Induction of labour with titrated oral Misoprostol suspension. A comparative study with vaginal Misoprostol

Zvandasara, P; Saungweme, G; Mlambo, J; Chidembo, W; Madzivanzira, N; Mwanjira, C

doi:10.4314/cajm.v54i9-12.62626

Cited by 5 publications

(4 citation statements)

References 7 publications

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“…Of the 103 trials identified, just 63 were RCTs. 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 The majority of RCTs were single-center trials conducted in academic hospitals, which can limit the generalizability of the results to other community-based populations. Among the 12 multicenter trials, the number of centers ranged from 2 to 49 and tended to include both university-affiliated and community hospitals.…”

Section: Limitations Of Trials On Labor Inductionmentioning

confidence: 99%

Challenges and Limitations of Clinical Trials on Labor Induction: A Review of the Literature

Viteri

Sibai

2018

AJP Rep

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Induction of labor is a common obstetric procedure performed in nearly a quarter of all deliveries in the United States. Pharmacological (prostaglandins, oxytocin) and/or mechanical methods (balloon catheters) are commonly used for labor induction; however, there is ongoing debate as to which method is the safest and most effective. This narrative review discusses key limitations of published trials on labor induction, including the lack of well-designed randomized controlled trials directly comparing specific methods of induction, heterogeneous trial populations, and wide variation in the protocols used and outcomes reported. Furthermore, the majority of published trials were underpowered to detect significant differences in the most clinically relevant efficacy and safety outcomes (e.g., cesarean delivery, neonatal mortality). By identifying the limitations of labor induction trials, we hope to highlight the importance of quality published data to better inform guidelines and drive evidence-based treatment decisions.

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Section: Limitations Of Trials On Labor Inductionmentioning

confidence: 99%

Challenges and Limitations of Clinical Trials on Labor Induction: A Review of the Literature

Viteri

Sibai

2018

AJP Rep

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“…[1,3] A reduced caesarean section rate was reported with the dose of oral misoprostol of 20 -25 µg 2-hourly compared with vaginal dinoprostone.…”

Section: Discussionmentioning

confidence: 99%

“…[2] Different routes of administering misoprostol for the induction of labour have been employed with the oral route preferred because of ease of administration and a short half-life. [1,3] A reduced caesarean section rate was reported with the dose of oral misoprostol of 20 -25 µg 2-hourly compared with vaginal dinoprostone. [1] Oral misoprostol 50 µg 4-hourly at up to 5 doses was also shown to be as safe and as effective as 25 µg 4-hourly when administered vaginally at 5 doses.…”

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confidence: 99%

Beliefs and practices in using misoprostol for induction of labour among obstetricians in Zimbabwe

2017

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Background. Misoprostol is commonly used for induction of labour in term pregnancy. There are different routes and dosing schedules for administering the drug. Objectives. To describe the prescribing pattern (dose, route, duration), beliefs and factors affecting use of misoprostol for inducing term pregnancy among practising obstetricians in Zimbabwe. Methods. A cross-sectional descriptive survey was undertaken among practising obstetricians in Zimbabwe. A questionnaire was sent as an email, WhatsApp or short message service (SMS, or text) web link to all practising obstetricians in Zimbabwe using the SurveyMonkey online tool. All consenting practitioners were requested to respond online. The responses were analysed using the SurveyMonkey software.Results. There were 52 responses from the 63 questionnaires, a response rate of 82.5%. Seventy-six percent preferred oral misoprostol for induction of labour. The most common indication for induction was prolonged pregnancy accounting for 58% of respondents. The largest group of the practitioners who responded (36%) learnt their misoprostol dosing regimen from WHO/FIGO/NICE guidelines. A composite of highly variable dose regimens referred to as 'other regimens' was the dosing regimen preferred by 34% of respondents. Fiftyeight percent of practitioners used two cycles of misoprostol dosing before concluding that induction had failed and 52% would resort to caesarean section immediately if induction failed. Conclusion.The results show marked heterogeneity in the dosing schedules employed by obstetricians for induction of labour with the majority not following standard misoprostol guidelines for labour induction. Beliefs and practices in using misoprostol for induction of labour among obstetricians in Zimbabwe Misoprostol is a prostaglandin E1 analogue widely used for the induction of labour in term pregnancy because of its low cost and efficacy when compared with most methods of induction.[1]Induction of labour was estimated to account for 9.6% of births during the World Health Organization (WHO) global survey on perinatal and maternal health.[2] Different routes of administering misoprostol for the induction of labour have been employed with the oral route preferred because of ease of administration and a short half-life. [1,3] A reduced caesarean section rate was reported with the dose of oral misoprostol of 20 -25 µg 2-hourly compared with vaginal dinoprostone.[1] Oral misoprostol 50 µg 4-hourly at up to 5 doses was also shown to be as safe and as effective as 25 µg 4-hourly when administered vaginally at 5 doses. [4] Various misoprostol induction regimens have been suggested and consequently clinicians have developed diverse prescribing patterns. Various professional bodies have produced recommended dosing regimens.The WHO, International Federation of Gynecology and Obstetrics (FIGO) and the National Institute for Health and Care Excellence (NICE) guidelines recommend 20 -25 µg oral misoprostol 2-hourly and 25 µg given vaginally every 6 hours. [2,5] The oral titra...

