Oral misoprostol for induction of labour

Alfirević, Z̄arko; Aflaifel, Nasreen; Weeks, Andrew

doi:10.1002/14651858.cd001338.pub3

Cited by 103 publications

(110 citation statements)

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“…The first two outcomes, although arguably the most clinically relevant, are not precisely defined and, due to their low incidence and potential for confounding causative factors, are impractical as endpoints for clinical research in prospective trials. Sample sizes required to detect an important change in their incidences are estimated to be around 60 000 and 150 000 subjects, respectively 4. Nevertheless, even low incidences yield substantial numbers when applied to a large population, and so remain important, not only for an individual but also from a public health perspective.…”

Section: Introductionmentioning

confidence: 99%

Induction of labour with retrievable prostaglandin vaginal inserts: outcomes following retrieval due to an intrapartum adverse event

Rugarn

Tipping²,

Powers

et al. 2016

BJOG

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ObjectiveTo assess adverse event (AE) resolution, delivery mode and neonatal outcomes after misoprostol or dinoprostone vaginal insert (MVI or DVI) retrieval due to AE during induction of labour (IOL).DesignRandomised, double‐blind trial, EXPEDITE.SettingThirty five obstetric departments, USA.PopulationConsisted of 1358 pregnant women with modified Bishop score ≤4 eligible for pharmacological IOL.Methods Post hoc analysis.Main outcome measures AEs prompting insert retrieval, times to AE resolution, delivery, delivery mode and neonatal intensive care unit (NICU) admissions.Results77/678 (11.4%) and 27/680 (4.0%) women had MVI and DVI retrieved due to AE, respectively (P < 0.001). The most common AEs prompting retrieval were uterine tachysystole with fetal heart rate (FHR) involvement and category II/III FHR pattern. Time to AE resolution varied for both treatments depending on the type of AE. For uterine tachysystole with FHR involvement, median resolution times were 1 hour 34.5 minutes (n = 36) and 8.5 minutes (n = 8) for MVI and DVI, respectively. Caesarean delivery occurred in a high proportion of women with insert retrieved due to AE (MVI: 44/77 (57.1%); DVI: 19/27 (70.4%)); the majority of caesareans were performed at least several hours after insert retrieval. Median times from retrieval to any delivery were not increased for women with insert retrieved due to AE. NICU admissions were 8/77 (10.4%) and 1/27 (3.7%) for MVI and DVI, respectively (P = 0.440).Conclusions AEs leading to insert retrieval were primarily uterine tachysystole with FHR involvement and category II/III FHR patterns. Insert retrieval due to an AE did not prolong time to delivery for either prostaglandin insert.Tweetable abstractInduction with prostaglandin vaginal inserts: outcomes following retrieval due to intrapartum adverse event.

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Section: Introductionmentioning

confidence: 99%

Induction of labour with retrievable prostaglandin vaginal inserts: outcomes following retrieval due to an intrapartum adverse event

Rugarn

Tipping²,

Powers

et al. 2016

BJOG

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“…It is cheap, stable at room temperature, easy to use, and without many digestive side effects [8]. Several studies comparing the effectiveness of prostaglandins for cervical ripening suggest that misoprostol is more effective than PGE 2 with a significant decrease in the cesarean section rate [9][10][11][12]. The World Health Organization, the International Federation of Gynecology and Obstetrics, and the ACOG allow the use of misoprostol for IOL under certain conditions [13].…”

Section: Introductionmentioning

confidence: 99%

“…The oral route may result in improved clinical outcomes over the vaginal route [10,11], and women's convenience and comfort also seem to be increased [15][16][17][18]. The regimens most frequently used were either 20-25 mg every 2 h for a maximum of 12 doses (24 h), or 50 mg every 4 h for a maximum of 6 doses (24 h).…”

Section: Introductionmentioning

confidence: 99%

What is the optimal duration of oral misoprostol treatment for cervical ripening?

Drakopoulos

Duyck

Gayet-Ageron

et al. 2016

The Journal of Maternal-Fetal & Neonatal Medicine

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Objectives: To evaluate the number of misoprostol tablets needed to obtain a Bishop score (BS) 6 or a significant cervical change ( 2 points in BS) during cervical ripening. Methods: Retrospective study of women with term singleton pregnancies and a BS56 taking oral misoprostol (20 mg first 2 doses followed by 40 mg every 2 h) for cervical ripening. Results: We included 400 women, 72% nulliparous, mean age of 31.3 ± 5.9 years and 70% with a baseline BS 2. During cervical ripening, 61 (15.3%) achieved a BS 6 and 205 (51.3%) a significant change in BS. The incremental risk to achieve a BS 6 after 4 tablets was low (+3.25%) with an incremental probability of +12.75% for painful uterine contractions and +0.5% for abnormal fetal tracing (AFT). The incremental probability to achieve a significant change in BS after 7 tablets was low (+2.0%). 24.3% women delivered by cesarean section which likelihood significantly increased with maternal age 535 years, BMI 30, nulliparity, AFT, and baseline BS 2. Conclusions: The marginal benefit of giving more than 7 misoprostol tablets (14 h) during cervical ripening is very low.

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“…It is recommended for this indication by the World Health Organization (WHO), the International Federation of Gynecology and Obstetrics (FIGO), and the Society of Obstetricians and Gynaecologists of Canada (SOGC) 1, 2, 3. A systematic review comparing misoprostol with Foley catheter and dinoprostone induction agents suggests that ‘Oral misoprostol for the induction of labour is safer than vaginal misoprostol and has the lowest rate of caesarean section’ 4. A recently completed UK National Institute of Health Research (NIHR) funded network and cost‐effectiveness analysis included 31 induction regimes evaluated in 611 trials with over 100 000 trial participants.…”

mentioning

confidence: 99%

“…Subgroup analyses of some important clinical outcomes show a clear dose effect. For example, when comparing oral misoprostol with dinoprostone, the rate of hyperstimulation increases as the initial dose rises from 25 to 200 μ g 4. It would therefore appear that there are safety benefits of using doses of 20–25 μ g, even if they may result in a slower induction process.…”

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confidence: 99%