.Materials and Methods: This is a cross sectional interventional hospital based comparative study which was carried in the department of Obstetrics and Gynecology in DMCH from 01.07.2008 to 31.12.2008.Results: Almost equal number of patients delivered vaginally spontaneously in both group, there is no association between route of administration and mode of delivery. Nausea,vomiting occurred more in oral group and uterine hypertonicity more in vaginal group.Conclusion: In this study, 50 patients were randomly selected for oral group and 50 patients for vaginal group. There were no significant differences regarding age, duration of pregnancy, Bishop's score and indication of induction of labour.KYAMC Journal Vol. 7, No.-1, Jul 2016, Page 668-672

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Use of Misoprostol in Term pregnant women for Good Delivery Outcome: Experience at a tertiary care Hospital in Dhaka

Journal of Science Foundation ◽

10.3329/jsf.v12i2.27733 ◽

2016 ◽

Vol 12 (2) ◽

pp. 22-26

Author(s):

Aftabun Nahar ◽

Rifat Sultana ◽

Fatema Mahbooba Akter ◽

Munira Ferdausi ◽

Md Abdullah Yusuf ◽

...

Keyword(s):

Pregnant Women ◽

Vaginal Delivery ◽

Tertiary Care ◽

Induction Of Labour ◽

Care Hospital ◽

Term Pregnancy ◽

Singleton Pregnancy ◽

Delivery Outcome ◽

Unfavourable Cervix ◽

Study Population

Background: Use of misoprostol in term pregnancy is very useful for the better outcome during delivery. Objective: The purpose of the present study was to see the delivery outcome among the term pregnant women. Methodology: This cohort study was carried out in the Department of Obstetrics and Gynaecology at Sir Salimullah Medical College and Mitford Hospital during the period from 1 st September 2005 to 28th February 2006. Primi or second gravida patients with the gestational age between 37 weeks to 42 weeks in singleton pregnancy with cephalic presentation and not in labour who came for delivery purposes during the study period at any age were selected as study population. After proper selection of the cases, induction of labour (IOL) was done by applying Tab Misoprostol 50mcg in the posterior vaginal fornix. Purpose of induction of labour was successful when vaginal delivery occurred without any untoward side effects and without any surgical interference. Result: Out of 60 pregnant women 21 (35%) patients had unfavourable Bishops' score with 3-5 and 39 (65%) patients had favorable Bishops' score with 6-10. 39 patients had favourable pre- induction cervical score, among them 79% had delivered vaginally and 21% had undergone LUCS. 21 patients had unfavourable cervix, among them 57% experienced vaginal delivery and 43% experienced LUCS. Out of all study population 60% of study population who were primigravide had vaginal delivery in 67% cases and caesarean section in 33% cases and among 40% 2nd gravida cases vaginal delivery was 79% and caesarean delivery was 21%. Conclusion: In conclusion the use of misoprostol during term pregnancy is significantly related with the normal delivery.Journal of Science Foundation 2014;12(2):22-26DOI: http://dx.doi.org/10.3329/jsf.v12i2.27733

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Induction of labour after 37 weeks of pregnancy using foley’s catheter: traction versus non-traction method

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20205781 ◽

2020 ◽

Vol 10 (1) ◽

pp. 275

Author(s):

Jaydeep J. Bhatu ◽

Disha Patel

Keyword(s):

Pregnant Women ◽

Vaginal Delivery ◽

Controlled Trial ◽

Foley Catheter ◽

Mode Of Delivery ◽

Induction Of Labour ◽

Labour Induction ◽

Unfavourable Cervix ◽

Foley’S Catheter ◽

Traction Group

Background: Cervical Foley’s catheter used now a days for induction of labour alone as well as a combined with cerviprim gel. The objective of the study was to assess the effectiveness of 750 cc traction on Foley catheter with no traction for labour induction in >37 weeks pregnancy.Methods: A randomized controlled trial performed on pregnant women at >37 weeks who were admitted for induction of labour with unfavourable cervix. They were randomly assigned into two groups, Foley’s with 750 cc traction and without traction. The primary outcomes were improvement in Bishop Score, number of favourable cervix following induction and the mode of delivery. The secondary outcomes were neonatal outcome, and maternal infection.Results: A total of 80 pregnant women were randomized into traction group (n=46) and non-traction group (n=34). Traction group had significantly (p=0.0462) higher number of vaginal delivery compared to non-traction group. Participants were comfortable using both methods. There was no difference in neonatal outcomes and risk of maternal infections in both groups.Conclusions: Application of traction did result in more vaginal delivery.

