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Oral versus vaginal misoprostol for induction of labor in Enugu, Nigeria: a randomized controlled trial

Archives of Gynecology and Obstetrics volume 291, pages 537–544 (2015)Cite this article

Abstract

Objective

The study aimed at comparing the effectiveness and maternal satisfaction of oral misoprostol with vaginal misoprostol for induction of labor at term.

Materials and methods

A randomized controlled trial of 140 term pregnant women at the University of Nigeria Teaching Hospital Enugu, Nigeria, was conducted from April 2011 to May 2012. The women were equally randomized into two groups (A and B) to receive oral and vaginal misoprostol, respectively.

Results

The vaginal route reduced the mean induction–vaginal delivery interval by four-and-half hours (20.7 ± 12.1 vs. 16.2 ± 10.4; mean difference: 4.50, 95 % CI 0.63–0.82; p = 0.02). Furthermore, the mean dose of misoprostol required to achieve induction of labor and the mean duration of oxytocin augmentation when indicated were significantly less in the vaginal group than in the oral group (2.5 ± 1.3 vs. 2.0 ± 1.1; mean difference: 0.50, 95 % CI 0.10–0.90; p = 0.02 and 4.6 ± 3.2 vs. 3.4 ± 3.1; mean difference: 1.20, 95 % CI 0.15–0.23; p = 0.03 respectively). However, neonatal complications and maternal satisfaction were similar between the two groups.

Conclusion

Both routes of administration are effective in the induction of labor at term and have comparable maternal satisfaction. However, the vaginal route has the added advantage of shorter induction–delivery interval among others, and thus should be highly considered when induction of labor is indicated at term.

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References

  1. Orhue AA (1997) Review of induction of labor. Trop J Obstet Gynaecol 14:1–14

    Google Scholar 

  2. Rasheed R, Alam AA, Younus S, Raza F (2007) Oral versus vaginal misoprostol for labor induction. J Pak Med Assoc 57(8):404–407

    PubMed  Google Scholar 

  3. Akhtar Z, Tahir Saleem S, Lateef F (2010) Comparison of oral versus vaginal misoprostol for induction of labor at term. JRMC 14(1):104–106

    Google Scholar 

  4. Shetty A, Danielian P, Templeton A (2001) A comparison of oral and vaginal misoprostol tablets in induction of labor at term. BJOG 108(3):238–243

    CAS  PubMed  Google Scholar 

  5. Ayaz A, Saeed S, Farooq MU, Ahmad I, Ali Bahoo ML, Saeed M (2009) Labor induction with randomized comparison of oral and intravaginal misoprostol in post-date multigravida women. Malays J Med Sci 16(1):34–38

    PubMed Central  PubMed  Google Scholar 

  6. Fisher SA, Mackenzie VP, Davies GA (2001) Oral versus vaginal misoprostol for induction of labor at term: a double blind randomised controlled trial. Am J Obstet Gynecol 185(4):906–910

    CAS  PubMed  Article  Google Scholar 

  7. Nopdonrattakoon L (2003) A comparison between intravaginal and oral misoprostol for labor induction: a randomised controlled trial. J Obstet Gynaecol Res 29(2):87–91

    CAS  PubMed  Article  Google Scholar 

  8. Deshmukh VL, Yelikar KA, Waso V (2013) Comparative study of efficacy and safety of oral versus vaginal misoprostol for induction or labour. J Obstet Gynaecol India 63(5):321–324

    PubMed Central  PubMed  Article  Google Scholar 

  9. Mehrotra S, Singh U, Gupta HP (2010) A prospective double blind study using oral versus vaginal misoprostol for labour induction. J Obstet Gynaecol 30(5):461–464

    CAS  PubMed  Article  Google Scholar 

  10. Komala K, Reddy M, Quadri IJ, B S, V R (2013) Comparative study of oral and vaginal misoprostol for induction of labor, maternal and fetal outcome. J Clin Diagn Res 7(12):2866–2869

    PubMed Central  PubMed  Google Scholar 

  11. Alfirevic Z, Weeks A (2006) Oral misoprostol for induction of labour. Cochrane Database Sys Rev 2:CD001338 (Review)

    Google Scholar 

  12. Nassar AH, Awwad J, Khalil AM, Abu-Musa A, Mehio G, Usta IM (2007) A randomised comparison of patient satisfaction with vaginal and sublingual misoprostol for induction of labour at term. BJOG 114(10):1215–1221

    CAS  PubMed  Article  Google Scholar 

  13. Cheng S, Ming H, Lee J (2008) Titrated oral compared with vaginal misoprostol for labor induction: a randomised controlled trial. Obstet Gynecol 111(1):119–125

