A comparative study of intracervical foley’s catheter with oxytocin and vaginal misoprostol for induction of labour

Background: Induction of labour implies stimulation of uterine contraction before spontaneous onset of labour with or without ruptured membranes. Aim of this study was to compare the efficacy and safety of intracervical Foley’s catheter with oxytocin and vaginal misoprostol for labour induction at term.Methods: A total 100 term pregnant women were chosen with bishop score <6 and divided into two groups: Foley’s catheter with oxytocin (Group A) and vaginal misoprostol (Group B). In Group A, a 16 F Foley’s catheter introduced beyond internal os and traction applied every 4 hourly to check for expulsion with simultaneous oxytocin infusion (2 mU/min up to 32 mU/min). In Group B, 25 mcg misoprostol administered every 4 hourly (maximum 6 doses or 150 mcg). Data analysed using SPSS software 20.0. A p value <0.05 was considered statistically significant.Results: No statistical difference found between demographic variables between two groups. Both primigravida and multigravida had poor pre-induction bishop score in both groups. Foley’s catheter (80%) and misoprostol group (96%) had successful induction and was statistically significant (p<0.05). Foley’s catheter took more time from induction-delivery both in primigravida and post-dated pregnant women. The rate of cesarean in Foley’s catheter group was high (62.5%) including 33% cases with failed induction. Foley’s catheter had less maternal and neonatal complications, less NICU admission as compared to misoprostol (p>0.05).Conclusions: Misoprostol was found better for successful induction, decreases induction-to-delivery interval and increases vaginal delivery as compared to Foley’s catheter but it needs constant supervision in view of hyperstimulation and tachysystole.

Oral misoprostol solution in comparison to vaginal misoprostol for induction of labour in a randomized controlled trial

Background: With more than 15% of all gravid women requiring prostaglandins in cervical ripening and labour induction. However, evidence is not clear about the preferred route or dose of the drug. So, this study was designed with objectives to compare the induction delivery interval and safety of titrated oral misoprostol solution with vaginal misoprostol for labour induction in term primigravida women.Methods: This randomized controlled clinical trial was conducted on a total of 100 patients randomly selected among primigravida at term women undergoing induction of labour for obstetric or medical indication for labour induction in Ain Shams University Maternity Hospital. They were divided into two Groups: Group I: patients undergoing induction of labour using misoprostol oral solution and Group II: patients undergoing induction of labour using vaginal misoprostol.Results: Oral misoprostol solution has less induction delivery duration and less side effects than vaginal misoprostol. The induction-delivery time with the oral route compared to the vaginal one (15.2 versus 20.3 hours respectively) with significant p-value (<0.001).Conclusions: Titrated oral misoprostol is safe and effective for labour induction in primigravida patients with unfavorable cervix.

A comparative study of the effect of induction of labour with vaginal misoprostol versus prostaglandin E2 gel on the incidence of pathological cardiotocography tracing

Background: The objective of the present study was to compare the two most commonly used agents for induction of labor-vaginal misoprostol and intracervical dinoprostone gel in terms of the incidence of cardiotocography (CTG) abnormalities and its correlation with fetal distress and fetomaternal outcome.Methods: This is prospective case-control study conducted in department of obstetrics and gynecology, RIMS, Ranchi over a period of 15 months. 112 women requiring induction were randomly assigned to two groups of 56 each, Group M received vaginal misoprostol and Group D received intracervical dinoprostone E2 gel. 56 women with spontaneous labor served as control group. Groups were compared in terms of the incidence of suspicious or pathological CTG tracings, fetal distress, induction to vaginal delivery time, vaginal delivery rates, dose requirements, rate of emergency cesarean.Results: Misoprostol was associated with shorter induction to delivery time (9.54 hours) than dinoprostone gel (13.54 hours), higher vaginal delivery rates (80.35% versus 62.5%), higher delivery rates (73.9%) with single dose itself unlike Group D, where 47.22% required more than one dose. Incidence of suspicious CTG was higher in group M (15.68%) versus 10.25% in Group D. Incidence of pathological CTG was also highest in Group M (7.8%) followed by Group D (2.56%) and Group C (7.8%). Dinoprostone gel lead to failed induction in 25% women, and hence higher caesarean rates.Conclusions: While misoprostol is a better agent for induction when compared with dinoprostone E2 gel in terms of induction-delivery time, higher vaginal delivery rates, less dose requirement, it is associated with greater incidence of non-reassuring/pathological CTG. There was justified improvement in perinatal outcome due to preparedness beforehand with use of CTG.

