Oral versus Vaginal Misoprostol for Labour Induction : A Comparative Study

Abstract

Objective: To compare the efficacy and safety of hourly titrated oral misoprostol in solution (OMS) with vaginal misoprostol (PV) for labor induction. Methods: Randomized Controlled Trial (RCT), double blind-add on the study was conducted from January-November 2016 in delivery ward of Moh. Hoesin general hospital. Women 30 weeks of gestation with an unfavorable cervix (Bishop score 6) and an indication for labor induction were randomly assigned to receive titrated oral or vaginal misoprostol. The OMS group received a basal unit of 20 ml misoprostol solution (1 g/ml) every 1 hour for four doses and then were titrated against individual uterine response. In the absence of regular uterine contractions, the dose was increased to 40 ml hourly for four doses and then 60 ml for four doses. The vaginal group received 25 g every 4 hours until attaining a more favorable cervix for three doses. All the subjects received amylum placebo. In labor within 12 hours was the primary outcome. Results: A total of 30 women were enrolled in this study. One subject in the OMS group was dropped out due to eclamptic seizure. The average interval from induction until in labour in OMS group was 5.753.14 hour and 6.604.46 hour in PV group (p = 0.56). In labour stage was achieved within 12 hours in 14 women (100%) in OMS group and 14 women (93.3%) in PV group (p = 1.00). Vaginal delivery was achieved within 24 hours in 13 women (92.9%) in OMS group and 15 women (100%) in PV group. The incidence of uterine hyperstimulation/ tachysystolic was 7.1% in OMS group compared with 13.3% in PV group. Fetal distress was found only 1 case (7.1%) in OMS group. There was no difference in the maternal and neonatal outcome of labor in both the groups. Conclusion: Oral titrated in solution, and vaginal route of administration of misoprostol for induction of labour are equally effective and safe. [Indones J Obstet Gynecol 2018; 6-2: 89-97] Keywords: hourly titrated oral misoprostol in solution, oral misoprostol, randomized controlled trial, vaginal misoprostol