Orally Administered Misoprostol for Induction of Labor with Prelabor Rupture of Membranes at Term

Abstract

Prelabor rupture of membranes (PROM) occurs in approximately 8% to 10% of women with term pregnancies. The management of PROM continues to be controversial. Approaches include expectant management and immediate induction of labor. The use of orally administered misoprostol for the management of women with PROM may provide significant advantages when they choose immediate induction of labor. This literature review presents current evidence that supports the use of oral misoprostol for women with PROM, including the benefits of a decreased interval time from PROM to vaginal birth, good safety profile, and reductions in the use of oxytocin augmentation and epidural anesthesia. In addition to clinically proven benefits to women of oral misoprostol for PROM, it also has the potential to reduce chorioamnionitis by reducing the number of sterile vaginal examinations performed thereby reducing the risk of ascending bacteria. Women have also reported acceptability and satisfaction when using oral misoprostol for immediate induction of labor. This review of literature discusses what is known about the use of orally administered misoprostol for the management of term PROM and makes recommendations for clinical use.

Effect of Premature Rupture of Membranes on Induction of Labor: A Historical Cohort Study

“…The pharmaceutical information for prostaglandin E2 medication states that all forms of treatment after rupture of the “chorioamniotic membrane” should proceed “with care”, without expanding on the possible problems that could occur. Administration of the synthetic prostaglandin E1 analog misoprostol is the most effective medication to induce labor 4 – 7 , and its use after PROM has been studied in detail 5 , 8 , 9 , 10 , 11 , 12 . Although previous studies did not find higher infection rates following the use of balloon catheters 13 , they are not commonly used.…”

“…In den Fachinformationen der Prostaglandin-E2-haltigen Medikamente wird darauf hingewiesen, dass nach einer Ruptur der „chorioamniotischen Membran“ eine Behandlung „mit Vorsicht“ erfolgen sollte, ohne näher auf mögliche Probleme einzugehen. Die Anwendung des synthetischen Prostaglandin-E1-Analogons Misoprostol ist das effektivste Medikament zur Geburtseinleitung 4 , 5 , 6 , 7 und auch zur Anwendung bei PROM gut untersucht 5 , 8 , 9 , 10 , 11 , 12 . Auch wenn Ballonkatheter in bisherigen Studien keine erhöhte Rate an Infektionen gezeigt haben 13 , so werden sie in diesen Situationen eher restriktiv eingesetzt.…”

Misoprostol Use Profile in a Public Hospital in Rio de Janeiro/Brazil: From the Perspective of a Hospital Pharmacy Dispensation

“…However, single dose administration of misoprostol 25 μg or 200 μg for discontinuation of pregnancy is not recommended by FIGO. 11 However, misoprostol in single dose 800 μg vaginally is a safe and effective choice for the curettage for interrupted gestation in the period between 7 and 12 weeks of pregnancy. 15 The using of misoprostol when compared to other methods for induction of abortion according to the gestational age brings benefits when compared to other methods.…”

“…4,5,6 According to the dosage form, it can be administered through vaginal, oral, oral and vaginal (in combination), rectally in single or multiple doses. [7][8][9][10][11][12] The development of mechanisms for the safe dispensation of this medicine for abortive purposes, for example, requires continuing education of the pharmacy team, mainly of the pharmacist who should ensure the woman's right to survival, life, privacy, liberty, and security. One of the foundations of the use of misoprostol is in the knowledge of the new administration protocols in terms of clinical indication, dose, and dosage.…”