Oral misoprostol for induction of labour

Area of Science:

• Obstetrics and Gynecology
• Pharmacology
• Clinical Trials

Background:

• Misoprostol, an orally active prostaglandin, is widely used for labor induction despite not being licensed in most countries.
• Its affordability and heat stability contribute to its common use in clinical practice.

Purpose of the Study:

• To evaluate the efficacy and safety of oral misoprostol for labor induction in women with viable fetuses.
• To compare oral misoprostol with placebo, vaginal dinoprostone, and intravenous oxytocin.

Main Methods:

• A systematic review of randomized controlled trials was conducted, searching the Cochrane Pregnancy and Childbirth Group's Trials Register.
• Data from 76 trials involving 14,412 women were analyzed, comparing oral misoprostol with various interventions.

Main Results:

• Oral misoprostol increased the likelihood of vaginal birth within 24 hours compared to placebo and reduced the need for oxytocin and cesarean sections.
• Compared to vaginal dinoprostone, oral misoprostol resulted in fewer cesarean sections.
• When compared to intravenous oxytocin, oral misoprostol showed a lower cesarean section rate but increased meconium-stained liquor.
• Oral and vaginal misoprostol showed no significant difference in serious maternal or neonatal morbidity, but oral administration led to fewer low Apgar scores and less postpartum hemorrhage.

Conclusions:

• Oral misoprostol is an effective agent for labor induction, achieving vaginal birth and reducing cesarean sections compared to other methods.
• Evidence supports oral regimens over vaginal routes, particularly when intense monitoring is challenging.
• A recommended dose of 20-25 mcg in solution is suggested for oral misoprostol use in labor induction.