Misoprostol versus oxytocin for labor induction in term and post-term pregnancy: randomized controlled trial

Abstract

CONTEXT: Misoprostol, a synthetic E1 methyl analog prostaglandin, is at present receiving attention as a cervical modifier and labor induction agent. However, there is still a need for better determination of its safety and effectiveness. OBJECTIVE: To compare intravaginal misoprostol versus intravenous oxytocin for cervical ripening and labor induction in pregnant women with unripe cervices. DESIGN: Randomized controlled trial. SETTING: The study was performed at the Leonor Mendes de Barros Maternity Hospital between November 1998 and December 2000. PARTICIPANTS: 210 pregnant women with intact membranes and indication for labor induction were selected. PROCEDURES: The women randomly received 25 µg of vaginal misoprostol every 4 hours, not exceeding 8 doses (105 women), or oxytocin in a continuous infusion (105 women). MAIN MEASUREMENTS: The main parameters measured were: latent period, time from induction to vaginal delivery, delivery route, occurrence of vaginal delivery with time, occurrence of uterine tonus alterations, hypoxia and neonatal morbidity. To verify the statistical significance of the differences between the groups, the chi-squared, Student t and log-rank tests were used. RESULTS: There were no significant differences between the groups concerning conditions for labor induction, age, parity, race, marital status, family income, initial Bishop Index and number of prenatal visits. The cesarean section rate, latent period and period from induction to vaginal delivery were significantly lower for the misoprostol group. With regard to uterine tonus alterations, tachysystole was significantly more common in the misoprostol group. However, there was no difference in hypoxia and neonatal morbidity between the groups. CONCLUSION: 25 µg of misoprostol used vaginally every 4 hours is safer and more efficient for cervical ripening and labor induction than oxytocin.

Induction of labor with misoprostol or oxytocin in Tanzania

“…Nausea and vomiting (21% versus 4%) were the commonest side-effects among the misoprostol group. Shivering occurred in 9 versus 3% [2,4]. The cost of induction was less than 0.20 dollar in 70% in the misoprostol group as compared to more than 2.10 US dollar in 77% in the oxytocin group (Table 2; p < 0.05).…”

Fatores associados ao parto vaginal em gestantes de alto risco submetidas à indução do parto com misoprostol

“…Embora outros ensaios clínicos em grandes maternidades brasileiras tenham sido publicados utilizando misoprostol para indução do parto com feto vivo [28][29][30] , não se consideraram os fatores preditivos para indução bem sucedida.…”

Effectiveness and safety of a new vaginal misoprostol product specifically labeled for cervical ripening and labor induction

“…Among the options currently available for cervical ripening and labor induction, prostaglandins have been very much in evidence (3, 17). However, further and larger studies are still necessary to expand scientific knowledge on the use of misoprostol in obstetrical care, in particular testing new routes of administration, new formulations, and their acceptability.…”

“…We know that one limitation of this study is its small sample size, which does not allow for an enough power to detect possible minimal real differences, however this should be considered as a pilot approach. Among the options currently available for cervical ripening and labor induction, prostaglandins have been very much in evidence (3,17). However, further and larger studies are still necessary to expand scientific knowledge on the use of misoprostol in obstetrical care, in particular testing new routes of administration, new formulations, and their acceptability.…”