Title: A comparative study to evaluate the effect of misoprostol for induction of labour at term by intravaginal versus sublingual route

Authors: Dr Rajkishori Dandotiya, Dr Suman Kumari, Dr M Rameswar Singh

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i4.35

Abstract

Background: Induction of labour is defined as the process of artificial stimulation of uterine contractions before the spontaneous onset of labour. Amongst the plethora of techniques available for induction of labour, Prostaglandins remain the single most effective mean of cervical ripening and inducing labour.

Objectives: Current study was carried out to compare the efficacy of sublingual misoprostol with intravaginal misoprostol for induction of labour.

Methodology: This was a hospital based randomized prospective study conducted in the Department of Obstetrics and Gynaecology at RIMS Imphal. 462 women at term pregnancy with single live foetus having Bishop Score ≤6 who required induction of labour for various indications were enrolled and randomly allocated into two groups. Group 1 received 50mcg misoprostol vaginally while second group received same dose of misoprostol sublingually every 4-6hourly. Outcome measures related to labour and maternal and fetal side effects were compared.

Results: There was no significant difference between both groups with regards to base line characteristic , indications for induction of labour,  mean interval from the initiation of induction to the delivery, neonatal outcome and maternal complications. However significant difference was observed in Bishop Score after 4 hours and requirement of oxytocin augmentation.

Conclusion:  Misoprostol can be used either sublingually or by vaginal route for induction of labour at term without any major fetal and maternal side effects.

Keywords: Induction, Labour, Misoprostol, Sublingual, Vaginal.

References

  1. Managing complications in pregnancy and childbirth: a guide for midwives and doctors. Geneva, World Health Organisation, 2000
  2. Souza AS, Amorim MM, Feitosa FE. Comparison of sublingual versus vaginal misoprostol for the induction of labour: a systematic review. BJOG. 2008; 115: 1340 – 1349.
  3. Caliskan E, Bodur H, Ozeren S, Corakci A, Ozkan S, Yucesoy I. Misoprostol 50 μg sublingually versus vaginally for labor induction at term: a randomized study. Gynecologic and Obstetric Investigation. 2005;59(3):155-61.
  4. Bartusevicius A, Barcaite E, Krikstolaitis R, Gintautas V, Nadisauskiene R. Sublingual compared with vaginal misoprostol for labour induction at term: a randomised controlled trial. Int J Obstet Gynaecol. 2006;113(12):1431-7.
  5. Nassar AH, Awwad J, Khalil AM, Abu‐Musa A, Mehio G, Usta IM. A randomized comparison of patient satisfaction with vaginal and sublingual misoprostol for induction of labour at term. Int J Obstet Gynaecol. 2007;114(10):1215-21.
  6. Zahran KM, Shahin AY, Abdellah MS, Elsayh KI. Sublingual versus vaginal misoprostol for induction of labor at term: A randomized prospective placebo‐ controlled study. J Obstet Gynaecol Res. 2009;35(6):1054-60
  7. Zieman M, Fong S, Benowitz N, Banskter D, Darney P. Absorption kinetics of misoprostol with oral or vaginal administration. Obstet Gynecol 1997; 90(1):88–92.
  8. Shetty A, Danilien P, Templeton A. A comparison of oral and vaginal misoprostol in induction of labor at term. Br J Obstet Gynaecol. 2001;108:218-24.
  9. Eroglu D, Oktem M, Yanik F, Kuscu E. Labour induction at term: A comparison of the effects of 50 mcg and 25 mcg vaginal misoprostol. Clin Exp Obstet Gynaecol 2007;34(2):102-5.
  10. Ayati S, Vahidroodsari F,  Farshidi F, Shahabian M, Afzal Aghaee M. Vaginal versus sublingual misoprostol for labour induction at term and post term. Iran J Pharm Res 2014;13(1):299-304.

Corresponding Author

Dr Suman Kumari

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