A comparative study of medical termination of pregnancy between 8-12 weeks with misoprostol versus mifepristone along with misoprostol at tertiary care hospital

Introduction: Medical method of abortion has advantages over surgical methods as it is noninvasive. Hence, no complications of anesthesia and administration of drugs is easy in medical methods. There is a need for evolving a safe and effective method for safe and effective method for terminating pregnancy in the first trimester. Aim: We have taken up the present study to know the efficacy of combination of mifepristone and misoprostol versus single drug misoprostol alone for 1st trimester abortion. Materials and methods: It was a Cross-Sectional Study carried on pregnant women coming for MTP under family planning op at CKM hospital for 2 years. The study included two groups Group-A and Group-B. Group-A consisted of 50 randomly selected cases received Vaginal Misoprostol 600 micrograms stat dose followed every 4th hourly by 400 micrograms for 24 hours, for a maximum of 4 doses. Group-B has 50 cases received Oral Mifepristone 200 mg and simultaneously 600 micrograms of vaginal Misoprostol stat dose followed every 4th hourly with 400 micrograms vaginal Misoprostol for a period of 24 hours maximum 4 doses. Depending on response USG was done within 24-48 hours in both studies and rescan after 2 weeks. V. Aruna Devi, M. Nagalakshmi, P. Rajitha. A comparative study of medical termination of pregnancy between 8-12 weeks with misoprostol versus mifepristone along with misoprostol at tertiary care hospital. IAIM, 2018; 5(10): 63-72. Page 64 Results: Among Group B subjects 86% had expulsion within 5-10 hrs and remaining 14% had expulsion within 10-15 hours. Among Group A subjects 76% required >24 hrs for expulsion, 10% required 20-24 hrs, 6% required 15-20 hrs and 8% needed 10-15 hrs for expulsion. The difference between grouping and induction to abortion interval was found to be statistically significant. In Group A, 15 subjects (30%) had complete expulsion of products. 35 subjects (70%) required D&C. In Group B, 43 subjects (86%) had complete expulsion, 7 subjects (14%) required D&C. The difference between grouping and final outcome was found to be statistically significant. Majority of study subjects who require D&C were present in Group A compared to Group B. The difference between grouping and D&C was found to be statistically significant. Conclusion: Thus combination of Mifepristone and vaginal Misoprostol is more efficacious than vaginal Misoprostol alone.

Medical Termination of Delayed Miscarriage: Four-Year Experience with an Outpatient Protocol / Terminação médica de gravidez inviável do 1° trimestre: quatro anos de experiência com um protocolo de tratamento em ambulatório

Abstract Purpose To evaluate the efficacy of an outpatient protocol with vaginal misoprostol to treat delayed miscarriage. Methods Retrospective analysis of prospectively collected data on women medically treated for missed abortion with an outpatient protocol. The inclusion criteria were: ultrasound-based diagnosis of missed abortion with less than 10 weeks; no heavy bleeding, infection, inflammatory bowel disease ormisoprostol allergy; nomore than 2 previous spontaneous abortions; the preference of the patient regarding the medical management. The protocol consisted of: 1) a single dose of 800 μg of misoprostol administered intravaginally at the emergency department, after which the patients were discharged home; 2) clinical and ultrasonographic evaluation 48 hours later - if the intrauterine gestational sac was still present, the application of 800 μg of vaginal misoprostol was repeated, and the patients were discharged home; 3) clinical and ultrasonography evaluation 7 days after the initiation of the protocol - if the intrauterine gestational sac was still present, surgical management was proposed. The protocol was introduced in January 2012. Every woman received oral analgesia and written general recommendations. We also gave them a paper form to be presented and filled out at each evaluation. Results Complete miscarriage with misoprostol occurred in 340 women (90.2%). Surgery was performed in 37 (9.8%) patients, representing the global failure rate of the protocol. Miscarriage was completed after the first misoprostol administration in 208 (55.2%) women, with a success rate after the second administration of 78.1% (132/169). The average age of the women with complete resolution using misoprostol was superior to the average age of those who required surgery (33.99 years versus 31.74 years; p = 0.031). Based on the ultrasonographic findings in the first evaluation, the women diagnosed with fetal loss achieved greater success rates compared with those diagnosed with empty sac (p = 0.049). Conclusions We conclude this is an effective and safe option in the majority of delayed miscarriage cases during the first trimester, reducing surgical procedures and their consequences.