    CAS  PubMed  Article  Google Scholar 

  14. Wing DA, Park MR, Paul RH (2000) A randomized comparison of oral and intravaginal misoprostol for labor induction. Obstet Gynecol 95(6):905–908

    CAS  PubMed  Article  Google Scholar 

  15. Arvidsson C, Hellborg M, Gemzell-Danielsson K (2005) Preference and acceptability of oral versus vaginal administration of misoprostol in medical abortion with mifepristone. Eur J Obstet Gynecol Reprod Biol 123(1):87–91

    CAS  PubMed  Article  Google Scholar 

  16. Oppegaard KS, Qvigstad E, Nesheim BI (2006) Oral versus self-administered vaginal misoprostol at home before surgical termination of pregnancy: a randomised controlled trial. BJOG 113(1):58–64

    CAS  PubMed  Article  Google Scholar 

  17. Ugwu EO, Onah HE, Obi SN, Dim CC, Okezie OA, Chigbu CO, Okoro OS (2013) Effect of the Foley catheter and synchronous low dose misoprostol administration on cervical ripening: a randomised controlled trial. J Obstet Gynaecol 33(6):572–577

    CAS  PubMed  Article  Google Scholar 

  18. Ekele BA, Nnadi DC, Gana MA, Shehu CE, Ahmed Y, Nwaobodo EI (2007) Misoprostol use for cervical ripening and induction of labor in a Nigerian Teaching Hospital. Niger J Clin Pract 10(3):234–237

    CAS  PubMed  Google Scholar 

  19. Adeniji OA, Oladokun A, Olayemi O, Adeniji OI, Odukogbe AA, Ogunbode A, Aimakhu CO, Omigbodun AO, Ilesanmi AO (2005) Pre-induction cervical ripening: trans-cervical Foley catheter versus intravaginal misoprostol. J Obstet Gynaecol 25(2):134–139

    CAS  PubMed  Article  Google Scholar 

  20. Fawole AO, Adegbola O, Adeyemi AS, Oladapo OT, Alao MO (2008) Misoprostol for induction of labour: a survey of attitude and practice in southwestern Nigeria. Arch Gynecol Obstet 278(4):353–358

    PubMed  Article  Google Scholar 

  21. Ugwu EO, Obi SN, Iferikigwe ES, Dim CC, Ezugwu FO (2014) Membrane stripping to prevent post-term pregnancy in Enugu, Nigeria: a randomized controlled trial. Arch Gynecol Obstet 289(1):29–34

    CAS  PubMed  Article  Google Scholar 

  22. Schoenhard G, Oppermann J, Kohn FE (1985) Metabolism and pharmacokinetic studies of misoprostol. Dig Dis Sci 30:126S–128S

    CAS  PubMed  Article  Google Scholar 

  23. Zieman M, Fong SK, Benowitz NL, Banskter D, Darney PD (1997) Absorption kinetics of misoprostol with oral or vaginal administration. Obstet Gynecol 90(1):88–92

    CAS  PubMed  Article  Google Scholar 

  24. Bano K, Mahjabeen Bhutta SZ (2009) Oral versus vaginal misoprostol for induction of labour at term. J Surg Pak (International) 14(1):38–41

    Google Scholar 

  25. Akter S, Chowdhury SB, Fatema N (2010) A comparison of orally administered misoprostol with vaginally administered misoprostol for cervical ripening and labour induction. ORION Med J 33(1):710–713

    Google Scholar 

  26. Colón I, Clawson K, Hunter K, Druzin ML, Taslimi MM (2005) Prospective randomized clinical trial of inpatient cervical ripening with stepwise oral misoprostol vs vaginal misoprostol. Am J Obstet Gynecol 192(3):747–752

    PubMed  Article  Google Scholar 

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Conflict of interest

We declare that we have no conflict of interest.

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Affiliations

  1. Department of Obstetrics/Gynaecology, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria

    Paschalina Constance Ezechukwu, Emmanuel Onyebuchi Ugwu, Samuel Nnamdi Obi & Chibuike Ogwuegbu Chigbu

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  1. Paschalina Constance Ezechukwu
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  2. Emmanuel Onyebuchi Ugwu
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  3. Samuel Nnamdi Obi
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  4. Chibuike Ogwuegbu Chigbu
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Correspondence to Emmanuel Onyebuchi Ugwu.

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Ezechukwu, P.C., Ugwu, E.O., Obi, S.N. et al. Oral versus vaginal misoprostol for induction of labor in Enugu, Nigeria: a randomized controlled trial. Arch Gynecol Obstet 291, 537–544 (2015). https://doi.org/10.1007/s00404-014-3429-8

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  • DOI: https://doi.org/10.1007/s00404-014-3429-8

Keywords

  • Induction of labor
  • Oral misoprostol
  • Vaginal misoprostol
  • Nigeria