The MisoPROM study: a multicenter randomized comparison of oral misoprostol and oxytocin for premature rupture of membranes at term.
OBJECTIVE
This study was undertaken to determine whether induction of labor with oral misoprostol will result in fewer cesarean deliveries than intravenous oxytocin in nulliparous women with premature rupture of membranes at term.


METHODS
Three hundred five women at 10 centers were randomly assigned to receive oral misoprostol, 100 microg every 6 hours to a maximum of two doses or intravenous oxytocin. The primary outcome measure was cesarean deliveries. Secondary outcomes were time from induction to vaginal delivery and measures of maternal and neonatal safety.


RESULTS
The study was stopped prematurely because of recruitment difficulties. We present the results for the 305 enrolled women. There was no difference in the proportion of women who underwent cesarean delivery (20.1% in the misoprostol group, 19.9% in the oxytocin group). The time interval from induction to vaginal delivery was also similar (11.9 hours for the misoprostol group, and 11.8 hours for the oxytocin group). Maternal and neonatal safety outcomes were similar for the two treatments. More infants born to women in the misoprostol group received intravenous antibiotics in the neonatal period (16.4% vs 6.9%, P=.01), although there were no differences in chorioamnionitis or in proven neonatal infections. Women receiving misoprostol were less likely to have postpartum hemorrhage than those receiving oxytocin (1.9% vs 6.2%, P=.05).


CONCLUSIONS
Oral misoprostol does not offer any advantage in time from induction to vaginal delivery or risk of cesarean section.
University of Michigan Medical Center, Ann Arbor, USA.
Ellen
E
Mozurkewich
Julie
J
Horrocks
Suzanne
S
Daley
Paul
P
Von Oeyen
Melissa
M
Halvorson
Mary
M
Johnson
Michael
M
Zaretsky
Mitra
M
Tehranifar
Lucy
L
Bayer-Zwirello
Alfred
A
Robichaux
Sabine
S
Droste
Garry
G
Turner
D000284:Administration, Oral; D000527:Alprostadil / Q000031:analogs & derivatives*; D020070:Cervical Ripening; D002585:Cesarean Section; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000188:drug therapy*; D006801:Humans; D007275:Injections, Intravenous; D007751:Labor, Induced / Q000379:methods*; D016595:Misoprostol / Q000008:administration & dosage*; D010121:Oxytocin / Q000008:administration & dosage*; D010298:Parity; D011247:Pregnancy
D016595:Misoprostol; D010121:Oxytocin; D000527:Alprostadil