Objective To compare the World Health Organization (WHO) recommended orally administrated dosage of misoprostol (25 μg) with a vaginal slow‐release (7 μg/hour) insert of misoprostol regarding time from induction to delivery and safety of the method. Design Open label, Randomised controlled trial (RCT). Setting Delivery ward at a secondary referral hospital in Stockholm, Sweden, from 1 October 2016 to 21 February 2018. Population One hundred and ninety‐six primiparous women with singletons in cephalic presentation at ≥37 weeks of gestation and with a Bishop score of ≤4. Methods Women were randomised to an oral solution of misoprostol (Cytotec® n = 99) or vaginal slow‐release misoprostol (Misodel® [MVI] n = 97). Main outcome measures Primary outcome: time from induction to vaginal delivery. Secondary outcomes: mode of delivery; proportion of vaginal deliveries within 24 hours (VD24); neonates with an Apgar score of <7 at 5 minutes; pH < 7.10; postpartum haemorrhage (PPH) of >1000 ml; hyperstimulation; and women's delivery experience (VAS). Results There was no difference in the time to vaginal delivery (median 21.1 hours in the MVI group and 23.2 hours in the oral group; Kaplan–Mayer log rank P = 0.31). There was no difference regarding the proportion of VD24 (50.5 versus 55.7%, P = 0.16). Hyperstimulation with non‐reassuring cardiotocography (CTG) was more common in the MVI group (14.4 versus 3.0%, P < 0.01). Terbutaline (Bricanyl®) was used more often for hyperstimulation in the MVI group (22.7 versus 4.0%, P < 0.01). There was no difference in the numbers of children admitted to the neonatal intensive care unit (NICU). Conclusions Vaginal delivery after induction of labour (IOL) with slow‐release misoprostol did not result in a shorter time from induction to vaginal delivery, compared with oral misoprostol solution, but was associated with a higher risk for hyperstimulation and fetal distress. There were no differences in mode of delivery or neonatal outcome. Tweetable abstract IOL with MVI was similar to oral solution of misoprostol but hyperstimulation and fetal distress were more common.

To investigate the reasons for not proceeding to surgery in patients undergoing presurgical evaluation for epilepsy. Methods: A retrospective cohort study of 401 consecutive patients who were evaluated for but did not proceed to surgery for epilepsy between 1990 and 2016 at three Swedish epilepsy surgery centers was performed. Reasons for not proceeding to surgery were categorized as inconclusive investigation, seizure onset within eloquent cortex, evidence of multiple seizure foci, infrequent seizures, risk of postoperative severe cognitive decline, patient or caregiver declining surgery or invasive investigation, severe psychiatric or somatic comorbidity, patient death during evaluation and complications during the evaluation. Chi-square tests were performed to compare ordered categorical variables. Results: During the entire time period the main reasons for rejection were inconclusive investigation (34,4%) and multifocal seizure onset (20,0%). The risk for severe cognitive decline postoperatively was more often a cause for rejection in more recent years. Patients declining invasive EEG or surgery accounted for a minor but not insignificant proportion (14,2%) of rejections. Conclusions: Inconclusive results from the presurgical evaluation and multifocal epilepsy were the main causes for not proceeding to surgery. The proportion of patients opting to abstain from surgery was low compared to other recent studies.

Background: Although the induction of labour is a commonly used procedure in obstetrical care, there are limited data on its psycho-emotional effects on the woman. This study analysed the expectations and experiences of women included in a randomised controlled trial comparing different routes of labour induction. The primary aim of this questionnaire-based study was to evaluate women’s general satisfaction with induced labours and identify factors associated with a negative experience. The secondary aim was to compare the orally administrated misoprostol (OMS) to a misoprostol vaginal insert (MVI), while focusing on general maternal satisfaction. Methods Primiparous women (n = 196) with a singleton foetus in cephalic presentation, ≥ 37 weeks of gestation, with a Bishop´s score ≤ 4 planning labour induction were randomly allocated to receive either OMS (Cytotec®) or MVI (Misodel®). Data were collected by validated questionnaires, the Wijma Delivery Expectation/Experience Questionnaire (A+B). The pre-labour part of the questionnaire (W-DEQ version A) was given to participants to complete within one hour before the start of induction, and the post-labour part of the questionnaire (W-DEQ version B) was administered after birth and collected before the women were discharged from hospital. Background characteristics and delivery outcomes were extracted from maternity files and correlated to the results from the questionnaires. Results The mean score of the post-labour questionnaire (W-DEQ B) was 61.2 (22.9) and OMS and MVI generated comparable experiences among the participating women with a W-DEQ B score of 59.4 (21.0) and 62.7 (24.7), respectively (p = 0.48). It was found that 11.8% (17/143) reported a severe fear of childbirth (W-DEQ A score ≥ 85). Women that stated a severe fear before the start of induction had a 3.7 times increased risk of experiencing labour induction negatively (OR 3.7 [95% CI; 1.04–13.41]). Conclusion Severe fear of childbirth was a risk factor for a negative experience of labour induction. OMS compared to MVI generated comparable results among participating women in this randomised controlled trial.

Background Although labor induction is a commonly used procedure in obstetrical care, there are limited data on its psycho-emotional effects on the woman. This study analysed the expectations and experiences of women in different routes of labor induction. The study’s primary aim was to compare women’s delivery experience if induced by orally administrated misoprostol (OMS) compared with misoprostol vaginal insert (MVI). Secondly, an evaluation of women’s general satisfaction with induced labor was made, and factors associated with a negative experience. Methods Primiparous women (n = 196) with a singleton fetus in cephalic presentation, ≥ 37 weeks of gestation, with a Bishop’s score ≤ 4 planning labor induction were randomly allocated to receive either OMS (Cytotec®) or MVI (Misodel®). Data were collected by validated questionnaires, the Wijma Delivery Expectation/Experience Questionnaire (A + B). The pre-labor part of the survey (W-DEQ version A) was given to participants to complete within 1 hour before the start of induction, and the post-labor part of the questionnaire (W-DEQ version B) was administered after birth and collected before the women were discharged from hospital. Results It was found that 11.8% (17/143) reported a severe fear of childbirth (W-DEQ A score ≥ 85). Before the induction, women with extreme fear had 3.7 times increased risk of experiencing labor induction negatively (OR 3.7 [95% CI, 1.04–13.41]). Conclusion No difference was identified between OMS and MVI when delivery experience among women induced to labor was analysed. Severe fear of childbirth before labor was a risk factor for a negative experience of labor induction. Trial registration Clinical trial register number NCT02918110. Date of registration on May 31, 2016.