Resumo Objetivo Avaliar a eficácia de um protocolo de tratamento médico da gravidez inviável do primeiro trimestre (GI1°T) com misoprostol vaginal em regime de ambulatório. Métodos Análise retrospectiva de dados colhidos prospectivamente de grávidas tratadas com misoprostol vaginal em ambulatório. Os critérios de inclusão foram: diagnóstico de GI1°T com < 10 semanas de gestação; ausência de hemorragia abundante, infeção, doença inflamatória intestinal ou alergia ao misoprostol; 2 abortamentos anteriores; e preferência da paciente por tratamento médico. O protocolo consiste em: dia 0-aplicação demisoprostol intravaginal (800μg) no Serviço de Urgência e alta para o domicílio; dia 2-se persistência de saco gestacional intrauterino, aplicação de segunda dose de misoprostol (800μg) e alta; Dia 7-se persistência de saco gestacional intrauterino, proposto esvaziamento uterino instrumentado. O protocolo foi implementado em janeiro de 2012. Todas as grávidas receberam analgesia oral e informação por escrito com recomendações gerais. Receberam ainda um formulário a ser preenchido em cada vinda à urgência. Resultados Das 377 mulheres incluídas, observou-se abortamento completo em 340 (90,2%). As restantes 37 (9,8%) necessitaram de tratamento cirúrgico - taxa de falência global do protocolo. Em 208 (55,2%), o sucesso foi observado ao fim da 1ª dose, com uma taxa de eficácia da 2ª dose de 78,1% (132/169). A idade média das mulheres com sucesso do tratamento médico foi superior à das mulheres sem sucesso do mesmo (33,99 versus 31,74 anos; p = 0,031). O sucesso do tratamento foi maior quando o diagnóstico ecográfico inicial era de um embrião sem vitalidade comparado com os casos de ovo anembrionado (p = 0.049). Conclusões Conclui-se que esta é uma opção de tratamento eficaz e segura na maioria das situações de GI1°T, evitando a necessidade de internamento e de intervenção cirúrgica.

A Prospective Study of Comparison of Cervical Ripening with Oral vs Vaginal Misoprostol in Nulliparous Women / 대한주산의학회잡지

OBJECTIVE: To compare the safety and efficacy of oral misoprostol, vaginal misoprostol, and oxytocin-only users for cervix ripening and labor induction in nulliparous women. METHODS: Randomly selected 11 patients were orally administered 50 microgram of misoprostol at first and then 100 microgram every 4 hours and the other 9 patients were vaginally administered 25 microgram of misoprostol at first after then the same doses every 4 hours. They all were nulliparous women with Bishop score 6 or less. Another 19 patients were oxytocin only users for cervical ripening and labor induction, who were nulliparous women with Bishop score 6 or less, and reviewed these medical records retrospectively. RESULTS: There were no differences among these three groups in patient characteristics such as maternal age, gestational age, parity and initial Bishop score. In oral misoprostol group, it took shorter time to get Bishop score 8 or more and become effacement 60% or more than vaginal misoprostol group. On the contrary, in vaginal misoprostol group, it took shorter time to become full dilatation and deliver than oral misoprostol group. However there were no significant statistical differences between two groups in obstetric and neonatal outcomes. CONCLUSION: Oral and vaginal misoprostol are effective in cervical ripening but there were no significant statistical differences in perinatal outcomes. Among many regimens of misoprostol administration for cervix ripening in nulliparous women, there is no standardized method until now. More studies will be needed for safe application of this drug.

