title: Titrated oral misoprostol solution--a new method of labour induction.
abstract: BACKGROUND
  Misoprostol, a cheap, stable, orally active prostaglandin analogue, is effective for labour induction when administered either vaginally or orally, but uterine hyperstimulation and rupture have been reported. Previous studies of oral misoprostol for labour induction have used fixed dosages 3-6-hourly.
  
  
  OBJECTIVE
  To develop a new method of misoprostol use for labour induction using very small, frequent, titrated oral dosages, and to pilot effectiveness.
  
  
  METHODS
  Open clinical pilot study.
  
  
  METHODS
  Coronation Hospital, an academic hospital in Johannesburg, South Africa.
  
  
  METHODS
  We developed a method using 2-hourly titrated misoprostol doses commencing with 20 micrograms, increased after three doses to 40 micrograms. To administer such small doses we dissolved one misoprostol tablet in 200 ml water. A pilot study of this method was undertaken in 25 women with various indications for induction of labour.
  
  
  RESULTS
  Eighteen women (72%) delivered vaginally within 32 hours of induction and two women developed uterine hyperstimulation. The caesarean section rate was 20%.
  
  
  CONCLUSIONS
  Women may respond to much smaller dosages of misoprostol than are currently in use. A multicentre randomised trial of this method is underway. We emphasise the dangers inherent in the current unregistered use of misoprostol in clinical practice.
authors.affiliation: Department of Obstetrics and Gynaecology, Coronation Hospital, Effective Care Research Unit, University of the Witwatersrand, Johannesburg.
authors.forename: G J
authors.initials: GJ
authors.lastname: Hofmeyr
authors.forename: B B
authors.initials: BB
authors.lastname: Matonhodze
authors.forename: Z
authors.initials: Z
authors.lastname: Alfirevic
authors.forename: E
authors.initials: E
authors.lastname: Campbell
authors.forename: M
authors.initials: M
authors.lastname: de Jager
authors.forename: C
authors.initials: C
authors.lastname: Nikodem
mesh_terms: D000284:Administration, Oral; D002585:Cesarean Section; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007751:Labor, Induced; D016595:Misoprostol / Q000008:administration & dosage*; D010120:Oxytocics / Q000008:administration & dosage*; D010865:Pilot Projects; D011247:Pregnancy
chemical_list: D010120:Oxytocics; D016595:Misoprostol