Outpatient oral misoprostol for prolonged pregnancies: a pilot investigation.
We evaluated the effectiveness of oral misoprostol for outpatient cervical ripening and labor induction in prolonged pregnancies. We performed a randomized, double-blind, placebo-controlled study of women at 40 to 42 weeks' gestation with well-dated pregnancies, singleton gestations, Bishop scores less than 6, vertex presentations, and intact membranes. Subjects received either oral misoprostol 100 microg or placebo daily for 3 days unless the subject developed significant cervical change or began labor spontaneously. Study drug was repeated every 24 hours for a maximum of three doses if subjects did not develop significant cervical change or enter labor. Induction of labor was not allowed while the subject was enrolled in the study. Forty-three subjects were randomized to receive misoprostol and 44 randomized to receive placebo. A significant difference was noted in reduction of time from study entry to both active phase (p < 0.001) and delivery (p < 0.001) in the misoprostol group. Fewer women remained undelivered after the 72-hour study period in the misoprostol group. There were no differences in route of delivery or neonatal outcomes between groups.


CONCLUSIONS
Daily administration of oral misoprostol over 3 days to women with prolonged pregnancies shortened time intervals from dosing to entry into active labor and delivery compared with placebo.
Gaffaney
Cecilia A Lyons
CA
Division of Maternal-Fetal Medicine, Women's Pavilion at Miller Children's Hospital, Long Beach Memorial Medical Center, Long Beach, California, USA. Cecilia_gaffaneylyons@pediatrix.com
Saul
Lisa L
LL
Rumney
Pamela J
PJ
Morrison
Elizabeth H
EH
Thomas
Steven
S
Nageotte
Michael P
MP
Wing
Deborah A
DA
D000020:Abortifacient Agents, Nonsteroidal / Q000627:therapeutic use*; D000328:Adult; D000553:Ambulatory Care / Q000379:methods; D020070:Cervical Ripening / Q000187:drug effects*; D016009:Chi-Square Distribution; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005323:Fetal Monitoring; D005500:Follow-Up Studies; D006801:Humans; D007751:Labor, Induced / Q000379:methods; D016595:Misoprostol / Q000627:therapeutic use*; D010865:Pilot Projects; D011247:Pregnancy; D011256:Pregnancy Outcome; D011273:Pregnancy, Prolonged / Q000188:drug therapy*; D011336:Probability; D012016:Reference Values; D018570:Risk Assessment; D016896:Treatment Outcome
D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol