A Comparison of 25 μg with 50 μg Misoprostol for Cervical Ripening and Induction of Labor (original) (raw)
Related papers
Labor induction post-term with 25 micrograms vs. 50 micrograms of intravaginal misoprostol
International Journal of Gynaecology and Obstetrics, 2003
Objectives: To compare the effectiveness of 25 mg vs. 50 mg of intravaginal misoprostol for cervical ripening and labor induction beyond 41 weeks' gestation. Methods: The study population consisted of 120 women not in active labor with a gestational age )41 weeks, singleton pregnancy with vertex presentation, reactive fetal heart rate tracing, amniotic fluid index G5, and Bishop score -5. Women were randomized to receive either 25 mg (ns60) or 50 mg (ns60) of intravaginal misoprostol. The dose was repeated every 4 h (maximum number of doses limited to six) until the patient exhibited three contractions in 10 min. The main outcome measure was the induction-vaginal delivery interval. Results: There was no significant difference between the two groups with regard to the inductionvaginal delivery interval (685"201 min in the 25 mg group vs. 627"177 min in the 50 mg group, Ps0.09). The proportion of women delivering vaginally with one dose of vaginal misoprostol was significantly greater in the 50 mg group (0y49 vs. 41y47, P-0.001). There were no differences in the rates of cesarean and operative vaginal delivery rates, or in the incidences of tachysystole and hyperstimulation syndrome in the two treatment groups. Neonatal outcomes were also similar. Conclusions: Intravaginal administration of 25 mg of misoprostol appears to be as effective as 50 mg for cervical ripening and labor induction beyond 41 weeks' gestation.
2023
Objective: To compare the effectiveness and safety of 50μg of sublingual misoprostol administered six (6) hourly to that of 50μg of vaginal misoprostol administered four (4) hourly. Methodology: A non-blinded, randomized controlled trial conducted from Sept 1, 2014, to Nov 31, 2014, at a tertiary hospital in Ghana. Hundred and sixty women with medical or obstetric indications for labour induction were randomized into two groups. Results: The rate of vaginal delivery, caesarean section, uterine tachysystole and uterine hyperstimulation were similar in both groups. Sixty-three (78.8%) and 66 (82.5%) mothers in the vaginal and sublingual groups delivered vaginally. More (10.0%) mothers in the vagina group required emergency caesarean for foetal distress. Six (vaginal group) and 8 (sublingual group) of the mothers required emergency caesarean for cephalopelvic disproportion. Three mothers from each group had an emergency caesarean section due to failed labour induction. Almost the same number of mothers had uterine tachysystole in both groups. More (3.8%) mothers in the vaginal group had uterine hyperstimulation. Differences in the mean induction delivery interval and the need for oxytocin augmentation were not significant. No differences were found in the intrapartum passage of meconium, blood loss in the third stage of labour, 5-minute Apgar score <7, and neonatal intensive care unit admissions. Conclusion: The sublingual regimen was as effective and safe as the vaginal regimen in achieving vaginal delivery.
Randomization of vaginal and sublingual misoprostol for cervical ripening and labor induction
Tropical Journal of Obstetrics and Gynaecology, 2020
Background: Planned induction of labor for various indications has become an established part of modern Obstetric practice. While the efficacy of misoprostol, a prostaglandin E1 analog as a cervical ripening labor induction agent has been established, the appropriate route and dosage are still objected to ongoing research. Objective: This study aims at comparing the efficacy of vaginally administered with sublingual misoprostol for cervical ripening and labor induction. Methodology: One hundred (100) pregnant women at term who fulfill the inclusion criteria were equally randomized into the two arms of the study to receive either 25 µg of misoprostol sublingually or 25µg vaginally. The induction delivery interval and fetal outcomes were compared in the two arms of the study. Results: The vaginal group required more doses of misoprostol than the sublingual group (1.68 ± 0.74 versus 1.26 ± 0.44, P = 0.005). Time from the administration of the first dose of misoprostol to the achievement of a Bishop score of 7 or active phase labor was shorter in the sublingual group than the vaginal route group (5.04 ± 1.77 hours versus 6.32 ± 1.36 hours, P = 0.001). Induction-delivery interval was shorter in the sublingual group than the vaginal route (10.02 ± 2.37 hours versus 11.12 ± 3.97 hours) although the difference was not statistically significant (P = 0.098). The mean Apgar scores at 1 min and 5 min were slightly better in the vaginal group than the sublingual group but the difference did not assume statistical significance (Apgar scores at 1 minute: 7.62 ± 0.83 versus 7.72 ± 0.88, at 5 minutes: 8.94 ± 1.23 versus 9.22 ± 0.46 for the sublingual versus the vaginal group, respectively, P = 0.561). Conclusions: The two routes of sublingual and vaginal administration showed comparable safety and effectiveness for cervical ripening and induction of labor in low-risk pregnancies at term. However, the sublingual route appears to be superior in terms of easy administration and patients' satisfaction.
