Oral or Vaginal Misoprostol for Labor Induction and Cesarean Delivery Risk

Area of Science:

• Obstetrics and Gynecology
• Reproductive Medicine
• Clinical Pharmacology

Background:

• Cervical ripening is crucial for labor induction.
• Misoprostol is commonly used for cervical ripening, with varying administration routes.
• Evidence comparing oral versus vaginal misoprostol in predominantly overweight populations is limited.

Purpose of the Study:

• To evaluate if oral misoprostol for cervical ripening increases cesarean delivery risk compared to vaginal misoprostol.
• To assess the impact of oral versus vaginal misoprostol on the time to vaginal delivery.
• To analyze secondary outcomes including uterine tachysystole and neonatal complications.

Main Methods:

• Single-center, retrospective cohort study comparing outcomes of labor induction.
• Vaginal misoprostol (25 mcg, 2013-2014) versus oral misoprostol (50 mcg, 2014-2015).
• Multivariable regression analysis to control for confounders, with cesarean delivery as the primary outcome.

Main Results:

• Cesarean delivery occurred more frequently with oral misoprostol (32%) versus vaginal misoprostol (21%) (P=.04).
• Oral misoprostol was associated with a higher adjusted odds of cesarean delivery (aOR 2.01).
• Time to vaginal delivery was longer with oral misoprostol (41 hours) compared to vaginal misoprostol (31 hours) (P=.01).

Conclusions:

• Oral misoprostol may be linked to an increased risk of cesarean delivery.
• The use of oral misoprostol may also prolong the time to achieve vaginal delivery.
• These findings suggest route of administration is an important consideration for labor induction with misoprostol.