Oral versus Vaginal Misoprostol for Labour Induction : A Comparative Study

Abstract

Objective: To compare the efficacy and safety of hourly titrated oral
misoprostol in solution (OMS) with vaginal misoprostol (PV) for
labor induction.
Methods: Randomized Controlled Trial (RCT), double blind-add on
the study was conducted from January-November 2016 in delivery
ward of Moh. Hoesin general hospital. Women 30 weeks of gestation
with an unfavorable cervix (Bishop score ï‚£6) and an indication
for labor induction were randomly assigned to receive titrated oral
or vaginal misoprostol. The OMS group received a basal unit of
20 ml misoprostol solution (1 ï­g/ml) every 1 hour for four doses
and then were titrated against individual uterine response. In the
absence of regular uterine contractions, the dose was increased to
40 ml hourly for four doses and then 60 ml for four doses. The
vaginal group received 25 ï­g every 4 hours until attaining a more
favorable cervix for three doses. All the subjects received amylum
placebo. In labor within 12 hours was the primary outcome.
Results: A total of 30 women were enrolled in this study. One subject
in the OMS group was dropped out due to eclamptic seizure. The
average interval from induction until in labour in OMS group was
5.753.14 hour and 6.604.46 hour in PV group (p = 0.56). In labour
stage was achieved within 12 hours in 14 women (100%) in OMS
group and 14 women (93.3%) in PV group (p = 1.00). Vaginal
delivery was achieved within 24 hours in 13 women (92.9%) in
OMS group and 15 women (100%) in PV group. The incidence of
uterine hyperstimulation/ tachysystolic was 7.1% in OMS group
compared with 13.3% in PV group. Fetal distress was found only 1
case (7.1%) in OMS group. There was no difference in the maternal
and neonatal outcome of labor in both the groups.
Conclusion: Oral titrated in solution, and vaginal route of
administration of misoprostol for induction of labour are
equally 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