A comparative study of misoprostol oral versus vaginal route for induction of labour

Debbarma, Apratim Mohan; Baidya, Jahar Lal; Ray, D. C.

doi:10.18203/2320-1770.ijrcog20201778

Cited by 3 publications

(5 citation statements)

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“…The dosing and timing of misoprostol ranges 25-50 mcg every 2-6h.However,ina study of balancing efficacy and safety, the minimum efficacious dose associated with less complication is 25 mcg [38], while the vaginal compared with the oral route appears to offer significant clinical advantage in successful vaginal delivery [39]. Dinoprostone is prostaglandin E2 that comes in two popular preparations as Cervidil, a control release hydrogel suppository 10 mg vaginal inserted every 12 h at 0.3 mg/h.…”

Section: Prostaglandinsmentioning

confidence: 99%

Induction of Labour

Nggada¹

2023

Current Challenges in Childbirth

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Induction of labour is one of the common obstetric interventions in the world with varied incidence rates between developed and developing countries. It is generally employed by obstetricians and physicians managing pregnant women when the risk of continuing such pregnancy is far greater than delivery at that said point. A detailed evaluation and indications for induction of labour should be done for every single woman. Methods of induction of labour could be pharmacological, mechanical or both; taking care to reduce or eliminate complications associated with this intervention. Decision for induction of labour should involve the most senior member of the team with a woman centered approach to care. Induction of labour carries multiple risks and complications compared with spontaneous onset of uterine contractions with increase tendency of operative vaginal delivery and caesarean section.

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Section: Prostaglandinsmentioning

confidence: 99%

Induction of Labour

Nggada¹

2023

Current Challenges in Childbirth

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“…Following completion of the electronic search strategy we were able to identify 1436 potentially relevant articles. After reading the abstracts and, when needed, full texts we managed to limit them to an overall number of 69 articles of which we finally selected 57 randomized trials that involved 10,975 parturient [ 15 – 70 ]. The methodological characteristics of included studies as well as patient characteristics are depicted in the “ Appendix ” and reveal comparable groups of oral vs vaginal misoprostol intake in terms of maternal age and body mass index, gestational age at delivery parity, Bishop score prior to the start of induction and neonatal birthweight.…”

Section: Resultsmentioning

confidence: 99%

“…P.R.O.M 8. Antepartum haemorrhage NA 25 µg sublingually 25 µg vaginally 102 included Compare the efficacy of sublingual versus vaginal misoprostol for induction of labour in primigravida at term DebBarma (2020) [ 70 ] 1.Single live fetus 2.Cephalic presentation 3.Gestaional age > 37w 4.Bishop score < 5 5. Intact membrane 6.…”

Section: Appendixmentioning

confidence: 99%

Efficacy and safety of oral and sublingual versus vaginal misoprostol for induction of labour: a systematic review and meta-analysis

Pergialiotis

Panagiotopoulos

Constantinou³

et al. 2022

Arch Gynecol Obstet

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Objective Misoprostol is a synthetic PGE1 analogue that is used for induction of labour. Current guidelines support the use of doses that do not exceed 25 mcg in order to limit maternal and neonatal adverse outcomes. The present meta-analysis investigates the efficacy and safety of oral compared to vaginally inserted misoprostol in terms of induction of labor and adverse peripartum outcomes. Methods We searched Medline, Scopus, the Cochrane Central Register of Controlled Trials CENTRAL, Google Scholar, and Clinicaltrials.gov databases from inception till April 2022. Randomized controlled trials that assessed the efficacy of oral misoprostol (per os or sublingual) compared to vaginally inserted misoprostol. Effect sizes were calculated in R. Sensitivity analysis was performed to evaluate the possibility of small study effects, p-hacking. Meta-regression and subgroup analysis according to the dose of misoprostol was also investigated. The methodological quality of the included studies was assessed by two independent reviewers using the risk of bias 2 tool. Quality of evidence for primary outcomes was evaluated under the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework, ranging from very low to high. Results Overall, 57 studies were included that involved 10,975 parturient. Their risk of bias ranged between low-moderate. There were no differences among the routes of intake in terms of successful vaginal delivery within 24 h (RR 0.90, 95% CI 0.80) and cesarean section rates (RR 0.92, 95% CI 0.82, 1.04). Sublingual misoprostol was superior compared to vaginal misoprostol in reducing the interval from induction to delivery (MD – 1.11 h, 95% CI – 2.06, – 0.17). On the other hand, per os misoprostol was inferior compared to vaginal misoprostol in terms of this outcome (MD 3.45 h, 95% CI 1.85, 5.06). Maternal and neonatal morbidity was not affected by the route or dose of misoprostol. Conclusion The findings of our study suggest that oral misoprostol intake is equally safe to vaginal misoprostol in terms of inducing labor at term. Sublingual intake seems to outperform the per os and vaginal routes without increasing the accompanying morbidity. Increasing the dose of misoprostol does not seem to increase its efficacy. Clinical trial registration Open Science Framework (https://doi.org/10.17605/OSF.IO/V9JHF).