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“…Acceleration of oxytocin were more common in the OMS group. 11 In contrast, Cheng, et al reported that oral titrated misoprostol may furtherly shorten the interval from induction to vaginal delivery compared to vaginal administration. In addition, the percentage of vaginal delivery  12 hours were more common in the OMS group compared to PV (p = 0.01, RR = 8.44 [4.52 to 15.76]).…”

Section: Vol 6 No 2 April 2018mentioning

confidence: 99%

Oral versus Vaginal Misoprostol for Labour Induction : A Comparative Study

Mahacakri

Bernolian

Pangemanan

et al. 2018

Indones J Obstet Gynecol

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Objective: To compare the efficacy and safety of hourly titrated oralmisoprostol in solution (OMS) with vaginal misoprostol (PV) forlabor induction.Methods: Randomized Controlled Trial (RCT), double blind-add onthe study was conducted from January-November 2016 in deliveryward of Moh. Hoesin general hospital. Women 30 weeks of gestationwith an unfavorable cervix (Bishop score 6) and an indicationfor labor induction were randomly assigned to receive titrated oralor vaginal misoprostol. The OMS group received a basal unit of20 ml misoprostol solution (1 g/ml) every 1 hour for four dosesand then were titrated against individual uterine response. In theabsence of regular uterine contractions, the dose was increased to40 ml hourly for four doses and then 60 ml for four doses. Thevaginal group received 25 g every 4 hours until attaining a morefavorable cervix for three doses. All the subjects received amylumplacebo. In labor within 12 hours was the primary outcome.Results: A total of 30 women were enrolled in this study. One subjectin the OMS group was dropped out due to eclamptic seizure. Theaverage interval from induction until in labour in OMS group was5.753.14 hour and 6.604.46 hour in PV group (p = 0.56). In labourstage was achieved within 12 hours in 14 women (100%) in OMSgroup and 14 women (93.3%) in PV group (p = 1.00). Vaginaldelivery was achieved within 24 hours in 13 women (92.9%) inOMS group and 15 women (100%) in PV group. The incidence ofuterine hyperstimulation/ tachysystolic was 7.1% in OMS groupcompared with 13.3% in PV group. Fetal distress was found only 1case (7.1%) in OMS group. There was no difference in the maternaland neonatal outcome of labor in both the groups.Conclusion: Oral titrated in solution, and vaginal route ofadministration of misoprostol for induction of labour areequally effective and safe.[Indones J Obstet Gynecol 2018; 6-2: 89-97]Keywords: hourly titrated oral misoprostol in solution, oral misoprostol,randomized controlled trial, vaginal misoprostol

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Induction of labour with titrated oral Misoprostol suspension. A comparative study with vaginal Misoprostol

Cited by 5 publications

References 7 publications

Challenges and Limitations of Clinical Trials on Labor Induction: A Review of the Literature

Challenges and Limitations of Clinical Trials on Labor Induction: A Review of the Literature

Beliefs and practices in using misoprostol for induction of labour among obstetricians in Zimbabwe

Oral versus Vaginal Misoprostol for Labour Induction : A Comparative Study

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