Comparison of vaginal and oral misoprostol, for the induction of labour in women with intra-uterine foetal death

Background: Misoprostol is a prostaglandin E1 analogue, a methyl-ester of prostaglandin E1 additionally methylated at C-16. Misoprostol is an effective myometrial stimulant of pregnant uterus, selectively binding to prostanoid receptors. The objective of the study was to compare the efficacy of vaginal and oral misoprostol for the induction of labour in women with intra-uterine foetal death (IUFD).Methods: A prospective randomised clinical trial, comparing 50µg oral and 50µg vaginal misoprostol, six hourlies for a maximum of four doses for the induction of labour in women with IUFD. All patients with IUFD after 28 weeks without previous uterine surgeries, without contraindications for prostaglandins are included in the study. The study was conducted in the Department of Obstetrics and Gynecology MVJ Medical College and Research Hospital, Hoskote. Bangalore from June 2012 to June 2015. It is a tertiary institution serving predominantly rural population. The primary outcome measure was the induction to delivery time, secondary all complications were noted.Results: Twenty-five women were randomised to the vaginal route and twenty-five to the oral route. The induction to delivery time was longer with vaginal misoprostol 10.5±4.03 compared to oral misoprostol (9.58±4.9). There was no significant difference in the amount of misoprostol needed to achieve successful induction in the two groups. 3 patients needed oxytocin augmentation to complete the induction of labour. There were no cases of failed induction. The systemic side effects (shivering, diarrhoea, vomiting and pyrexia) were more common with oral misoprostol (44.5%) compared to vaginal misoprostol (20%).Conclusions: Oral misoprostol achieved successful induction of labour in women with IUFD in a shorter time than vaginal misoprostol. Both routes are equally effective in termination of pregnancy. Sublingual route is easy to administer, patient compliant, no need for internal examination, less chance of labour dysfunction, less chance of post-partum sepsis.

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TO COMPARE THE EFFECTIVENESS OF EXTRA-AMNIOTIC SALINE INSTILLATION THROUGH FOLEY CATHETER PRIOR TO ORAL MISOPROSTOL WITH ORAL MISOPROSTOL ALONE IN INDUCING LABOUR IN PREGNANCIES >28 WEEKS WITH INTRAUTERINE FOETAL DEATH- A RANDOMIZED CONTROLLED TRIAL AT TE

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v4i2.944 ◽

2020 ◽

Vol 4 (2) ◽

Author(s):

Kamlesh Yadav ◽

Shilpee Singh

Keyword(s):

Birth Weight ◽

Foley Catheter ◽

Study Groups ◽

Induction Of Labour ◽

Foetal Death ◽

Group I ◽

Oral Misoprostol ◽

The Mean ◽

Group Ii ◽

Saline Instillation

Background: The present study aims to compare the results of EASI followed by oral misoprostol and oral misoprostol alone for induction of labour in pregnancies of more than 28 weeks with intrauterine foetal death. Methods: The present observational and prospective study is an attempt to compare the efficacy of extra-amniotic saline instillation with Foley catheter prior to oral misoprostol and oral misoprostol alone in induction of labour of pregnancies more than 28 weeks with intrauterine fetal death. Results: Most of the cases delivered vaginally in both study groups. The mean induction delivery time in group I was higher than group II and the results were statistically significant on comparing both groups. In group I, 78% cases were delivered within 24 hours whereas in group II 96% cases delivered within 24 hours of induction. There was no significant difference in the mean number of required misoprostol in both groups (p>0.05). Need of supplementation with oxytocin was more in group I as compared to group II and the p value is significant (p<0.01). Mean birth weight in group I was 2.25±0.75 kg and in group II was 2.27±0.77 kg. Maximum number of babies had birth weight between 1.52-2.50 kg with 44% in group I and 40% in group II (p>0.05). Only 4 cases had uterine tachysystole and only 1case had postpartum pyrexia. Very few complications were recorded in both the study groups (p>0.05). Conclusion: We concluded that oral misoprostol tablet alone is more effective at inducing and setting up the active labour in pregnancies of >28 weeks with intrauterine foetal death than EASI followed by oral misoprostol. It is inexpensive, has a long shelf life, can be easily stored at room temperature and patient remains ambulatory after induction with oral misoprostol. Oral misoprostol alone seems to have an edge over extra-amniotic saline instillation followed by oral misoprostol in all aspects. Keywords: Misoprostol, Extra-amniotic saline, Induction of labour.

