A randomised comparison of oral misoprostol and vaginal prostaglandin E<sub>2</sub> tablets in labour induction at term

Shetty, Asha P; Livingstone, I.; Sk, Acharya; Rice, Pat; Danielian, Peter; Templeton, Allan

doi:10.1111/j.1471-0528.2004.00107.x

Cited by 26 publications

(18 citation statements)

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“…[94][95][96] The remaining 14 studies were included in the review. [37][38][39][40][41][42][43][44][45][46][47][48][49][50] Eight studies, of which three included only nulliparous women, [42][43][44] compared vaginal misoprostol with vaginal PgE 2 , 37-44 four studies compared vaginal misoprostol with IC PgE 2 , [45][46][47][48] one study compared oral misoprostol with vaginal PgE 2 49 and one study compared oral misoprostol with IC PgE 2 . 50 The individual and total doses of misoprostol and PgE 2 and the frequency of administration varied among the studies (Table 1).…”

Section: Resultsmentioning

confidence: 99%

Systematic review: Misoprostol compared with prostaglandin E₂ for labour induction in women at term with intact membranes and unfavourable cervix: a systematic review*

Crane

Butler

Young

et al. 2006

BJOG

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Background Misoprostol is a commonly used prostaglandin to induce labour. A potential risk of induction, however, is caesarean delivery, especially in women with an unfavourable cervix.Objectives To evaluate the use of misoprostol, compared with prostaglandin E 2 (PgE 2 ), for labour induction in women at term with an unfavourable cervix and intact membranes.Search strategy PubMed, Medline, EMBASE and the Cochrane Library were searched for articles published in any language from January 1987 to December 2005, using the keywords 'misoprostol', 'labour/labor' and 'induction'.Selection criteria We identified randomised trials of women at term ( ‡37 weeks of gestation) with intact membranes and unfavourable cervix, undergoing labour induction with misoprostol, orally, vaginally, sublingually or buccally, compared with PgE 2 vaginally or intracervically.Data collection and analysis Caesarean delivery was the primary outcome, with tachysystole and hyperstimulation as secondary outcomes. The primary analysis compared any misoprostol with any PgE 2 for all women, with a subgroup analysis for nulliparous women. Secondary analyses compared different routes and doses of misoprostol (oral or vaginal and 25 microgram or >25 microgram) and PgE 2 (intracervical or vaginal). Relative risks (RR) and 95% confidence intervals (CI) were calculated using random effects models.Main results Fourteen of 611 articles identified met the criteria for systematic review, with three providing information for nulliparous women. There was no difference in the risk of caesarean delivery between misoprostol and PgE 2 groups (RR = 0.99, 95% CI = 0.83-1.17). Any misoprostol was associated with higher risks of tachysystole and hyperstimulation compared with any PgE 2 (RR = 1.86, 95% CI = 1.01-3.43 and RR = 3.71, 95% CI = 2.00-6.88, respectively). There was a higher rate of vaginal delivery within 24 hours among all vaginal deliveries with any misoprostol compared with any PgE 2 (RR = 1.14, 95% CI = 1.00-1.31), and among all deliveries, a lower rate of oxytocin use (RR = 0.71, 95% CI = 0.60-0.85) but a trend towards increased meconium staining was observed (RR = 1.22, 95% CI = 0.96-1.55). The use of misoprostol at starting dosages >25 microgram had similar findings to the primary analysis. Studies of lower misoprostol dosing (starting dose of 25 microgram) did not show any differences in the outcomes of interest, but the sample size of this secondary analysis was small (304 women, 155 receiving misoprostol).Author's conclusions Although misoprostol in women at term with an unfavourable cervix and intact membranes was more effective than PgE 2 in achieving vaginal delivery within 24 hours, misoprostol does not reduce the rate of caesarean delivery either in all women or in the subgroup of nulliparous women, and it increases the rates of tachysystole and hyperstimulation. Further studies of misoprostol using a starting dose of 25 microgram may be warranted.

