Comparison of oral misoprostol with vaginal misoprostol for cervical ripening

To determine the efficacy and safety of stepwise oral misoprostol with vaginal misoprostol for cervical ripening for induction of labour. Interventional Quasi - Experimental study. The study was of 15 months [April to 30 June] duration conducted at Obstetrics and Gynaecology department Military Hospital Rawalpindi. 100 females between 37-42 weeks of gestation were randomly divided into two groups 1and 2. Patients in group -1 assigned to the stepwise oral misoprostol arm received 50 micro g initially followed by 100 micro g every 04 hours upto maximum 04 doses ; group-2 assigned to the vaginal misoprostol arm received 25 micro g every 04 hours up to maximum 04 doses. Subsequent doses of misoprostol were withheld if adequate uterine activity [>/= 3 contractions in 10 minutes] or a Bishop score >/= 8 had been achieved, or active labour had begun. The main outcomes were the interval from first misoprostol dose to delivery and mode of delivery. Patients were also monitored for adverse events. There was no difference in the average interval from the first dose of misoprostol to delivery in the oral [21.1 +/- 7.9 hrs] and vaginal [21.5 +/- 11.0 hrs, p = NS] misoprostol groups. 9 patients in the oral group [18%] and 16 patients in the vaginal group [32%] underwent caesarean section [p<0.05]. There were no significant differences in the occurrence of tachysystole, hypertonus, hyperstimulation or neonatal outcome between two groups. Oral misoprostol appears to be as effective as vaginal misoprostol for cervical ripening with a low incidence of hyperstimulation, no increase in side effects, and is associated with a lower cesarean section rate

Use of misoprostol for induction of labour in unfavourable cervix

Objective of this study was to determine the maternal and fetal outcome after induction of labour with misoprostol in term pregnancies with unripened cervix. Experimental study. Non probability convenient, in the labour ward of Nawabshah medical college hospital Sindh, Pakistan from 6th April 2008 to 5th Dec 2008. Total 114 patients were induced with misoprostol who had singleton pregnancy of more than 36 weeks with cephalic presentation, reactive CTG and unfavorable cervix [Bishop Score <4]. Sampling strategy was non probability convenient sampling. However, patients with previous cesarean section, parity >4, nonreactive CTG, any contraindication to induction of labour and bishop score > 4 were excluded from the study. After taking an informed consent, patients were given 100mcg misoprostol in posterior fornix of vagina every 6 hour till 3 doses or initiation of labour. Labour was recorded on partogram. Maternal and fetal outcome were recorded on a self designed proforma. Majority of patients i.e. 63 [55.26%] belonged to age group of 23-30 years. Eighty seven [76.31%] patients who received induction were primigravida while 27 [23.68%] patients were P2-P4. Thirty six [31.57%] patients required single dose of misoprostol, 54 [47.36%] patients required two doses while 24 [21%] patients required three doses. Out of all these 114 patients, labour was successfully completed in 93 [81.57%] patients. While cesarean section was done in 21 [18.42%] patients. About 48 [42.10%] patients were delivered in 8 to 9 hours. Uterine hyper stimulation was seen in 9 [7.89%] patients. Apgar score was less than 7 in six [5.26%] newborns. Misoprostol is safe for induction of labour with an unfavorable cervix. The results were satisfying with minimal complications

Sublingual misoprostol: A better choice for cervical priming before manual vacuum aspiration.

Background: Misoprostol is effective for cervical priming before manual vacuum aspiration (MVA). Aim of study was to determine whether sublingual misoprostol with a shorter interval of 2 hours before MVA would be as effective as its standard vaginal administration. Study Design: This randomized control trial included 82 women randomly assigned to receive 400 mcg of misoprostol, either sublingually or vaginally. MVA was performed 2 hours and 3 hours after in sublingual and vaginal group, respectively. Results: Cervical dilatation of 8 mm was achieved within 2 hours in sublingual group. Mean time taken for procedure (14.4 ± 5.3: sublingual group and 16.2 ± 5.7: vaginal group), and blood loss was comparable (12.2 ± 9.7 ml in sublingual group and 13.7 ± 8.5 ml in vaginal group). Conclusion: 2 hour of cervical priming with 400 mcg of sublingual misoprostol before MVA was as good as 3 hours with vaginal administration of the same dose.