A Comparison of the effect of Oral Misoprostol and Vaginal Misoprostol on the Labor Induction at Term / 대한산부인과학회지

OBJECTIVE: To compare the safety and the efficacy of oral 100 microgram versus vaginal 50 microgram misoprostol for labor induction at term. METHODS: Eighty patients with indicated for labor induction were randomized to receive either oral misoprostol 100 microgram or 50 microgram of vaginal misoprostol. In both groups, the dosage was repeated every 6 hours, if needed, to a maximum of four doses. We compared the Bishop score during labor induction, average interval from induction to delivery, vaginal delivery rate within 12 hours and 24 hours, mode of delivery, neonatal outcomes, and maternal complications between two groups. RESULTS: In two groups, demographic characteristics were similar. Regarding the change of Bishop score checked after 4 hours and 8 hours, it was statistically shown that the score was significantly high in oral misoprostol group compared to vaginal misoprostol group (5.9+/-1.4 vs. 5.1+/-1.1, p<0.05; 8.6+/-2.3 vs. 7.1+/-2.1, p<0.05). In nulliparous women, the average interval from induction to delivery was shorter in oral misoprostol group than in vaginal misoprostol group (927.4+/-344.7 minutes vs. 1130.6+/-297.0 minutes, p<0.01). In multiparous women, the average interval from induction to delivery was shorter in oral misoprostol group than in vaginal misoprostol group (674.2+/-110.4 minutes vs. 831.1+/-181.6 minutes, p<0.01). There was no clinical or statistical difference between two groups in mode of delivery, cesarean section rate, fetal heart rate abnormalities, tachysystole, hyperstimulation syndrome, meconium staining and fetal outcome (Apgar score at 1 and 5 minutes, birth weight). CONCLUSION: These results suggest that oral misoprostol 100 microgram is more effective for cervical ripening and induction of labor than vaginal misoprostol 50 microgram.

Vaginal misoprostol versus extra amniotic balloon for second trimester induced abortion

The study was carried out at Hung Vuong Hospital in 1998 to compare vaginal misoprostol with extra-amniotic balloon to induce abortion in second trimester. Patients were received either 800mcg misoprostol vaginally (n=87) or 500ml of 0.9% NaCl solution inserted into extra-amniotic cavity (n= 93) for induced abortion. Vaginal misoprostol was repeated 24-hourly for maximum of three times. The abortion rates were 98.9% and 96.8% for misoprostol and balloon group, respectively. A second attempt was need in approximate one third of patients in misoprostol group and 10% in balloon group. Side effects of misoprostol were mild and transient. Vaginal misoprostol is as effective as balloon for induced abortion in second trimester. Misoprostol is cheap and easily stored and used. Vaginal misoprostol could be considered as an alternative to balloon for induced abortion

A Comparison of Intravaginal Misoprostol with Oral Dinoprostone for Labor induction at Term / 대한산부인과학회잡지

OBJECTIVE: To compare the safety and efficacy of intravaginal misoprostol versus oral dinoprostone for labor induction at term. METHODS: One hundred of patients at term were randomized to receive either 50microgram of misoprostol vaginally every 4 hours or dinoprostone 0.5mg orally every 1 hour for the maximum of six doses. Intravenous infusion of oxytocin was administered under such circumferences as the patient did not go into active labor after maximum dose, SROM was developed without an adequate contraction pattern, or the patient had arrest of dilatation(no change in cervical dilatation for 2 hours). We compared the frequency of oxytocin augmentation, administration to delivery interval, vaginal delivery rate within 12 hours and 24 hours, intrapartum complications, induction failure, mode of delivery, neonatal outcomes, and maternal complications between two groups. RESULTS: The average interval from administration to delivery was shorter in the misoprostol group(739.4+/-372.4min vs 1087.7+/-765.1min, p<0.05), but the interval from administration to vaginal delivery of each group was similar(724.3+/-375.4min vs 800.3+/-697.0min). Regarding the frequency of vaginal delivery within 24 hours, however, misoprostol group was higher than dinoprostone group(88% vs 56%, p<0.001). And oxytocin augmentation of labor occurred less commonly in misoprostol group than in dinoprostone group(20% vs 76%, p<0.05). Any statistically significant difference in intrapartum complications, mode of delivery, and neonatal or maternal adverse outcome was not appeared between these two group. CONCLUSION: Vaginal misoprostol is as effective and safe as oral dinoprostone for cervical ripening and induction of labor at term. In addition, vaginal misoprostol contributes the curtailment of labor induction expenditure due to its moderate price; misoprostol costs 100 won per 50microgram.