title: What is the optimal duration of oral misoprostol treatment for cervical ripening?
abstract: OBJECTIVE
  To evaluate the number of misoprostol tablets needed to obtain a Bishop score (BS) ≥ 6 or a significant cervical change (≥2 points in BS) during cervical ripening.
  
  
  METHODS
  Retrospective study of women with term singleton pregnancies and a BS < 6 taking oral misoprostol (20 μg first 2 doses followed by 40 μg every 2 h) for cervical ripening.
  
  
  RESULTS
  We included 400 women, 72% nulliparous, mean age of 31.3 ± 5.9 years and 70% with a baseline BS ≤ 2. During cervical ripening, 61 (15.3%) achieved a BS ≥ 6 and 205 (51.3%) a significant change in BS. The incremental risk to achieve a BS ≥ 6 after 4 tablets was low (+3.25%) with an incremental probability of +12.75% for painful uterine contractions and +0.5% for abnormal fetal tracing (AFT). The incremental probability to achieve a significant change in BS after 7 tablets was low (+2.0%). 24.3% women delivered by cesarean section which likelihood significantly increased with maternal age <35 years, BMI ≥ 30, nulliparity, AFT, and baseline BS ≤ 2.
  
  
  CONCLUSIONS
  The marginal benefit of giving more than 7 misoprostol tablets (14 h) during cervical ripening is very low.
authors: a Department of Obstetrics and Gynecology , Faculty of Medicine, Geneva University Hospitals , Geneva , Switzerland.|b Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel , Brussels , Belgium , and.
authors: Panagiotis
authors: P
authors: Drakopoulos
authors: a Department of Obstetrics and Gynecology , Faculty of Medicine, Geneva University Hospitals , Geneva , Switzerland.
authors: Céline
authors: C
authors: Duyck
authors: c Department of Community Health and Medicine , Clinical Research Center and Division of Clinical Epidemiology, Geneva University Hospitals, University of Geneva , Geneva , Switzerland.
authors: Angèle
authors: A
authors: Gayet-Ageron
authors: a Department of Obstetrics and Gynecology , Faculty of Medicine, Geneva University Hospitals , Geneva , Switzerland.
authors: Sonia
authors: S
authors: Fernandez
authors: a Department of Obstetrics and Gynecology , Faculty of Medicine, Geneva University Hospitals , Geneva , Switzerland.
authors: Olivier
authors: O
authors: Irion
authors: a Department of Obstetrics and Gynecology , Faculty of Medicine, Geneva University Hospitals , Geneva , Switzerland.
authors: Begoña
authors: B
authors: Martinez de Tejada
mesh_terms: D000284:Administration, Oral; D000328:Adult; D020070:Cervical Ripening / Q000187:drug effects*; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007751:Labor, Induced / Q000379:methods; D016595:Misoprostol / Q000008:administration & dosage*; D010120:Oxytocics / Q000008:administration & dosage*; D011247:Pregnancy; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D010120:Oxytocics; D016595:Misoprostol
keywords: Oral misoprostol; cervical ripening; dosing; duration; induction of labor