Title: To compare the efficacy and safety of sublingual and vaginal dose of Misoprostol for induction of labor in term viable pregnancies
Authors: Dr Shweta Patel, Dr Shabd Yadav, Dr Kalpana Yadav
DOI: https://dx.doi.org/10.18535/jmscr/v8i7.70
Abstract
Objective: To compare the efficacy and safety of misoprostol by sublingual and vaginal route for induction of labor in term viable pregnancies.
Material and Methods: This prospective study was conducted on 200 women, who presented with indication of induction of labor. After taking informed consent cases were randomly divided into sublingual and vaginal group with 100 cases in each. Starting dose of misoprostol for induction in primigravida was 50µg and in miultigravida was 25µg followed by 25µg if required, up to maximum of 5 doses. Primary outcome was to determine efficacy of drug in term of total vaginal deliveries after induction and to determine safety in view of total number of cesarean section and fetal outcome. Secondary outcome was to compare total dose, number of doses, induction delivery interval, antepartum complications and fetal outcome in both groups.
Result: Total number of successful vaginal deliveries were more in sublingual group (87%). Significant number of primigravidae in sublingual group delivered with single dose of 50µg misoprostol compare with vaginal group (56.89% in s/l v/s 32.69%in p/v group). Induction delivery interval, oxytocin augmentation, meconium stained liquor, abnormal uterine action, total number of cesarean sections all were less in sublingual group than vaginal group. No significant difference was seen in neonatal outcome.
Conclusion: Sublingual route of misoprostol has better efficacy than vaginal route of misoprostol for induction of labor.
Keywords: Misoprostol, Induction of labor, Meconium stained liquor.
References
- Goldberg AB, Wing DA, Induction of labor: the misoprostol controversy. Midwifery womens Health 2003:48:244-8.
- Campos Perez G;voto LS. Misoprostol to induce labor. Lancet 1992; 339:64
- HOPC, Ngai SW, Liu KL, GCY, Lee SW, Vaginal misoprostol compared with oral misoprostol in termination of second trimester pregnancy. Obstet Gynecol 1997; 90:735-8
- Khan RU, EL Refaey H, Sharma S, Sooranna D, Stafford M. Oral, rectal and vaginal pharmacokinetics of misoprostol. Obstet Gynecol 2004; 103;866-70
- Caliskan E, Bodur H, Ozeren S, Corakci A et al: Misoprostol 50mg sublingually versus vaginally for labor induction at term. Gynaecol Obstet Invest 2005; 59:155-61.
- Bartusevicius, A., Barcaite, E., Krikstolaitis, R., Gintautas, V. and Nadisauskiene, R. (2006), Sublingual compared with vaginal misoprostol for labour induction at term BR. J. OBS GYN An Internal Journal of Obs Gyn 113:1431-0528.
- Nassar AH, Awwad J, Khalil AM, Abu Musa A. et al: A randomized comparison of patient satisfaction with vaginal and sublingual misoprostol for induction of labor at term. BJOG 2007; 114:1215-21
- Feitosa FEL, Sampaio ZS, Alencar Ca Jr et al: Sublingual versus vaginal misoprostol for induction of labor. Int J Gynaecol Obstet 2006; 94:91-5.
- Stephanie A. Fisher, V. Paul Mackenzie, Gregory A.L. Davies. Oral versus vaginal misoprostol for induction of labor: A double-blind randomized controlled trial. American Journal of Obstetrics & Gynecology 2001 Oct;185(4): 906-10.
- Moraes Filho OB, Albuquerque RM, Pacheco AJC et al: Misoprostol sublingual versus vaginal para inducao do parto a termo. Rev Bras Ginocol Obstet 2005; 27: 24-31.