Sonda de Foley cervical versus misoprostol vaginal para o preparo cervical e indução do parto: um ensaio clínico randomizado / Cervical Foley catheter versus vaginal misoprostol for cervical ripening and induction of labor: a randomized clinical trial

OBJETIVO: comparar a efetividade da sonda e Foley com o uso de misoprostol vaginal para o preparo cervical e indução do parto. MÉTODOS: ensaio clínico randomizado, não cego, realizado entre Janeiro de 2006 a Janeiro de 2008. Foram incluídas 160 gestantes com indicação de indução do parto, divididas em dois grupos: 80 para uso da sonda de Foley e 80 para misoprostol vaginal. Os critérios de inclusão foram: idade gestacional a partir de 37 semanas, feto único, vivo, cefálico e índice de Bishop igual ou menor que 4. Foram excluídas pacientes com cicatriz uterina, ruptura das membranas, peso fetal estimado maior que 4000 g, placenta prévia, corioamnionite e condições que impunham o término imediato da gestação. Os testes estatísticos utilizados foram Mann-Whitney, χ2 de Pearson ou exato de Fischer, sendo considerado significativo se menor que 0,005. RESULTADOS: o misoprostol desencadeou mais vezes o parto de forma espontânea (50,0 versus 15,0 por cento para Foley p<0,001) e menor uso de ocitocina (41,2 versus 76,2 por cento), sendo que esse grupo apresentou mais taquissistolia (21,2 versus 5,0 por cento). A sonda de Foley causou mais desconforto à paciente (28,7 versus 1,2 por cento). Não houve diferenças em relação ao tempo necessário para evolução do índice de Bishop (20,69 versus 21,36 horas), para o desencadeamento do parto (36,42 versus 29,57 horas) e nas taxas de cesáreas (51,2 versus 42,5 por cento). Não houve diferenças significativas no desempenho perinatal, com frequências semelhantes de cardiotocografia anormal (20,0 versus 21,2 por cento), presença de mecônio (13,7 versus 17,5 por cento) e necessidade de UTI neonatal (3,7 versus 6,2 por cento). CONCLUSÕES: o uso da sonda de Foley apresentou efetividade semelhante ao misoprostol para o preparo cervical, porém foi menos efetivo para o desencadeamento espontâneo do parto. Nossos resultados apoiam a recomendação de seu uso para o preparo cervical, sobretudo em pacientes portadoras de uma cicatriz de cesárea.

PURPOSE: to compare the effectiveness of the Foley balloon with vaginal misoprostol for cervical ripening and labor induction. METHODS: randomized clinical trial, not blind, conducted from January 2006 to January 2008. A total of 160 pregnant women with indication for induction of labor were included and divided into two groups, 80 for Foley and 80 for vaginal misoprostol. Inclusion criteria were: gestational age of 37 weeks or more, a live single fetus with cephalic presentation and a Bishop score of four or less. We excluded patients with a uterine scar, ruptured membranes, estimated fetal weight greater than 4000 g, placenta previa, chorioamnionitis and conditions that imposed the immediate termination of pregnancy. Statistical tests employed were Mann-Whitney, χ2 test or Fisher's exact test, and p value was significant if less than 0.005. RESULTS: misoprostol triggered more frequently spontaneous delivery (50.0 versus 15.0 percent for Foley, p<0.001) and required less use of oxytocin (41.2 versus 76.2 percent), and this group presented more tachysystole (21.2 versus 5.0 percent). The Foley catheter caused more discomfort to the patient (28.7 versus 1.2 percent). There were no differences in the time required for development of the Bishop score (20.69 versus 21.36 hours), for triggering delivery (36.42 versus 29.57 hours) or in rates of cesarean delivery (51.2 versus 42.5 percent). There were no significant differences in perinatal performance, with similar rates of abnormal cardiotocography (20.0 versus 21.2 percent), presence of meconium (13.7 versus 17.5 percent) and need for neonatal intensive care unit (3.7 versus 6.2 percent). CONCLUSIONS: the use of the Foley catheter was as effective as misoprostol for cervical ripening, but less effective in triggering spontaneous labor. Our results support the recommendation of its use for cervical ripening, especially in patients with cesarean scar.

