A comparison of vaginally administered misoprostol with extra-amniotic saline solution infusion for cervical ripening and labor induction.
OBJECTIVE
The purpose of this study was to compare intravaginal misoprostol with extra-amniotic saline solution infusion with concomitant oxytocin for cervical ripening and labor induction in viable pregnancies.


METHODS
Two hundred women with indications for labor induction and unfavorable cervices were assigned randomly to vaginal misoprostol or extra-amniotic saline solution infusion. Twenty-five micrograms of misoprostol was administered every 4 hours up to six doses, followed by intravenous oxytocin administration. Patients who had received extra-amniotic saline solution infusion also received intravenous oxytocin along with a maximum 12-hour saline solution infusion through Foley catheters that were placed above the internal cervical os.


RESULTS
One hundred women were randomly assigned to misoprostol, and 100 women were assigned randomly to extra-amniotic saline solution infusion. The average interval from start of induction to vaginal delivery was longer in the misoprostol group (1323.3 +/- 700.3 minutes) than in the extra-amniotic saline solution infusion group (970.4 +/- 502.7 minutes; P =.006, log transformed data). Abnormal fetal heart rate tracings were found in 30% of the patients who received misoprostol and in 19% of the patients who received extra-amniotic saline solution infusion (relative risk, 1.6; 95% CI, 1.0-2.4; P =.05). There was more tachysystole in the misoprostol group (8%) than in the extra-amniotic saline solution infusion group (1%; P =.02). There were no differences in the routes of deliveries or neonatal outcomes between groups.


CONCLUSIONS
Extra-amniotic saline solution infusion with oxytocin administration appears more effective and is associated with fewer maternal complications than misoprostol for cervical ripening and labor induction.
Mullin
Patrick M
PM
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California-Keck School of Medicine, 12240 N. Mission Road, Los Angeles, CA 90033, USA.
House
Michael
M
Paul
Richard H
RH
Wing
Deborah A
DA
D002404:Catheterization; D020070:Cervical Ripening / Q000187:drug effects*; D004359:Drug Therapy, Combination; D005260:Female; D006340:Heart Rate, Fetal / Q000187:drug effects; D006801:Humans; D007751:Labor, Induced; D016595:Misoprostol / Q000627:therapeutic use*; D010120:Oxytocics / Q000627:therapeutic use*; D011247:Pregnancy; D012965:Sodium Chloride / Q000008:administration & dosage* / Q000627:therapeutic use; D013997:Time Factors
D010120:Oxytocics; D016595:Misoprostol; D012965:Sodium Chloride