Misoprostol 50 μg Sublingually versus Vaginally for Labor Induction at Term
2005
Objective: To co mpare the efficacy of misoprostol 50 μg vaginally and 50 μg sublingually for labor induction at term. Materials and Methods: One hundred and twenty wo men were randomized to receive misoprostol 50 μg vaginally (n = 60) or 50 μg sublingually misoprostol (n = 60). The doses were g iven every 5 h (maximu m 5 doses). Primary outcome measure was vaginal delivery rate. Induction to delivery t ime, delivery within 12 h, the nu mber of misoprostol doses given and neonatal outcomes were secondary outcome measures. Results: Vaginal delivery rates were 75% in the sublingual group and 73% in the vaginal group (RR, 1.09; 95% CI, 0.4-2.4).The nu mber o f wo men delivering within 12 h was 20 (45.5%) in the vaginal group and 12 (27%) in the sublingual group (RR, 0.5; 95% CI, 0.3-1). There were no significant differences in the number of doses needed, incidence of contractility disturbances, or neonatal results. Conclusion: Sublingual misoprostol is as efficacious as vaginal misoprostol for induction of labor and neonatal outcomes are similar.
2018
Background: Cervical ripening plays an important role in successful labor induction. Objective: This study aimed to compare the effects of misoprostol, laminaria tent, and isosorbide dinitrate (ISDN) on cervical ripening. Methods: This double-blind three-armed clinical trial was conducted at Shahidan Mombini Teaching Hospital in Sabzevar, Iran, in 2016 on 96 singleton term pregnant women. Participants were randomly allocated to receive either two 20-mg ISDN tablets vaginally every 4 hours for a maximum of three doses or 25 mcg misoprostol vaginally every 6 hours for a maximum of two doses or laminaria tent for a maximum of 12 hours. The method of randomization was covariate adaptive randomization and the primary outcome measures were Bishop Score changes and labor duration. SPSS software version 18 was used for statistical analyses. Kruskal-Wallis, chi-square and ANOVA tests were applied for data analyses. Results: Bishop Score changes were higher in the misoprostol group than in the two other groups (p=0.014). Time from start of medication to active phase of labor and delivery were 6.22±3.11 and 11.78±5.3 minutes in the misoprostol group, 11.25±3.07 and 17.62±4.07 minutes in the laminaria group, and 10.12±3.48 and 17.37±4.79 minutes in the ISDN group respectively (p<0.001). Cesarean rate was higher in the misoprostol group than the two other groups (p=0.016). No significant differences were observed between the study groups in terms of Apgar score and meconium-stained amniotic fluid. Conclusions: Use of misoprostol results in more improvement of Bishop Score and reduced length of labor phases in comparison to laminaria tent and ISDN.
MISOPROSTOL INDUCTION OF LABOR IN MULTIPARA PREGNANT WOMEN: A MINI-SURVEY FOR PREDICTORS OF OUTCOME.
