Ruptured membranes at term: randomized, double-blind trial of oral misoprostol for labor induction.
OBJECTIVE
To determine if oral misoprostol can replace oxytocin for labor stimulation in women with ruptured membranes at term and without evidence of labor.


METHODS
Nulliparous women at 36 to 41 weeks with a singleton, cephalic-presenting fetus and ruptured membranes without evidence of labor were randomized to receive oral misoprostol (100 microg) or a placebo every 4 hours for a maximum of two doses. Intravenous oxytocin was initiated if active labor had not ensued within 8 hours of the initial study drug dose.


RESULTS
Fifty-one women were randomized to oral misoprostol and 51 women to the placebo. Misoprostol reduced the use of oxytocin stimulation of labor from 90% to 37% (P <.001) and was associated with approximately a 7-hour shorter elapsed time in the labor unit. Uterine hyperactivity, defined as six or more contractions in 10 minutes without fetal heart rate decelerations, occurred in 25% of women randomized to misoprostol. However, uterine hyperactivity associated with fetal heart rate decelerations occurred in only three (6%) women, none of whom required emergency cesarean delivery. Route of delivery and infant outcomes were not related to misoprostol use.


CONCLUSIONS
Oral misoprostol (100 microg) given in a maximum of two doses 4 hours apart significantly reduced the use of oxytocin in the management of women with ruptured membranes without labor at term.
Lo
Julie Y
JY
Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75235-9032, USA. julie.lo@utsouthwestern.edu
Alexander
James M
JM
McIntire
Donald D
DD
Leveno
Kenneth J
KJ
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D036861:Delivery, Obstetric; D004311:Double-Blind Method; D005260:Female; D005322:Premature Rupture of Fetal Membranes; D006801:Humans; D007262:Infusions, Intravenous; D007751:Labor, Induced; D016595:Misoprostol / Q000008:administration & dosage*; D010120:Oxytocics / Q000008:administration & dosage*; D010121:Oxytocin / Q000008:administration & dosage; D011247:Pregnancy; D011256:Pregnancy Outcome; D016896:Treatment Outcome; D014590:Uterine Contraction / Q000187:drug effects
D010120:Oxytocics; D016595:Misoprostol; D010121:Oxytocin