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“…Main problem reported with vaginal misoprostol is uterine hyper stimulation and excessive contractions which is common with high dose and specially when used in multigravida. 16 Earlier studies have reported that when misoprostol is administered correctly, the absolute hazards are modest. Vaginal misoprostol reduced the time from IOL to vaginal birth compared to other techniques of labor induction and augmentation, but it did not lower the rate of the cesarean section when compared to oral misoprostol.…”

Section: Discussionmentioning

confidence: 99%

“…Main problem reported with vaginal misoprostol is uterine hyper stimulation and excessive contractions which is common with high dose and specially when used in multigravida. 16 …”

Section: Discussionmentioning

confidence: 99%

Maternal and fetal outcomes in women undergoing induction of labor with low dose vaginal misoprostol

Shafqat,

Zeb,

Fatima

et al. 2023

Pak J Med Sci

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Objective: To determine Maternal and Fetal outcome in women undergoing induction of labour with low dose misoprostol. Method: A cross-sectional study was carried out to determine the efficacy of Misoprostol for induction of labor (IOL) in MTI, Lady Reading Hospital (LRH), Peshawar from 21st January to 31st December 2021. All pregnant women with singleton pregnancy and cephalic presentation admitted for Induction of Labor were included in the study. Maternal and Fetal outcome was noted. Induction of labor was started with 25 micrograms of Misoprostol, repeated every six hours depending on Bishop Score. Results: Three hundred and thirty-seven women were included in this study. The majority of females (76%) were in 18-35 years age group. In 92.3% of females, the Bishop score was less than six. The maximum number of females (33.5%) delivered after eight hours of IOL. Sixty-six (66.46%) of females had gestational age of 37-40 weeks. Premature rupture of membranes was the most common indication (32.9%). Three doses of misoprostol were required in 31.2% of females. Only 5.6% of females required six doses of misoprostol for induction. With Misoprostol 85.1% of females delivered spontaneously, 2.37% required forceps delivery, 1.7% required vacuum delivery, and 10.68% delivered by Caesarean Section. APGAR score was 8 /10 in 84% of neonates at birth. Eighty-seven %(87.8%) of neonates did not require NICU admission. Conclusion: Misoprostol is a safe medicine to be used to induce labor in females. It can help shorten the duration of labor, with good fetomaternal outcome. doi: https://doi.org/10.12669/pjms.39.5.7072 How to cite this: Shafqat T, Zeb L, Fatima SS, Bhittani R. Maternal and fetal outcomes in women undergoing induction of labor with low dose vaginal misoprostol. Pak J Med Sci. 2023;39(5):---------. doi: https://doi.org/10.12669/pjms.39.5.7072 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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A comparative study of misoprostol oral versus vaginal route for induction of labour

Cited by 3 publications

References 10 publications

Induction of Labour

Induction of Labour

Efficacy and safety of oral and sublingual versus vaginal misoprostol for induction of labour: a systematic review and meta-analysis

Maternal and fetal outcomes in women undergoing induction of labor with low dose vaginal misoprostol

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