Oral misoprostol (100 μg) versus vaginal misoprostol (25 μg) in term labor induction: a randomized comparison

Abstract

Vaginal misoprostol in its currently recommended dose of 25 microg seems to be more efficacious than the 100 microg oral dose.

Oral, vaginal and sublingual misoprostol for induction of labor

“…There were no significant differences in the rates of vaginal delivery not achieved within 24 h, excessive uterine activity and cesarean section, neonatal or maternal outcomes. Higher instrumental vaginal delivery rates after oral misoprostol were reported in one study only (35.3% versus 14%; OR 3.35, 95% CI 1.25–8.96) [15]. In one study ( n = 153) misoprostol was used either 100 μg orally or 50 μg vaginally six hourly [13].…”

“…In two trials (n = 337) an oral misoprostol dose of 100 μg or vaginal dose of 25 μg every three or six hours was used [15,18]. There were no significant differences in the rates of vaginal delivery not achieved within 24 h, excessive uterine activity and cesarean section, neonatal or maternal outcomes.…”

“…Seventeen studies were included in this systemic review (Table 1). Fourteen studies comparing oral with vaginal misoprostol and involving 3042 women were identified [5–18]. In these trials the dose of oral misoprostol ranged from 50 μg three to four hourly ( n = 1223), to 100 μg three to six hourly ( n = 490) and 200 μg three to six hourly ( n = 1329).…”

A randomised controlled trial comparing low dose vaginal misoprostol and dinoprostone vaginal gel for inducing labour at term

“…Replacing dinoprostone with misoprostol would allow considerable cost savings. Although misoprostol can be administered vaginally, orally or rectally, the vaginal route appears, at present, to offer the most benefits in terms of efficacy and minimising side effects 4–6 . Danielian et al 7 found that 50 μg of misoprostol was more effective than dinoprostone gel and had a similar side effect profile, but others have demonstrated that a dosing regimen of 50 μg or higher is associated with an increased incidence of uterine contraction abnormalities 8,9 .…”

Pharmacokinetic Analysis of Hourly Oral Misoprostol Administration – A Pilot Study

“…Early studies indicated that the risk of inducing fetal hypoxia occurs with fixed-dosage of misoprostol such as 100 μg orally or 25 μg vaginally every 4 hours (recommended dose) until adequate labor commences [8][9][10]. In one pilot study, small, frequent (every 2 hours), titrated doses of oral misoprostol minimized the risk of uterine hyperstimulation and prevented fetal hypoxia [11,12].…”