Objectives: To evaluate dose-related outcome of induction of labor (IOL) using misoprostol vaginal inserts (MVI) in multipara pregnant women so as to determine the appropriate dose for getting trial success defined as having vaginal delivery (VD) within 24-hr induction-to-delivery (ITD) interval. Patients & Methods: 644 pregnant women underwent clinical evaluation and vaginal examination to determine Bishop score using the Simplified Bishop Score (SBS). All women received 25 ?g MVI only once and were monitored for labor progress as judged by SBS and uterine contractions with fetal heart monitoring. In absence of fetal distress manifestations and membranes were still intact, but uterine contractions occurred <3 times/10 minutes, another MVI was used for a maximum of 6 doses. Uterine contraction augmentation was provided as amniotomy or/and oxytocin infusion started 4-hrs after the last MVI was placed. Study outcomes included trail success rate, number of MVI used, frequency and mode of augmentation and delivery assistance. Results: 530 women (82.3%) had VD; 159 women without augmentation, 182 women had amniotomy, 105 women received oxytocin drip and 84 women required both. Only 168 women (26.1%) had instrumentally-assisted VD. Mean ITD interval was 10.9?6.3 hr; 492 women had ITD interval <24 hr for a trial success rate of 76.4%. Cesarean section was indicted in 114 women (17.7%). Only 29 women received four, 71 three, 93 two, while 451 women received one MVI, VD rate was significantly (p<0.00001) lower among women received higher number of MVI. Statistical analyses defined high MVI dose and BMI as negative, while high parity is a positive significant predictor for trial success. High MVI dose and BMI are positive, while high SBS and high parity are negative significant predictors for long ITD interval. Kaplan-Meier regression analysis defined the appropriate MVI for IOL trial success at a mean dose of 1.5?0.039 (95% CI: 1.4-1.55). Conclusion: MVI is a satisfactory modality for IOL trial in multipara pregnant women with VD rate of 82.3% and ITD interval of <24-hr in 76.4%. Lower BMI and higher number of previous VD indicate higher possibility of trial success. SBS is appropriate for women selection for trial and follow-up and can predict outcome if combined with BMI, parity and number of MVI used.
A comparison of two methods of labor induction with vaginal misoprostol
International journal of gynaecology and obstetrics, 2003
Objectives: To evaluate if labor induction with 50 mg of vaginal misoprostol twice per day is as effective as and safer than 100 mg used once per day. Methods: Misoprostol was used to induce labor in 204 consecutive pregnant women assessed as needing labor induction, 104 at the University Hospital of the West Indies in Kingston, Jamaica, and 100 at the Victoria Jubilee Hospital, also in Kingston. At the former institution the women were administered 100 mg of misoprostol once per 24 h and at the latter 50 mg every 12 h. The doses were repeated if there was no cervical change or if the woman was not in labor. Bishop scores were determined before initiation of induction and again 12 h later. Women's records were reviewed after 24 h to determine delivery outcome. Results: The indications for labor induction were similar in each group. There was no significant difference in the group demographics. In the group given 50 mg of misoprostol twice per day the mean time"S.D. from insertion of misoprostol to delivery was significantly shorter than in the other group (560.14"269.20 min vs. 729.90"471.65 min; P-0.01), and the percentage of women who were delivered within 12 h was higher (75% vs. 56.8%; P-0.002). There was no significant difference between the two groups in the rate of cesarean births, the need for oxytocin, or blood loss. Only two patients experienced uterine hyperstimulation, both in the group that had received 100 mg of misoprostol per day. There was no significant difference between the two groups in the birthweight of the neonates and in the number of neonates with Apgar scores less than 7 at 1 min and 5 min. There were, however, significantly fewer neonates who needed resuscitation (6% vs. 14.7%; Ps0.04) and admission to the special care nursery (7% vs. 17%; Ps0.03) in the group that had received 50 mg of misoprostol twice per day. Conclusions: A dose of 50 mg of misoprostol twice per day appears to be more efficient and safer than a dose of 100 mg once per day, but this may partially be due to weaknesses in the study design.
A masked randomized comparison of oral and vaginal administration of misoprostol for labor induction
Obstetrics and gynecology, 1998
To test the null hypothesis that administering misoprostol orally or vaginally will result in no difference in time to vaginal birth, and to determine whether different frequencies of tachysystole and hyperstimulation are associated with route of administration. Two hundred six women after 37 completed weeks' gestation who presented with an indication for induction were randomly assigned to receive misoprostol (50 microg) either orally or vaginally every 4 hours as needed to induce labor. Placebo use and allocation concealment accomplished blinding until data analysis was completed. Sample size was calculated to allow a two-tailed alpha of .05 and power (1-beta) of 80%. All fetal heart rate and uterine activity graphs were classified according to Curtis' criteria before induction groups were unmasked. Analysis involved 104 women in the oral group and 102 in the vaginal group. The mean time (+/-standard deviation) to vaginal birth with oral misoprostol was 1072 (+/-593) minut...