Oral versus vaginal misoprostol for labour induction.
OBJECTIVE
To compare the safety and efficacy of oral versus vaginal misoprostol for induction of labour.


METHODS
Three hundred and ten live singleton term pregnancies with medical or obstetric indication for labour induction were randomly assigned to receive 50 microgram (microg) misoprostol orally or vaginally every 4-6 hours to a maximum of six doses. Main outcome measures were time of intervention to vaginal birth and number of doses required. Secondary outcome measures included frequency of tachysystole/hyper stimulation, maternal side effects, caesarean section (LSCS) rate, instrumental delivery rate and neonatal outcome (apgar score, need of neonatal intensive care). This study was conducted at Kharadar General Hospital; Karachi. Data was collected on a Performa and analyzed using software SPSS (version 10.0) and p-value was used to test the statistical significance.


RESULTS
The mean induction to delivery interval was significantly shorter in the vaginal group compared with the oral group (13.5 hrs vs. 20.6 hrs p < 0.010). In the vaginal group fewer doses of misoprostol were required (1.93 VS 2.52 p < 0.001) and there was reduced need for additional oxytocin 65 (44.8%) vs. 89 (53.9%) p < 0.19, but there was an increased incidence of hyperstimulation and tachysystole (8.3% vs. 1.8%). The modes of delivery were similar in the two groups. A higher incidence of neonatal intensive care unit (NICU) admission in the vaginal group was mainly due to respiratory distress syndrome (RDS).


CONCLUSIONS
In this study Misoprostol proved to be a safe and effective drug to use for induction of labour (IOL). Vaginal route was more efficacious compared to the oral route. A slightly higher number of patients in the vaginal group had hyper stimulation and neonates required NICU admission.
Rasheed
Rozina
R
Department of Obstetrics and Gynaecology, Kharadar General Hospital, Karachi.
Alam
Azra Ahsan
AA
Younus
Shehnaz
S
Raza
Farahnaz
F
D000282:Administration, Intravaginal; D000284:Administration, Oral; D000328:Adult; D004305:Dose-Response Relationship, Drug; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D006801:Humans; D007751:Labor, Induced / Q000379:methods*; D016595:Misoprostol / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology; D010120:Oxytocics / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology; D011247:Pregnancy
D010120:Oxytocics; D016595:Misoprostol