Comparison of 25 and 50 μg Vaginally Administered Misoprostol for Preinduction of Cervical Ripening and Labor Induction

Abstract

Our purpose was to compare the efficacy of 25 µg and 50 µg intravaginally administered misoprostol tablets for cervical ripening and labor induction. Either 25-µg (n: 58) or 50-µg (n: 56) misoprostol tablets were randomly administered intravaginally to 114 subjects with an unripe cervix for labor induction. The physician was blinded to the medication. Intravaginal misoprostol was given every 4 h until the onset of labor. The mean Bishop score before misoprostol administration was 2.1 ± 1.6 in the 25-µg group and 2.0 ± 1.4 in the 50-µg group (p > 0.05). With the 25-µg dose the time until delivery was significantly longer (991.2 ± 514.4 min vs. 703.12 ± 432.6 min in the 50-µg group). The use of oxytocin augmentation was significantly higher in the 25-µg group (63.8%) than the 50-µg group (32.1%; p < 0.05). The proportions of patients with tachysystoles and hypersystoles were not significantly different between the two groups (19 and 6.9%, respectively, in the 25-µg group and 25 and 17.8%, respectively, in 50-µg group; p > 0.05). Overall, in the 25-µg group more women achieved vaginal delivery (79.3 vs. 60.7%; p < 0.05). The rate of cesarean sections due to nonreassuring fetal status was higher in the 50-µg misoprostol group (28.6 vs. 10.3%; p < 0.05). The number of neonates with a low 1-min Apgar score (<7) was significantly higher in the 50-µg misoprostol group (26.8 vs. 8.6%; p < 0.05), but 5-min Apgar scores and umbilical artery blood gas values at the time of delivery were not significantly different between the groups (p > 0.05). One patient in the 25-µg group suffered a ruptured uterus. Intravaginal administration of 25 µg of misoprostol is a clinically effective labor induction regimen and has the least adverse effects and complications.

A Comparison of 25 μg with 50 μg Misoprostol for Cervical Ripening and Induction of Labor

“…The proportion of women delivering within the first twelve hours and next twelve hours of induction were similar among the groups, which is consistent with the finding by other investigators [14,17]. This is contrast to the finding of Meydanli et al [19] and Elhassan et al [17] Meydanli reported that more women delivered between 12-24 hours in the 25 µg group while El-hassan reported that fewer delivered vaginally in the 25 µg group.…”

“…There was no statistical significant difference between the two misoprostol regimens in terms of clinical efficacy. Although the study found that induction delivery interval was similar among the two groups, other investigators [13][14][15][16][17][18] had demonstrated that it was shorter in the 50 µg group. In a meta-analysis comparing 25 µg with 50 µg misoprostol, the induction vaginal delivery interval was nearly five hours shorter in the 50 µg group [19].…”

“…There was no difference in the overall caesarean section delivery rates unlike increase in caesarean section rate in the 50 µg group reported by Has et al [14] Elhassan et al [17] showed an increase in caesarean section rate in 25 µg group. In this study, there was no significant difference in occurrence of uterine contraction abnormalities among regimens, although some researchers have demonstrated an increase incidence of uterine contraction abnormalities in the 50 µg groups [13][14][15].…”

Comparative Evaluation of 25µg and 50µg of travaginal Misoprostol for Induction of Labor

“…In a comparative study reported by Has et al showed the rate of Cesarian Section due to fetal distress was higher with higher dose (28.6 vs. 10.3% p>0.05). 5 This was comparable to our study (group B 20 % vs group A 16%). We observed that the incidence of normal contraclity pattern (tachysystole, hyperstumulation) was higher in 50 g (24% vs 14%, p>0.05%) was comparable with study by Sanchez-Ramos et al 6 Minor side effects were common with higher dose but uterine Rupture did not occur in both groups in our study.…”

“…Babies with low Apgar score, requiring admission were significantly higher in 50 g group. This was in concurrence with the observations made by Has et al 5 Contrary to this Sanchez-Ramos et al in their meta-analysis of five randomize clinical trials reported comparable neonatal outcomes with the two doses.…”