Comparison of oral and vaginal misoprostol for cervical ripening before evacuation of first trimester missed miscarriage

To assess the effectiveness of misoprostol in cervical ripening before evacuation of conception in the first trimester missed miscarriages, and to compare between oral and vaginal routes of administration. A randomized controlled study was carried out in Baghdad Teaching Hospital, Baghdad, Iraq in 2006. One hundred and twenty women with first trimester missed miscarriages were divided into 2 study groups, randomized for oral and vaginal 400 mcg misoprostol priming of cervix, and 2 control groups randomized for oral and vaginal placebo, before undergoing surgical evacuation of conception after 3 hours. Measured outcomes were: post medication cervical dilatation, time needed to dilate the cervix surgically, blood loss, and development of the side effects of misoprostol. Post medication cervical dilatation was higher in the misoprostol group 7.07 +/- 1.36 mm for oral misoprostol, 7.77 +/- 1.22 mm for vaginal misoprostol, versus the control groups 2.43 +/- 0.5 mm. Post medication cervical dilatation was significantly higher in the vaginal misoprostol group, compared to the oral group p = 0.04. The time required to dilate the cervix in the misoprostol group was shorter, compared with placebo. There were no significant differences in the amount of blood loss between oral p = 0.74, and vaginal misoprostol groups p = 0.62, and gastrointestinal side effects were significantly more in the oral misoprostol group p = 0.014. Misoprostol is an effective cervical priming agent when administered either orally or vaginally before evacuation of conception in the termination of the first trimester missed miscarriage

Comparison of the safety and efficacy of intravaginal misoprostol [prostaglandin E1] with those of dinoprostone [Prostaglandin E2] for cervical ripening and induction of labor in Bab El-Shaariah hospital

This clinical trial was to evaluate and to compare the effectiveness, safety, and side effects of intravaginal misoprostol [prostaglandin E1] with vaginal dinoprostone for cervical ripening and labor induction in Bab El-Shaariah Hospital. Women with Biopsy score 6 or less admitted for labor induction at term were eligible for this randomized controlled trial. Exclusion criteria were multiple pregnancy, breech, fetal distress, or previous uterine scar. The allocation to the intravaginal micoprostol group [145 patients] [20 micro g given every 2 hours increased to 40 micro g depending on uterine contractions] or to the vaginal dinoprostone group [81 patients] [2mg twice, 6 hours apart] from March 2004 to February 2006. The mean time to delivery was significantly shorter with misoprostol [19.8 +/- 10.4 hours] than with prostaglandin E2 [31.3 +/- 13.0 hours, p<0.001]. Delivery within 24 hours of induction was significantly more frequent with misoprostol [71.9% of subjects vs 31.3%, p<0.001]. There was no difference in the cesarean delivery rate with misoprostol [25.6% Vs 22.2%, p<0.67]. The incidence of uterine hyper-stimulation was higher with prostaglandin E2 [7.4% Vs 0.7%, p<0.007]. There were no uterine ruptures with both groups. There was no difference in neonatal outcome. Compared with prostaglandin E2, misoprostol is more effective in cervical ripening and induction of labor, is as safe for patients who do not have a history of cesarean birth

[ use of castor oil on cervical ripening in pregnancies after 40 weeks]

The role of castor oil on cervical ripening is poorly understood and data in examining its efficacy within clinical trial are limited. This study was performed to evaluate the effect of utilizing castor oil on cervical ripening in pregnancies after 40 weeks. A randomized clinical trial study was performed on 200 pregnant women after 40 weeks in Shabikhany Hospital, in the City of Kashan, in 2004 to 2006. Women were divided to two groups [100 women in case group and 100 women in control group]. Case group took 60 ml castor oil, while the control group omitted treatment. Comparison was then compared between the two groups for demographic characteristics: increase of Bishop Score, means of Bishop Score at entrance to study and 24 hours after entrance to study, onset of labor within 24 hours, method and time of delivery and newborns Apgar score by X[2], followed by Fisher's exact test, and paired-samples T and T-tests. Results showed that there were no significant differences in mother's age, education, nationality, gravidity, gestational age, parity between two groups. Paired-sample T test showed significant difference between means of Bishop Score at entrance of study and 24 hours after entrance of study in case and control groups[p=0.00]. Furthermore, the mean increase of Bishop score in the case group was 4.5 +/- 3.63 versus 0.67 +/- 1.25 in the control group during the 24 hour period. During 24 hours after entrance to study, uterine contraction occurred in 70% women in case and 12% women in control groups. Statistical test showed significant difference between the two groups and an increase of Bishop Score at the onset of uterine contractions [P<0.001]. There were no significant differences in method of delivery and Apgar score in their newborns between the two groups. The results of this study showed that use of castor oil may lead to cervical ripening in pregnant women after 40 weeks, without increase in complication of pregnancy, such as caesarean, and decrease Apgar score

