Induction of labour at term: 25 mcg 2 hourly oral misoprostol or 6 hourly intracervical cerviprime, safety and efficacy (original) (raw)
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International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2018
Induction of labour is defined as the process of artificially initiating uterine contractions, prior to their spontaneous onset, with progressive effacement and dilatation of the cervix and ultimately, the delivery of the baby. 1 There are many indications for term labour induction, including post dated pregnancy, preeclampsia, diabetes mellitus, oligohydramnios, intrauterine fetal growth retardation and abnormal ante partum fetal surveillance results. 2 With more than 15% of all gravid women requiring aid in cervical ripening and labour induction, there is widespread interest in, and demand for, an effective and safe method of assistance. The immature cervix is the greatest barrier to labour induction. As oxytocin affects mostly uterine contractions and minimally cervical ripening, prostaglandin agents are the first choice for labour inductions as they exert a local effect on the ABSTRACT Background: With more than 15% of all gravid women requiring prostaglandins in cervical ripening and labour induction. However, evidence is not clear about the preferred route or dose of the drug. So this study was designed with objectives to compare the induction delivery interval and safety of titrated oral misoprostol solution with vaginal misoprostol for labour induction in term primigravida women. Methods: In this randomised controlled trial out of 576 eligible women, 220 women as per inclusion criteria between 37 and 42 weeks of gestation with an unfavourable cervix (Bishop score <6) with indication for labour induction were randomly assigned (110each) to receive titrated oral solution of 20 mL misoprostol solution (1 mcg/mL) every 1 hour for four doses and then were titrated against individual uterine response or vaginal misoprostol 25 mcg every 4 hours. Vaginal delivery within 12 hours was the primary outcome. The data were analyzed by intention-to-treat. Results: Vaginal delivery occurred within 12 hours in 56 (50.9%) women in the titrated oral group and 24 (21.8%) women in the vaginal group with significant p-value (<0.001). The incidence of caesarean, hyper stimulation, low apgar score was less in the titrated oral group. More women experienced nausea in the titrated oral group. Conclusions: Titrated oral misoprostol is safe and effective for labour induction in primigravida patients with unfavourable cervix.
Journal of Medical Science And clinical Research, 2018
Background: Induction of labour is defined as the process of artificial stimulation of uterine contractions before the spontaneous onset of labour. Amongst the plethora of techniques available for induction of labour, Prostaglandins remain the single most effective mean of cervical ripening and inducing labour. Objectives: Current study was carried out to compare the efficacy of sublingual misoprostol with intravaginal misoprostol for induction of labour. Methodology: This was a hospital based randomized prospective study conducted in the Department of Obstetrics and Gynaecology at RIMS Imphal. 462 women at term pregnancy with single live foetus having Bishop Score ≤6 who required induction of labour for various indications were enrolled and randomly allocated into two groups. Group 1 received 50mcg misoprostol vaginally while second group received same dose of misoprostol sublingually every 4-6hourly. Outcome measures related to labour and maternal and fetal side effects were compared. Results: There was no significant difference between both groups with regards to base line characteristic , indications for induction of labour, mean interval from the initiation of induction to the delivery, neonatal outcome and maternal complications. However significant difference was observed in Bishop Score after 4 hours and requirement of oxytocin augmentation. Conclusion: Misoprostol can be used either sublingually or by vaginal route for induction of labour at term without any major fetal and maternal side effects.
A comparative study of misoprostol oral versus vaginal route for induction of labour
International Journal of Reproduction, Contraception, Obstetrics and Gynecology
Background: Induction of labour at term is a common obstetric intervention. Prostaglandin E2 has been the agent of choice for pre-induction of cervical ripening for several decades. In recent time, prostaglandin E1 analogue (misoprostol) is a preferred new agent for pre-induction cervical ripening and labour induction owing to inexpensive, stable in room temperature, administrable through several routes. The ideal dose, route, and frequency of administration of misoprostol are still under investigation.Methods: A double blind parallel group placebo control randomized clinical trial was done in the department of obstetrics and gynecology of Agartala Govt. Medical College among 130 pregnant women those required induction of labour. In this clinical trial, the women were allocated by lottery to receive oral misoprostol (25 μg) and vaginal placebo (same dosage) or vaginal misoprostol (25 μg) and oral placebo (same dosage. Both active and placebo drug (25 mcg) were repeated at 4 hours. i...
