Labour Induction at Term; Oral versus Intravaginal Misoprostol

Abstract

Objective: To compare oral misoprostol (100mg) to vaginal misoprostol (25 µg) for cervical ripening and labor induction. Study design: Interventional study Place & duration of study: The study was carried out at Lady Willingdon Hospital, Lahore, during August 2006 to January 2007. Patients & methods: Fifty nine women with medical or obstetric indications for labor induction with undilated uneffaced cervices were assigned randomly to receive 100µg of oral or 25µg of vaginal misoprostol every 4 hours for 24 hours. Intravenous oxytocin was then given using a standardized protocol. Results: Among 59 subjects. 29 received oral and 30 received vaginal misoprostol. The mean interval from start of induction to delivery was 1240 ± 845 minutes for orally treated women and 1381±802 minutes for vaginally treated women (P=.06). More orally treated women delivered vaginally in 24 hours than vaginally treated women 17 versus 16 (P=.14). Twenty five women (86.2%) who received oral misoprostol delivered vaginally, compared with 26 women (86.7%) who received vaginal misoprostol (P=.07). Oxytocin was given to 14 (49.6%) orally treated and 16(53.3%) vaginally treated subjects. More women in oral group had tachysystole, three compared with one (P.06) and – hyper stimulation. Frequencies of intrapartum complications and birth outcome were similar between groups. Conclusion: Oral misoprostol 100 µg and vaginal misoprostol 25µg were similarly effective for cervical ripening and labor induction. Oral administration was associated with trends toward higher likelihood of vaginal delivery and more uterine tachysystole.