Titrated oral misoprostol solution compared with intravenous oxytocin for labor augmentation: a randomized controlled trial.
OBJECTIVE
To compare titrated oral misoprostol to intravenous oxytocin for labor augmentation among women at 36 to 42 weeks of gestation with spontaneous onset of active labor.


METHODS
Women meeting the general selection criteria with regular contractions and an effaced cervix dilated between 3 and 9 cm, and who had inadequate uterine contractions (two or fewer contractions every 10 minutes) during the first stage of labor, were randomly assigned to titrated oral misoprostol or intravenous oxytocin. Augmentation-to-vaginal delivery interval and vaginal delivery within 12 or 24 hours were the primary outcomes. The data were analyzed by intention to treat.


RESULTS
Of the 231 women, 118 (51.1%) were randomized to titrated oral misoprostol and 113 (48.9%) to titrated intravenous oxytocin. The median interval from the start of augmentation to vaginal delivery was 5.22 hours (3.77-8.58 hours, 25th-75th percentile) in the misoprostol group, and 5.20 hours (3.23-6.50 hours, 25th-75th percentile) in the intravenous oxytocin group (P=.019). Complete vaginal delivery occurred within 12 hours for 92 women (78.0%) in the misoprostol group and for 97 women (85.8%) in the oxytocin group (P=.121; relative risk 0.91, 95% confidence interval 0.80-1.03). There were no significant differences between the two groups who delivered vaginally within 24 hours. Side effects and neonatal outcomes also did not differ between the two groups.


CONCLUSIONS
Labor augmentation with titrated oral misoprostol or intravenous oxytocin resulted in similar rates of vaginal delivery within 12 and 24 hours.


BACKGROUND
ClinicalTrials.gov, www.clinicaltrials.gov, NCT00695331.


METHODS
I.
Ho
Ming
M
From the Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung, Taiwan; the Department of Obstetrics and Gynecology, China Medical University Beigang Hospital, Beigang, Taiwan; and the School of Medicine and Biostatistics Center, China Medical University, Taichung, Taiwan.
Cheng
Shi-Yann
SY
Li
Tsai-Chung
TC
D000284:Administration, Oral; D000328:Adult; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007751:Labor, Induced / Q000379:methods*; D016595:Misoprostol / Q000008:administration & dosage*; D010120:Oxytocics / Q000008:administration & dosage*; D010121:Oxytocin / Q000008:administration & dosage*; D011247:Pregnancy; D011446:Prospective Studies; D016896:Treatment Outcome
D010120:Oxytocics; D016595:Misoprostol; D010121:Oxytocin