Pakistan Armed Forces Medical Journal, 2019
Objective: To compare the outcome of oral misoprostol (20µg 2 hourly) with vaginal misoprostol (25µg 6hourly) for induction of labour in term pregnancies, in terms of frequency of vaginal delivery and cesarean section. Study Design: Randomized clinical trial. Place and Duration of Study: Department of Gynecology and Obstetrics, Unit II, Maternal and Child Health Centre, Pakistan Institute of Medical Sciences, Islamabad from, Jan to Dec 2015. Subjects: All pregnant women at term (>37 weeks gestation) with obstetric and medical indication for induction of labour and having Bishop Score ≤6 were included in this study. Parity ≥4, previous history of obstetric and gynecological surgery and suspected cephalopelvic disproportion were excluded. Material and Methods: The study was conducted after approval from the ethical committee of the hospital. The subjects fulfilling inclusion criteria were enrolled after informed consent. The women randomized to group A received 20 ug oral misoprost...
Journal of Obstetrics and Gynaecology Research, 2002
Objective: To compare the efficacy and safety of 100 µg oral misoprostol for induction of labor between the regimen of 3 hour and 6 hour interval administration.Methods: Singleton pregnancies indicated for induction of labor between 34 and 42 weeks of gestation in the condition of unfavorable cervix (Bishop score ≤ 4) and no contraindication for prostaglandins therapy were recruited into the study. All pregnant women were randomly assigned to receive 100 µg oral misoprostol every 3 hours or 6 hours until the cervix was favorable for amniotomy, spontaneous rupture of membranes or active labor occurred.Results: The mean time interval from induction to vaginal delivery was significantly shorter in the 3 hour interval group, compared with the 6 hour interval group (13.82 ± 6.98 h and 17.66 ± 7.48 h, P = 0.0019). There was no significant difference between the groups with regard to mode of delivery, analgesic requirement, maternal complication and neonatal outcome.Conclusions: 100 µg ora...
A comparison of vaginal misoprostol and prostaglandin E2 for induction of labour at term
Our objective was to compare the efficacy of vaginal misoprostol and tablet PGE2 for induction of labor at term.Methods: In this RCT a total of 140 women at term gestation were given either misoprostol (50 mcg) or prostaglandin E2 (3 mg) for induction of labour. The study was conducted at the Gynae/Obstetrics department, PAEC Hospital Islamabad, in a period of six months. All women requiring induction, having gestational age > 37 weeks, singleton pregnancy with cephalic presentation, bishop score < 6 and reassuring fetal heart rate tracing were included in the study. The study outcome was measurement of efficacy in terms of induction delivery interval, number of vaginal deliveries achieved within 24 hours, mode of delivery, total doses, need for oxytocin and number of successful inductions. Results: The mean age and average gestational age was similar in the two groups of patients. In group A (51.4%) patients required two doses while in group B (32.9%) took two doses. Similarly, (60%) patients required oxytocin in group A compared to (50%) in group B. The mean delivery induction interval was 10.8 hours (650 minutes) in group A compared to 9.01 hours (541 minutes) in group B; and this difference in two means is statistically significant. In group A (18.5%) patients required emergency cesarean section while in group B (27.1%) needed cesarean section. The major indication for emergency cesarean section in group B was fetal distress. Therefore misoprostol can play a very important role in the practice of obstetrics and gynecology in resource depleted countries where other prostaglandins are expensive and storage at low temperature is a problem.
Efficacy of Misoprostol and Prostaglandin E2 Gel for Induction of Labor in Term Pregnancy
Journal of Postgraduate Medical Institute, 2020
Objective: To compare the efficacy of Misoprostol with prostaglandin E2 in terms of induction to labor and delivery intervals in women with full term pregnancy. Methodology: This randomized controlled trial was conducted in the Department of Obstetrics and Gynecology, Lady reading Hospital (LRH), Peshawar from July 2017 to June 2018 on 116 patients who were admitted for induction of labor. All the selected patients were randomly allocated into two groups i.e. group A who received 50 mcg tablet of Misoprostol and group B who received 2 mg of Prostaglandin E2 gel vaginally. The main outcome variables were interval from induction to labor, induction to delivery and mode of delivery. Student t test was applied for calculation of difference between the two groups to find out the efficacy of Misoprostol and Prostaglandin E2 Gel in induction and onset of significant uterine contractions and induction to delivery interval. Results: The interval from insertion of drug to the onset of labo...