Oral versus vaginal misoprostol for labour induction

To compare the safety and efficacy of oral versus vaginal misoprostol for induction of labour.

Three hundred and ten live singleton term pregnancies with medical or obstetric indication for labour induction were randomly assigned to receive 50 microgram (microg) misoprostol orally or vaginally every 4-6 hours to a maximum of six doses. Main outcome measures were time of intervention to vaginal birth and number of doses required. Secondary outcome measures included frequency of tachysystole/hyper stimulation, maternal side effects, caesarean section (LSCS) rate, instrumental delivery rate and neonatal outcome (apgar score, need of neonatal intensive care). This study was conducted at Kharadar General Hospital; Karachi. Data was collected on a Performa and analyzed using software SPSS (version 10.0) and p-value was used to test the statistical significance.

The mean induction to delivery interval was significantly shorter in the vaginal group compared with the oral group (13.5 hrs vs. 20.6 hrs p < 0.010). In the vaginal group fewer doses of misoprostol were required (1.93 VS 2.52 p < 0.001) and there was reduced need for additional oxytocin 65 (44.8%) vs. 89 (53.9%) p < 0.19, but there was an increased incidence of hyperstimulation and tachysystole (8.3% vs. 1.8%). The modes of delivery were similar in the two groups. A higher incidence of neonatal intensive care unit (NICU) admission in the vaginal group was mainly due to respiratory distress syndrome (RDS).

In this study Misoprostol proved to be a safe and effective drug to use for induction of labour (IOL). Vaginal route was more efficacious compared to the oral route. A slightly higher number of patients in the vaginal group had hyper stimulation and neonates required NICU admission.