Simplifying oral misoprostol protocols for the induction of labour

Weeks, Andrew; Navaratnam, Kate; Alfirević, Z̄arko

doi:10.1111/1471-0528.14657

Cited by 22 publications

(22 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Regimens of 20-200 µg of OM given four to six hourly, and up to 12 doses of 50 µg over four days have been reported [22][23][24][25][26] . A starting dose of 20 µg of OM in solution, titrated against uterine contractions and administered hourly in increasing doses of up to 60 µg, is currently thought to be a safe, cost effective method for IOL [22][23][24][25] , although more simplified regimens are needed 36 . The hourly dosing regimen has been calculated according to the pharmokinetics of OM where its half-life as well as the time taken to achieve peak serum concentrations has been estimated to vary from approximately 20-40 mins respectively 25,37 .…”

Section: Low Dose Oral Misoprostolmentioning

confidence: 99%

Induction of labour in an out patient setting?

Goonewardene

2018

Sri Lanka J Obstet & Gynae

View full text Add to dashboard Cite

Section: Low Dose Oral Misoprostolmentioning

confidence: 99%

Induction of labour in an out patient setting?

Goonewardene

2018

Sri Lanka J Obstet & Gynae

View full text Add to dashboard Cite

“…Until recently, however, no low‐dose misoprostol tablet has been commercially available, resulting in an ongoing debate regarding whether off‐label oral use is acceptable when labeled alternatives for vaginal administration are available 5 …”

Section: Introductionmentioning

confidence: 99%

An audit of oral administration of Angusta® (misoprostol) 25 µg for induction of labor in 976 consecutive women with a singleton pregnancy in a university hospital in Denmark

Helmig

Hvidman

2020

Acta Obstet Gynecol Scand

View full text Add to dashboard Cite

Introduction Induction of labor (IOL) is used to improve the outcome of pregnancy for mother and child. Since 2013, oral misoprostol has been used for IOL at Aarhus University Hospital, Denmark. The purpose of the present paper is to describe our experience of the use of a new, 25‐µg misoprostol tablet commercially manufactured for the purpose of IOL regarding efficacy and outcome for mother and neonate in both an inpatient and an outpatient regimen. Material and methods We performed an audit from 1 April 2016, including data on all IOL in women with singleton pregnancies until 1000 consecutive women were registered. Data from 976 consecutive women with gestational age ≥37+0 weeks induced in accordance with the “Aarhus protocol” were included in the present analyses. All inductions were by oral misoprostol. Outpatient induction is standard procedure in low‐risk pregnancies, that is, pregnancies with a healthy mother and no signs of placental insufficiency. In the outpatient IOL, the first dose of misoprostol is administered after a normal cardiotocography registration at the hospital. Subsequent doses are taken at home according to a predefined regimen. Following delivery, data on baseline variables and outcome variables for the mother and neonate were retrieved from the medical records. Results In 71.9% of cases, the women were induced in an outpatient regimen. Delivery within 24 hours was achieved in 38.8% of women (nulliparous 32.3%, multiparous 50.9%) and within 48 hours in 70.1% (nulliparous 66.2%, multiparous 77.2%). Hyperstimulation during induction occurred in 0.6%. The mode of delivery was spontaneous vaginal in 75.5% of cases. The cesarean section rate was 14.9% (nulliparous 20.7%, multiparous 4.1%). Apgar <7 at 5 minutes and pH <7.0 in the umbilical artery was seen in 0.9% and 0.7%, respectively. Conclusions Induction of labor by a commercially produced low‐dose (25 µg) misoprostol tablet for oral induction according to the “Aarhus protocol” is feasible in an outpatient as well as an inpatient regimen. Delivery was achieved within 48 hours for 70.1% of women. Few adverse events were seen; however, the audit was underpowered for safety.

show abstract

“…The vaginal and oral routes of misoprostol administration are those most used to induce labor in routine practice, with the recommended dose being 25 μg [7]. Nevertheless, the sublingual route [8] may reduce the number of vaginal examinations required, increasing patient comfort and lowering the risk of maternal and fetal infection [9].…”

Section: Introductionmentioning

confidence: 99%

Misoprostol administered sublingually at a dose of 12.5 μg versus vaginally at a dose of 25 μg for the induction of full-term labor: a randomized controlled trial

et al. 2020

View full text Add to dashboard Cite

Background: Labor induction is defined as any procedure that stimulates uterine contractions before labor begins spontaneously. The vaginal and oral routes of administration of misoprostol are those most used for the induction of labor in routine practice, with the recommended dose being 25 μg. Nevertheless, the sublingual route may reduce the number of vaginal examinations required, increasing patient comfort and lowering the risk of maternal and fetal infection. Based on a previous systematic review, the objective of this study was to compare the frequency of tachysystole as the main outcome measure when misoprostol is administered sublingually at the dose of 12.5 μg versus vaginally at a dose of 25 μg to induce labor in a full-term pregnancy with a live fetus. Methods: A randomized, placebo-controlled, triple-blind clinical trial was conducted at two maternity hospitals in northeastern Brazil. Two hundred patients with a full-term pregnancy, a live fetus, Bishop score ≤ 6 and an indication for induction of labor were included. Following randomization, one group received 12.5 μg misoprostol sublingually and a vaginal placebo, while the other group received a sublingual placebo and 25 μg misoprostol vaginally. The primary outcome was the frequency of tachysystole. Student's t-test, the chi-square test of association and Fisher's exact test were used, as appropriate. Risk ratios and their 95% confidence intervals were calculated. Results: The frequency of tachysystole was lower in the group using 12.5 μg misoprostol sublingually compared to the group using 25 μg misoprostol vaginally (RR = 0.15; 95%CI: 0.02-0.97; p = 0.002). Failure to achieve vaginal delivery within 12 and 24 h was similar in both groups. Sublingual administration was preferred to vaginal administration by women in both groups; however, the difference was not statistically significant. Conclusion: The effectiveness of labor induction with low-dose sublingual misoprostol was similar to that achieved with vaginal administration of the recommended dose; however, the rate of tachysystole was lower in the sublingual group, and this route of administration may prove a safe alternative.

show abstract

Simplifying oral misoprostol protocols for the induction of labour

Cited by 22 publications

References 22 publications

Induction of labour in an out patient setting?

Induction of labour in an out patient setting?

An audit of oral administration of Angusta® (misoprostol) 25 µg for induction of labor in 976 consecutive women with a singleton pregnancy in a university hospital in Denmark

Misoprostol administered sublingually at a dose of 12.5 μg versus vaginally at a dose of 25 μg for the induction of full-term labor: a randomized controlled trial

Contact Info

Product

Resources

About