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COMPARATIVE STUDY BETWEEN FOLEY CATHETER AND DINOPROSTONE GEL FOR CERVICAL RIPENING AND INDUCTION OF LABOUR IN PATIENTS AT TERM WITH UNFAVOURABLE CERVIX (BISHOP'S SCORE<4)

10.36106/gjra/7400171 ◽

2019 ◽

pp. 1-4

Author(s):

Shrikant Warade ◽

Anshul Pahwa ◽

Savita Dhongade

Keyword(s):

Foley Catheter ◽

Mode Of Delivery ◽

Induction Of Labour ◽

Cervical Ripening ◽

Labour Induction ◽

Time Interval ◽

Vaginal Deliveries ◽

Unfavourable Cervix ◽

Group B ◽

Singleton Pregnancies

BACKGROUND- Since ancient times, labour inducton is a well established obstetric concept. In the past few decades, rate of labour induction has increased dramatically. The primary objective of this study was to compare the efcacy of transcervical foley catheter with intracervical dinoprostone gel for cervical ripening and labour induction in term singleton pregnancies with unfavourable cervix. METHODS- Term singleton pregnancies fullling inclusion criteria were randomized by chit box system to receive intracervical dinoprostone or transcervical foley catheter. Progress of labour was monitored with the help of partogram. Labour augmentation was done by oxytocin. RESULTS- 110 patients in each group were enrolled. Group A was induced with transcervical Foley catheter and group B with dinoprostone gel. Baseline characteristics like maternal age, parity, gestational age were comparable in each group. There was a signicant difference in the Bishop's score (<.0.05) at the end of 12 hours, Group B showing a greater improvement than A. A signicant difference was also observed in the requirement of augmentation with Pitocin, 77.27% in foley group and 63.63% in dinoprostone group . Although, there was no signicant difference observed in the mode of delivery (p>0.05) and induction to delivery time interval (p>0.05) , maternal and neonatal morbidity between the groups. CONCLUSION- To conclude, Dinoprostone is associated with rapid cervical ripening . Although, mean induction to delivery interval and number of vaginal deliveries were comparable between the groups. Moreover, cost and safety prole of foley catheter makes it comparable or even superior to dinoprostone gel for cervical ripening and induction of labour, especially in developing countries.

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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

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20182346 ◽

2018 ◽

Vol 7 (6) ◽

pp. 2339

Author(s):

Puneeta Mahajan ◽

Rajendra Popatrao Shitole

Keyword(s):

Vaginal Delivery ◽

Controlled Trial ◽

Oral Solution ◽

Cervical Ripening ◽

Labour Induction ◽

P Value ◽

Oral Misoprostol ◽

Unfavourable Cervix ◽

Oral Group ◽

Vaginal Misoprostol

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: In this randomised controlled trial out of 576 eligible women, 220 women as per inclusion criteria between 37 and 42 weeks of gestation with an unfavourable cervix (Bishop score <6) with indication for labour induction were randomly assigned (110each) to receive titrated oral solution of 20 mL misoprostol solution (1 mcg/mL) every 1 hour for four doses and then were titrated against individual uterine response or vaginal misoprostol 25 mcg every 4 hours. Vaginal delivery within 12 hours was the primary outcome. The data were analyzed by intention-to-treat.Results: Vaginal delivery occurred within 12 hours in 56 (50.9%) women in the titrated oral group and 24 (21.8%) women in the vaginal group with significant p-value (<0.001). The incidence of caesarean, hyper stimulation, low apgar score was less in the titrated oral group. More women experienced nausea in the titrated oral group.Conclusions:Titrated oral misoprostol is safe and effective for labour induction in primigravida patients with unfavourable cervix.

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Maternal and perinatal outcomes in women with eclampsia by mode of delivery at Riley mother baby hospital: a longitudinal case-series study

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03875-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Koech Irene ◽

Poli Philippe Amubuomombe ◽

Richard Mogeni ◽

Cheruiyot Andrew ◽

Ann Mwangi ◽

...

