Oral misoprostol versus intracervical prostaglandin E2 gel for active management of premature rupture of membranes at term.
OBJECTIVE
To compare the efficacy and safety of oral misoprostol with intracervical prostaglandin E2 (PGE2) gel for the active management of premature rupture of membranes (PROM) at term.


METHODS
Women with pregnancies between 37 and 42 weeks presenting with PROM at term and a Bishop score of 5 or less were randomly assigned to receive either a 4-hourly oral dose of 50 microg of misoprostol up to a maximum of 3 doses or 2 applications of intracervical PGE2 gel at a 6-hour interval. Oxytocin was given if labor had not started after 12 hours.


RESULTS
Twenty women in the misoprostol group (n=31) delivered within 12 hours compared with 5 in the PGE2 group (n=30) (P<0.001). The induction-to-delivery interval in the misoprostol group was shorter than in the PGE2 gel group (615 min vs 1070 min; P<0.001). The mode of delivery was comparable between the 2 groups (P=0.821). Abnormalities in uterine contractions and neonatal outcomes were also comparable. The requirement for oxytocin was lower and patient satisfaction was better in the misoprostol group.


CONCLUSIONS
Oral misoprostol is a safe and efficacious alternative to intracervical PGE2 gel in the active management of PROM at term.
Nagpal
Monika B
MB
Department of Obstetrics and Gynecology, Lady Hardinge Medical College, New Delhi, India. drmonikanagpal@gmail.com
Raghunandan
Chitra
C
Saili
Arvind
A
D000282:Administration, Intravaginal; D000284:Administration, Oral; D000328:Adult; D015232:Dinoprostone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000188:drug therapy; D005782:Gels; D006801:Humans; D007751:Labor, Induced / Q000379:methods*; D016595:Misoprostol / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D010120:Oxytocics / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D017060:Patient Satisfaction; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D013997:Time Factors; D014590:Uterine Contraction / Q000187:drug effects; D055815:Young Adult
D005782:Gels; D010120:Oxytocics; D016595:Misoprostol; D015232:Dinoprostone