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Oral Misoprostol vs. Vaginal Misoprostol For Cervical Ripening and Labor Induction

This study compared the efficacy of oral versus vaginal misoprostol for cervical ripening and labor induction. 80 women were randomly assigned to receive 50 micrograms of misoprostol either orally or vaginally every 6 hours until the initiation of labor. The induction-to-delivery interval was significantly longer in the oral misoprostol group compared to the vaginal group. More women in the oral group required oxytocin augmentation and had cesarean deliveries. There were no significant differences in adverse outcomes for newborns between the two groups. The results suggest that vaginal misoprostol may be more effective than oral misoprostol for cervical ripening and labor induction.

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34 views

Oral Misoprostol vs. Vaginal Misoprostol For Cervical Ripening and Labor Induction

This study compared the efficacy of oral versus vaginal misoprostol for cervical ripening and labor induction. 80 women were randomly assigned to receive 50 micrograms of misoprostol either orally or vaginally every 6 hours until the initiation of labor. The induction-to-delivery interval was significantly longer in the oral misoprostol group compared to the vaginal group. More women in the oral group required oxytocin augmentation and had cesarean deliveries. There were no significant differences in adverse outcomes for newborns between the two groups. The results suggest that vaginal misoprostol may be more effective than oral misoprostol for cervical ripening and labor induction.

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Corín Anel
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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International Journal of Gynecology and Obstetrics (2005) 89, 142 143

www.elsevier.com/locate/ijgo

BRIEF COMMUNICATION

Oral misoprostol vs. vaginal misoprostol for cervical


ripening and labor induction
I. Adama,T, O.A. Hassana, E.M. Elhassanb
a

New Halfa Teaching Hospital, Sudan


University of Geizera, Sudan

Received 30 June 2004; received in revised form 16 November 2004; accepted 23 November 2004

KEYWORDS
Oral misoprostol;
Labor;
Vaginal delivery

Induction of labor can be necessary for various


obstetrical and medical indications, and its success
depends mainly on the condition of the cervix [1].
In recent years there has been a wide interest in
the drug misoprostol, which was originally manufactured for the prevention and treatment of
peptic ulcers. Misoprostol has recently been
reported to be as effective as dinoprostone for
cervical ripening and labor induction, and it costs
much less than dinoprostone and does not require
refrigeration [2]. Because of variations in its
pharmacokinetics, it can be applied by different
routes [3]. The effectiveness and safety of intravaginal and oral misoprostol have been reported to
be similar [4], but the oral route seems to have
been the more attractive option because its
T Corresponding author. P.O. Box 61, New Halfa, Sudan. Tel.:
+249 421 822101, +249 421 821880; fax: +249 421 822070.
E-mail address: [email protected] (I. Adam).

administration of is easier and does not restrict


womens mobility.
A prospective, randomized, controlled clinical
trial was performed at New Halfa teaching hospital
to test the efficacy of oral vs. vaginal misoprostol
for cervical ripening and labor induction.
Women admitted to the labor ward from June
2002 through November 2003 were approached for
participation in the study. Inclusion criteria were a
singleton pregnancy and an unripe cervix (Bishops
score b5). Women undergoing uterine surgery,
experiencing antepartum hemorrhage, or with a
history of asthma, heart disease, and/or grand
multiparity (z7 pregnancies) were excluded.
The women were randomly assigned to the
oral or vaginal misoprostol group. Tablets of 50
Ag of misoprostol (Cytotec; SearleSearle LLC, a
subsidiary of Pharmacia Corporation Chicago)
were administered every 6 h until initiation of
labor (or a maximum of 4 doses). Uterine
contractions were assessed by palpation and
fetal heart sound by auscultation. Outcome
measures were induction-to-delivery interval,
necessity of oxytocin augmentation, presence of
meconium-stained liquor, cesarean delivery rate,
Apgar score, and referral of the newborn to the
pediatrician.

0020-7292/$ - see front matter D 2005 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd.
All rights reserved.
doi:10.1016/j.ijgo.2004.11.033

Oral misoprostol
Table 1

143

Comparison of different outcome measures in the oral misoprostol vs. vaginal misoprostol groupa

Variable

Oral group (n=40)

Vaginal group (n=40)

P value

Induction-to-delivery interval, h
Oxytocin use
Meconium-stained liquor
Vaginal delivery
Forceps delivery
Cesarean delivery
Apgar score 1N7
Apgar score 5N7
Birth weight, meanFS.D., kg
Newborn referral of the baby to the pediatrician

20.06F6.5
18 (45)
1 (2.5)
20 (50)
8 (20)
12 (30)
38 (95)
38 (95)
2.97F0.38
5 (12.5)

15.5F7.5
10 (25)
3 (7.5)
25 (62.5)
7 (17.5)
8 (20)
36 (90)
36 (90)
3.04F0.45
6 (15)

0.005
0.43
0.65
0.05
0.15
0.05
0.83
0.83
0.54
0.96

Values are given as No. (%) unless otherwise indicated.

Means were compared using the t test whereas


percentages were compared using the v 2 test. A P
value of 0.05 or less was considered significant.
Eighty women were enrolled to the study, 40 in
each group. There were no statistical differences in
the indications for induction or the baseline
characteristics of the 2 groups (data not shown).
The induction-to-delivery interval was significantly longer in the oral than in the vaginal
misoprostol group (20.06F6.5 h vs. 15.5F7.5;
P=0.005). More women in the oral group received
oxytocin (45.06% vs. 25.0%; PN0.05). Significantly
fewer women in the oral group were delivered
vaginally ( P=0.05). The cesarean delivery rate was
significantly higher in the oral than in the vaginal
group, 30% vs. 20% ( P=0.05). There were no
significant differences between the 2 groups
regarding meconium-stained liquor, birth weight,

Apgars score, and newborn referral to the pediatrician (Table 1).

References
[1] Brindley BA, Sokol RJ. Induction and augmentation of labor:
bases and methods for current practice. Obstet Gynecol Surv
1988;43:730 43.
[2] Elhassan EH, Mirghani OA, Adam I. Intravaginal misoprostol
vs. dinoprostone as cervical ripening and labor-inducing
agents. Int J Gynecol Obstet 2004;85:285 6.
[3] Khan RU, El-Rafaey H, Sharma S, Sooranna D, Stafford M.
Oral, rectal and vaginal pharmacokinetics of misoprostol.
Obstet Gynecol 2004;103:866 70.
[4] Nopdonrattakoon L. A comparison between intravaginal and
oral misoprostol for induction. J Obstet Gynaecol Res
2003;29:87 91.

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