Titrated low‐dose vaginal and/or oral misoprostol to induce labour for prelabour membrane rupture: a randomised trial

Abstract

Titrated low-dose misoprostol may be a reasonable alternative for IOL in the presence of PROM, particularly in women with an unfavourable cervix. Safety and rare serious adverse events could not be evaluated in a trial of this size.

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

“…39 An RCT was conducted with 758 nulliparous and multiparous women at 34 weeks' gestation or more who had PROM, using a complex low-dose titrated misoprostol protocol or vaginal prostaglandin E2 gel. 40 There was a nonstatistically significant trend toward fewer cesareans and a failure to achieve vaginal birth in less than 24 hours in the titrated oral misoprostol group. There was a reduction in use of oxytocin (24% vs 66%; RR, 0.36; 95% CI, 0.28-0.46), epidural anesthesia (24% vs 31%; RR, 0.77; 95% CI, 0.61-0.97), and fewer cesareans for failure to progress (5% vs 9%; RR, 0.54; 95% CI, 0.31-0.92) in the titrated misoprostol group.…”

“…No difference in the incidence of uterine tachysystole was noted. Oxytocin alone was found to be most effective for women with a favorable cervix, but the titrated oral regimen was superior for participants with an unfavorable cervix …”

“…An RCT was conducted with 758 nulliparous and multiparous women at 34 weeks' gestation or more who had PROM, using a complex low‐dose titrated misoprostol protocol or vaginal prostaglandin E2 gel . There was a nonstatistically significant trend toward fewer cesareans and a failure to achieve vaginal birth in less than 24 hours in the titrated oral misoprostol group.…”

“…Recent studies evaluating safety and effectiveness of oral misoprostol for PROM have been conducted since the pub-lication of the meta-analyses by Lin and Alfirevic. [39][40][41][42] Compared to expectant management, a dose of 50 mcg of oral misoprostol administered every 4 hours for up to 4 doses in 84 multiparous women with PROM and an unfavorable cervix was associated with a significantly shorter interval from PROM to uterine contractions (9.6 h vs 14.8 h; P Ͻ .001), a shorter PROM to birth interval (11.6 h vs 17 h; P Ͻ .001) and lower rates of cesarean (5% vs 24%; P Ͻ .05), although it is important to note that women could elect for cesarean birth if no labor occurred after 24 hours of expectant management. 39 An RCT was conducted with 758 nulliparous and multiparous women at 34 weeks' gestation or more who had PROM, using a complex low-dose titrated misoprostol protocol or vaginal prostaglandin E2 gel.…”

“…Oxytocin alone was found to be most effective for women with a favorable cervix, but the titrated oral regimen was superior for participants with an unfavorable cervix. 40 In addition to the above study, an RCT was conducted with 61 women experiencing PROM who had a Bishop score below 5. The participants were treated with 50 mcg oral misoprostol every 4 hours up to 3 doses or prostaglandin E2 gel every 6 hours up to 2 doses.…”