Misoprostol 50 microg sublingually versus vaginally for labor induction at term: a randomized study.
OBJECTIVE
To compare the efficacy of misoprostol 50 mug vaginally and 50 mug sublingually for labor induction at term.


METHODS
One hundred and sixty women were randomized to receive misoprostol 50 microg vaginally (n = 80) or 50 microg sublingually misoprostol (n = 80). The doses were given every 4 h (maximum 6 doses). Primary outcome measure was number of cesarean deliveries. Induction to delivery time, delivery within 24 h, the number of misoprostol doses given; the need for oxytocin augmentation, tachysystole and uterine hyperstimulation rates and neonatal outcomes were secondary outcome measures.


RESULTS
The mean induction to delivery time was 748 +/- 379 min in the vaginal group and 711 +/- 425 in the sublingual group (p = 0.56). The number of women delivering within 24 h was 73 (91.3%) in the vaginal group and 74 (92.5%) in the sublingual group (p = 0.78). The mean number of misoprostol doses required was significantly higher in the sublingual group (1.9 +/- 1.2) compared with the vaginal group (1.1 +/- 0.4; p < 0.001). More women in the sublingual group experienced tachysystole (n = 14, 17.5%) compared with the vaginal group (n = 3, 3.8%; p = 0.005). Seven cases (8.8%) in the vaginal group and 12 cases in the sublingual group (15%) required emergent cesarean delivery for fetal heart rate abnormalities (p = 0.22). Other neonatal outcomes including umbilical artery pH, Apgar scores and intensive care unit admission were similar in the two groups.


CONCLUSIONS
Sublingual misoprostol is as efficacious as vaginal misoprostol for induction of labor. More frequent tachysystole is observed with misoprostol 50 microg sublingually, but neonatal outcomes are similar.
Caliskan
Eray
E
Department of Obstetrics and Gynecology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey. eray68@hotmail.com
Bodur
Harika
H
Ozeren
Semih
S
Corakci
Aydin
A
Ozkan
Sabiha
S
Yucesoy
Izzet
I
D000282:Administration, Intravaginal; D000286:Administration, Sublingual; D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data; D005260:Female; D006340:Heart Rate, Fetal; D006801:Humans; D007751:Labor, Induced / Q000379:methods*; D016595:Misoprostol / Q000008:administration & dosage* / Q000009:adverse effects; D010120:Oxytocics / Q000008:administration & dosage* / Q000009:adverse effects; D011247:Pregnancy; D011256:Pregnancy Outcome; D013997:Time Factors
D010120:Oxytocics; D016595:Misoprostol