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Section: Resultsmentioning

confidence: 99%

Systematic review: Misoprostol compared with prostaglandin E₂ for labour induction in women at term with intact membranes and unfavourable cervix: a systematic review*

Crane

Butler

Young

et al. 2006

BJOG

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“…Our trial is the largest to date of oral misoprostol and dinoprostone gel13 17 – 20 and was large enough to detect clinically important differences in caesarean birth and vaginal birth not achieved within 24 hours. We were powered to detect a threefold difference in the less common outcome of uterine hyperstimulation with changes in fetal heart rate.…”

Section: Discussionmentioning

confidence: 98%

Oral misoprostol for induction of labour at term: randomised controlled trial

Dodd

Crowther

Robinson

2006

BMJ

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Objective To compare oral misoprostol solution with vaginal prostaglandin gel (dinoprostone) for induction of labour at term to determine whether misoprostol is superior. Design Randomised double blind placebo controlled trial. Setting Maternity departments in three hospitals in Australia. Population Pregnant women with a singleton cephalic presentation at ≥ 36+6 weeks' gestation, with an indication for prostaglandin induction of labour. Interventions 20 g oral misoprostol solution at two hourly intervals and placebo vaginal gel or vaginal dinoprostone gel at six hourly intervals and placebo oral solution. Main outcome measures Vaginal birth within 24 hours; uterine hyperstimulation with associated changes in fetal heart rate; caesarean section (all); and caesarean section for fetal distress. Results 741 women were randomised, 365 to the misoprostol group and 376 to the vaginal dinoprostone group. There were no significant differences between the two treatment groups in the primary outcomes: vaginal birth not achieved in 24 hours (misoprostol 168/365 (46.0%) v dinoprostone 155/376 (41.2%); relative risk 1.12, 95% confidence interval 0.95 to 1.32; P = 0.134), caesarean section (83/365 (22.7%) v 100/376 (26.6%); 0.82, 0.64 to 1.06; P = 0.127), caesarean section for fetal distress (32/365 (8.8%) v 35/376 (9.3%); 0.91, 0.57 to 1.44; P = 0.679), or uterine hyperstimulation with changes in fetal heart rate (3/365 (0.8%) v 6/376 (1.6%); 0.55, 0.14 to 2.21; P = 0.401). Although there were differences in the process of labour induction, there were no significant differences in adverse maternal or neonatal outcomes. Conclusions This trial shows no evidence that oral misoprostol is superior to vaginal dinoprostone for induction of labour. However, it does not lead to poorer health outcomes for women or their infants, and oral treatment is preferred by women.

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“…Uterine hyperstimulation (and its syndrome), is a frequent finding in the delivery suite. It is commonly iatrogenic and, may follow the use of prostaglandin in induction of labour (Kelly et al 2003, Shetty et al 2004 or oxytocin in labour augmentation (Shyken & Petrie 1995, Goetzl et al 2001. The occurrence of spontaneous uterine hyperstimulation syndrome, such as this case, is less common with an incidence of 1 in 3000 to 4000 pregnancies (Steer 2002).…”

Section: Discussionmentioning

confidence: 94%

Use of salbutamol by aerosol inhalation in the management of spontaneous uterine hyperstimulation

Hadoura

Selo-Ojeme

2005

Journal of Obstetrics and Gynaecology

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A randomised comparison of oral misoprostol and vaginal prostaglandin E₂ tablets in labour induction at term

Cited by 26 publications

References 24 publications

Systematic review: Misoprostol compared with prostaglandin E₂ for labour induction in women at term with intact membranes and unfavourable cervix: a systematic review*

Systematic review: Misoprostol compared with prostaglandin E₂ for labour induction in women at term with intact membranes and unfavourable cervix: a systematic review*

Oral misoprostol for induction of labour at term: randomised controlled trial

Use of salbutamol by aerosol inhalation in the management of spontaneous uterine hyperstimulation

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A randomised comparison of oral misoprostol and vaginal prostaglandin E2 tablets in labour induction at term

Cited by 26 publications

References 24 publications

Systematic review: Misoprostol compared with prostaglandin E2 for labour induction in women at term with intact membranes and unfavourable cervix: a systematic review*

Systematic review: Misoprostol compared with prostaglandin E2 for labour induction in women at term with intact membranes and unfavourable cervix: a systematic review*

Oral misoprostol for induction of labour at term: randomised controlled trial

Use of salbutamol by aerosol inhalation in the management of spontaneous uterine hyperstimulation

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A randomised comparison of oral misoprostol and vaginal prostaglandin E₂ tablets in labour induction at term

Systematic review: Misoprostol compared with prostaglandin E₂ for labour induction in women at term with intact membranes and unfavourable cervix: a systematic review*

Systematic review: Misoprostol compared with prostaglandin E₂ for labour induction in women at term with intact membranes and unfavourable cervix: a systematic review*