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Effectiveness of Sublingual Versus Oral Misoprostol for Induction of Labour at Term

Indian Journal of Public Health Research & Development ◽

10.37506/v11/i1/2020/ijphrd/194153 ◽

2020 ◽

Vol 11 (1) ◽

pp. 840

Author(s):

Rekha Parimkayala ◽

Shraddha Shetty K.

Keyword(s):

Induction Of Labour ◽

Oral Misoprostol

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Cervical ripening and induction of labour: Inpatient or outpatient, oral misoprostol or Foley catheter?

Ceylon Medical Journal ◽

10.4038/cmj.v62i3.8512 ◽

2017 ◽

Vol 62 (3) ◽

pp. 117

Author(s):

M Goonewardene

Keyword(s):

Foley Catheter ◽

Induction Of Labour ◽

Cervical Ripening ◽

Oral Misoprostol

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

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20202341 ◽

2020 ◽

Vol 9 (6) ◽

pp. 2520

Author(s):

Raj M. Mehta ◽

Babulal S. Patel ◽

Akshay C. Shah ◽

Shashwat K. Jani ◽

Vismay B. Patel ◽

...

Keyword(s):

Adverse Events ◽

Comparative Study ◽

Mode Of Delivery ◽

Induction Of Labour ◽

Successful Outcome ◽

Oral Misoprostol ◽

Misoprostol Group ◽

Group A ◽

Vaginal Misoprostol ◽

Group B

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.

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Comparative study of mifepristone and misoprostol versus misoprostol alone in induction of labour in late intrauterine fetal death

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20180878 ◽

2018 ◽

Vol 7 (3) ◽

pp. 987

Author(s):

Hemalatha K. R. ◽

Qutejatul Kubra Mulla

Keyword(s):

Fetal Death ◽

Induction Of Labour ◽

Intrauterine Fetal Death ◽

Combination Regimen ◽

Intrauterine Death ◽

Group I ◽

Oral Misoprostol ◽

Undesirable Consequence ◽

Group Ii ◽

A Prospective Study

Background: Intrauterine fetal death is most undesirable consequence of pregnancy and stressful condition for women and family and for health professional. Naturally, majority of women (over 90%) go in for spontaneous labour and deliver within 3 weeks of intrauterine death. Prolonged retention of dead fetus in utero has complications like DIC, psychological stress and infection. Various methods are available to induce labor in intrauterine fetal death. One such regimen is medical management using a combination of Mifepristone and Misoprostol. The objective of this study was to compare efficacy and safety of combination of mifepristone and misoprostol versus misoprostol only in induction of labour in late intrauterine fetal death.Methods: A prospective study was carried out in KIMS, Hubli between Jan 2014 to Dec 2015.Data from 100 women with intrauterine fetal death between gestational age of 24-42 weeks were analysed. They were divided into 2 groups of 50 each. Group I received single oral dose of 200mg mifepristone followed 24 hours later with oral misoprostol (100µg-50µg) every 4 hourly. Group II received only misoprostol. Outcomes were measured in terms of induction to delivery interval and number of misoprostol doses required.Results: Mean induction to delivery interval in Group I was 8.3 hours versus13.4 hours in Group II. Induction delivery interval was shorter in combined regimen. Total dose of misoprostol was also less in Group I.Conclusions: Both regimens are safe for induction of labour in late intrauterine fetal death. However, the induction delivery interval and dose of misoprostol required was decreased in combination regimen.

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