A randomized comparison of oral misoprostol versus Foley catheter and oxytocin for induction of labor at term.
OBJECTIVE
We sought to compare the efficacy and safety of oral misoprostol administered to patients with the efficacy and safety in a control group treated with a Foley catheter and oxytocin for induction of labor.


METHODS
Two hundred patients requiring induction of labor at term with a Bishop score of </=5 were randomized to receive oral misoprostol or a cervical Foley catheter plus oxytocin. Patients in the misoprostol group received 50 microg at 4-hour intervals for a maximum of 6 doses or until an adequate contraction pattern developed. Those in the control group had a Foley catheter inserted in the cervix, whereas oxytocin was administered intravenously by a standard incremental infusion protocol to a maximum dose of 36 mU/min.


RESULTS
In multiparous patients the percentage delivered of their neonates within 24 hours and the median induction-to-delivery times were similar in the 2 groups. In nulliparous patients, however, delivery within 24 hours was significantly less likely in the misoprostol group (53.4% vs 82. 5%; P <.001), and the median induction-to-delivery time was longer (23.3 hours vs 17.2 hours; P <.01). There were no differences in the incidence of meconium, chorioamnionitis, low Apgar scores, or cesarean delivery. The incidence of hyperstimulation was higher in the oxytocin-Foley group (4.1% vs 13.1%; P =.02).


CONCLUSIONS
Oral misoprostol is as effective as oxytocin-Foley catheter for inducing labor in multiparous women. Misoprostol appears less efficacious in nulliparous patients.
Abramovici
D
D
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Tennessee, Memphis 38103, USA.
Goldwasser
S
S
Mabie
B C
BC
Mercer
B M
BM
Goldwasser
R
R
Sibai
B M
BM
D000284:Administration, Oral; D000328:Adult; D002404:Catheterization; D020070:Cervical Ripening / Q000187:drug effects; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007751:Labor, Induced; D016595:Misoprostol / Q000008:administration & dosage* / Q000009:adverse effects*; D007744:Obstetric Labor Complications / Q000188:drug therapy; D010120:Oxytocics / Q000008:administration & dosage* / Q000009:adverse effects*; D010121:Oxytocin / Q000008:administration & dosage*; D010298:Parity; D011247:Pregnancy; D013577:Syndrome; D013997:Time Factors; D014590:Uterine Contraction / Q000187:drug effects
D010120:Oxytocics; D016595:Misoprostol; D010121:Oxytocin