[Study of the effect of castor oil on cervical ripening]

Currenthy different pharmaceutical, mechanical, and surgical, techniques are used for cervical ripening. Castor oil, one of the herbal preparations is also widely used for this purpose but few studies have been reported on its efficacy and safety. Therefore, this study was conducted to evaluate the effect of castor oil on cervical ripening. This research is a randomized control clinical trial and the study population were all term pregnant women admitted to selected health clinics in Mashad, Iran in 2003 [1382]. The study involved 47 pregnant women with gestational age of 40 to 42 weeks, without regular uterine contractions, with Bishop score of 4 or less, and with no clinical or obstetric complications. The subjects were first selected purposively and then assigned into two control and experimental groups by random allocation. The experimental group received 60 cc castor oil while the control group received no intervention. Both groups were followed up for 24 hours for cervical ripening. For data collection, checklists were used for interviews, observation, examination, and fetal movements were recorded. Data analysis was done using chi-quare, Fisher, s test and independent t-test. At the outset, no significant difference was observed in the two groups Bishop score but a significam increase was obserued in the Bishop score of the expenimental group. A significamt increase was seen in the labor initiation ratio of the experimental group but no significant differnces were obserued between the two groups in their mean Apgar scores and delivery method. According to the finding, the application of 60 cc castor oil can assist cervical ripening

Efficacy of dinoprostone, Intracervical foleys and misoprostol in labor induction

To compare the efficacy for Dinoprostone, intracervical foleys and misoprostol in labor trial regarding effects on cervical ripening, mode of delivery, induction to delivery interval and maternal complications i.e. tachysystole and postpartum haemorrhage. Randomized clinical trial. Hamdard University Hospital and Patel Hospital between July 2004 - June 2005. Randomized trial was conducted such that group-A received Dinoprostone at 6 hourly intervals upto two doses. Group-B was induced with intracervical foley catheter. Group-C received 50 micro g oral misoprostol 4 hourly to a maximum of four doses. Cervical ripening, induction to delivery time interval, mode of delivery and maternal morbidity were main outcome measures. Test of proportions was used to compare the significance between the managements. In 226 cases, 219 [97%] were successfully induced while 7[3%] did not respond the labour induction. The rates of caesarean section in dinoprostone, intracervical foley and misoprostol were 14.7%, 14.1% and 12.3%, respectively, however, this difference was insignificant among three groups [p=0.911]. Rate of earlier response [12 hours] to labor induction among three groups was insignificant [3.8% vs 4% and 13.7% respectively, p=0.125]. Marginal significance of higher rate of complications was observed in those patients who were given misoprostol [p=0.08]. In this series, all three agents were equally effective in terms of cervical ripening, induction-delivery interval, mode of delivery and maternal complications

Vaginal misoprostol in managing premature rupture of membranes

We compared the efficacy of misoprostol with that of prostaglandin E2 in cervical ripening and labour induction. Thus 238 women with rupture of membranes beyond 36 weeks gestation without labour were randomized to receive 50 microg misoprostol vaginal gel or 5 mg of prostaglandin E2 gel. Bishop score was evaluated before drug application and 6 hours later. Clinical data and perinatal outcome were recorded. Mean time from induction to delivery and the need for oxytocin were significantly less in the misoprostol group. There were no significant differences in spontaneous labour rate, type of delivery and perinatal outcome. It is concluded that intravaginal misoprostol is safe and more effective than prostaglandin E2 for preinduction cervical ripening in premature rupture of membranes beyond 36 weeks gestation