Keyword(s):

Pregnant Women ◽

Perinatal Mortality ◽

Mode Of Delivery ◽

Case Series ◽

Perinatal Outcomes ◽

Induction Of Labour ◽

Chi Square ◽

Case Series Study ◽

Chi Square Test ◽

Series Study

Abstract Background Eclampsia, considered as serious complication of preeclampsia, remains a life-threatening condition among pregnant women. It accounts for 12% of maternal deaths and 16–31% of perinatal deaths worldwide. Most deaths from eclampsia occurred in resource-limited settings of sub-Saharan Africa. This study was performed to determine the optimum mode of delivery, as well as factors associated with the mode of delivery, in women admitted with eclampsia at Riley Mother and Baby Hospital. Methods This was a hospital-based longitudinal case-series study conducted at the largest and busiest obstetric unit of the tertiary hospital of western Kenya. Maternal and perinatal variables, such as age, parity, medications, initiation of labour, mode of delivery, admission to the intensive care unit, admission to the newborn care unit, organ injuries, and mortality, were analysed using the Statistical Package for the Social Sciences software version 20.0. Quantitative data were described using frequencies and percentages. The significance of the obtained results was judged at the 5% level. The chi-square test was used for categorical variables, and Fisher’s exact test or the Monte Carlo correction was used for correction of the chi-square test when more than 20% of the cells had an expected count of less than 5. Results During the study period, 53 patients diagnosed with eclampsia were treated and followed up to 6 weeks postpartum. There was zero maternal mortality; however, perinatal mortality was reported in 9.4%. Parity was statistically associated with an increased odds of adverse perinatal outcomes (p = 0.004, OR = 9.1, 95% CI = 2.0–40.8) and caesarean delivery (p = 0.020, OR = 4.7, 95% CI = 1.3–17.1). In addition, the induction of labour decreased the risk of adverse outcomes (p = 0.232, OR = 0.3, 95% CI = 0.1–2.0). Conclusion There is no benefit of emergency caesarean section for women with eclampsia. This study showed that induction of labour and vaginal delivery can be successfully achieved in pregnant women with eclampsia. Maternal and perinatal mortality from eclampsia can be prevented through prompt and effective care.

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A study of effect of oral PGE1 and cervical PGE2 on induction of labor and mode of delivery

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20181995 ◽

2018 ◽

Vol 7 (6) ◽

pp. 2160

Author(s):

Sukanya Mukherjee ◽

H. Valson ◽

Balaji K.

Keyword(s):

Mode Of Delivery ◽

Induction Of Labor ◽

Cervical Ripening ◽

P Value ◽

Singleton Pregnancy ◽

Outcome Indicators ◽

Oral Misoprostol ◽

Vaginal Deliveries ◽

Group A ◽

Group B

Background: Induction of labor is one of the most important procedures done by the Obstetricians. Induction of labor with the help of prostaglandins offer the advantage of promoting cervical ripening along with stimulating the contractility of the myometrium.Methods: 200 pregnant women with singleton pregnancy both nulliparous and multiparous, were included in the study at term gestation (>39weeks) with Bishop’s score <6, and reactive NST. The subjects were divided in to two groups Group A including patients who were given oral PGE1 - 50 mcg Tab, and Group B with cervical PGE2, 0.5 mg, gel. The outcome indicators were recorded in both Group A and Group B and analyzed. The mean time taken from induction to vaginal delivery in Group A was 628±67 minutes and in Group B was 839±118 minutes. Incidence of LSCS in Group B when compared to Group A (p value <0.005).Results: Incidence of LSCS in Primi’s in Group B compared to Primi’s in Group A was statistically significant (p value 0.009). Non-progression of labor was observed to be the major indication for LSCS in Group B. Meconium stained labor was found to be the major indication for LSCS in Group A.Conclusions: The study concludes that using 50 mcg oral misoprostol, is an effective and safe mode of induction of labor in comparison to PGE2 gel. Vaginal deliveries are more with the use of oral misoprostol and the induction to delivery interval is also lesser than that in cervical PGE2 use.

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