title: Vaginal misoprostol versus intravenous oxytocin for the management of second-trimester pregnancies with intrauterine fetal death: A randomized clinical trial.
abstract: OBJECTIVE
  The aim of this study was to compare vaginal misoprostol versus intravenous (i.v.) oxytocin in the management of pregnancies with second-trimester intrauterine fetal death (IUFD).
  
  
  METHODS
  This randomized clinical trial was conducted on 85 pregnant women with IUFD and unripe cervix who were admitted for labor induction. Forty were randomly allocated to receive 200 mcg vaginal misoprostol every 12 h, and 45 were randomly assigned to receive high-dose i.v. oxytocin (starting from 6 mU/min to reach the maximum dose of 40 mU/min). This study is registered at www.irct.ir (IRCT201307159568N5).
  
  
  RESULTS
  The induction-to-delivery interval in the misoprostol group (10.5 ± 5.3 [range 4-27] h) was significantly lower than that in the oxytocin group (14 ± 6.8 [range 4-30] h) (P = 0.009). The total hospital stay in the misoprostol group (22.6 ± 9.5 [range 12-48] h) was significantly lower than that in the oxytocin group (35.3 ± 16.4 [range 12-72] h) (P = 0.000). Although the successful induction rate was higher in the misoprostol group, this was not significant (95% vs 86.7%, P = 0.1). Placenta retention occurred more in the oxytocin group (20% vs 5%, P = 0.03).
  
  
  CONCLUSIONS
  Both vaginal misoprostol and high-dose i.v. oxytocin are highly effective in labor induction in second-trimester pregnancies with IUFD and an unripe cervix. However, vaginal misoprostol seems to be superior to i.v. oxytocin.
authors.affiliation: Maternal, Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran.|Shariati Hospital, Hormozgan University of Medical Sciences, Bandar-Abbas, Iran.
authors.forename: Zhila
authors.initials: Z
authors.lastname: Abediasl
authors.affiliation: Maternal, Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Mahdi
authors.initials: M
authors.lastname: Sheikh
authors.affiliation: Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Parichehr
authors.initials: P
authors.lastname: Pooransari
authors.affiliation: Maternal, Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Zahra
authors.initials: Z
authors.lastname: Farahani
authors.affiliation: Shariati Hospital, Hormozgan University of Medical Sciences, Bandar-Abbas, Iran.
authors.forename: Farah
authors.initials: F
authors.lastname: Kalani
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage / Q000494:pharmacology*; D000028:Abortion, Induced / Q000379:methods*; D000282:Administration, Intravaginal; D000328:Adult; D005260:Female; D005313:Fetal Death; D006801:Humans; D007262:Infusions, Intravenous; D016595:Misoprostol / Q000008:administration & dosage / Q000494:pharmacology*; D017063:Outcome Assessment, Health Care; D010120:Oxytocics / Q000008:administration & dosage / Q000494:pharmacology*; D010121:Oxytocin / Q000008:administration & dosage / Q000494:pharmacology*; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D055815:Young Adult
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D010120:Oxytocics; D016595:Misoprostol; D010121:Oxytocin
keywords: demise; fetus; induction; intrauterine fetal death; labor