Comparison Between Use of Oral Misoprostol Versus Vaginal Misoprostol for Induction of Labour at Term

Original Article

Abstract

Background and Objective

In modern obstetrics, around 30% of cases require induction of labour for various reasons. Misoprostol is gaining popularity as pharmacological inducing agent, though the route and dosage of administration are not standardised. The objective of the study is to compare the safety and efficacy of the two routes of misoprostol administration—oral (100 μg 4th hourly) and vaginal (25 μg 4th hourly), for induction of labour at term.

Methods

In this randomised trial, 104 women having crossed the expected date of delivery without going into spontaneous labour and cases which had premature rupture of membranes <12 h were considered for labour induction and were divided into two equal groups. Group A received 100 μg misoprostol orally 4th hourly, and group B received 25 μg misoprostol vaginally 4th hourly. Labour characteristics and maternal and foetal outcome were compared.

Results

In terms of maternal outcome, mean number of doses for oral group is 2.73 and vaginal group is 3.04. In oral group, mean induction to vaginal delivery interval was 13 h 43 min and in vaginal group interval is 13 h 26 min which was statistically not significant. The need for oxytocin augmentation was also statistically not significant. Both groups had equal number of failed inductions. Emergency LSCS done for foetal distress was more in vaginal group 2.9% compared to oral group which is 1%, but difference was not statistically significant (p value −0.55). Number of thick MSL in oral group was 3.2% as compared to vaginal group which is 10.7% which was statistically significant (p value −0.04). APGAR score at 5 min 7/10 was seen in 7.7% in vaginal group as compared to 0% in oral group which was also statistically significant (0.004). Number of NICU admissions was also more in vaginal group compared to oral group.

Conclusion

Misoprostol in either oral or vaginal route has proven to be equally effective for inducing labour in women at term pregnancy. However, occurrence of lesser incidence of meconium-stained liquor and NICU admissions and fewer caesareans with better neonatal outcome in women induced with oral misoprostol outweighs its advantages over the vaginal misoprostol.

Keywords

Pregnancy Misoprostol Induction NICU 

Notes

Compliance with Ethical Standards

Conflict of interest

Both authors declare that they have no conflict of interest.

Human and Animal Right Statements

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation and with Helsinki Declaration 1975, as revised in 2008.

Ethical statement

This study was approved by the institutional ethical committee.

Informed Consent

Informed consent was obtained from all patients for being included in the study.

References

  1. 1.
    Cunningham FG, Leveno KJ, Bloom SL, et al. Williams obstetrics. In: Labour induction. 24th ed. McGraw Hill: New York; 2014. p. 523–4.Google Scholar
  2. 2.
    Arias F, Daftary SN, Bhide AG. Practical guide to high risk pregnancy and delivery. In: Bhide A, Arulkumaran S, editors. Abnormal labour and delivery. 3rd ed. Amsterdam: Elsevier; 2008. p 373–90.Google Scholar
  3. 3.
    Khatri R, Sharma J, Amatya A. Oral, vaginal misoprostol: which route for induction of term labor? N J Obstet Gynaecol. 2007;2(1):23–8.Google Scholar
  4. 4.
    Rasheed R, Alam AA, Younus SR. Oral versus vaginal misoprostol for labour induction. J Pak Med Assoc. 2007;57(8):404–7.PubMedGoogle Scholar
  5. 5.
    Emmaneul PC, Ugwu EO, Obi SN, et al. Oral versus vaginal misoprostol for induction of labor in Enugu, Nigeria. Arch Gynaecol Obstetr. 2015;291(3):537–44.CrossRefGoogle Scholar
  6. 6.
    Komala K, Reddy M, Quadri IJ, et al. Comparative study of oral and vaginal misoprostol for induction of labour, maternal and fetal outcome. J Clin Diag Res. 2013;7(12):2866–969.Google Scholar
  7. 7.
    Uludag S, Salihoglu Saricali F, Madazli R, et al. A comparison of oral and vaginal misoprostol for induction of labor. Eur J Obstet Gynecol Reprod Biol. 2005;122(1):57–60.CrossRefPubMedGoogle Scholar
  8. 8.
    Deshmukh VL, Yelikar KA, Waso V. Comparitive study of efficacy and safety of oral versus vaginal misoprostol for induction of labour. J Obstet Gynaecol. 2013;63(5):321–4.Google Scholar
  9. 9.
    Abbassi RM, Sirichand P, Rizvi S. Safety and efficacy of oral versus vaginal misoprostol use for induction of labor at term. J Coll Phys Surg Pak. 2008;18(10):625–9.Google Scholar

Copyright information

© Federation of Obstetric & Gynecological Societies of India 2017

Authors and Affiliations

  1. 1.Department of Obstetrics and GynaecologyMMC & RIMysuruIndia

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