Guideline No. 432c: Induction of Labour

Robinson, Debbie; Campbell, Kim; Hobson, Sebastian; MacDonald, W Kim; Sawchuck, Diane; Wagner, Brenda

doi:10.1016/j.jogc.2022.11.009

Cited by 6 publications

(4 citation statements)

References 21 publications

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“…In our study, we administered 25 μg misoprostol solution every 2 hours in accordance with the recommendations set forth by the Society of Obstetricians and Gynecologists of Canada (SOGC) 12 and the National Institute for Health and Care Excellence (NICE) 13 . Consistent with previous reports, we found no statistically signi cant differences in the rates of labor onset and vaginal delivery between groups that received oral misoprostol and those that received oxytocin.…”

Section: Discussionmentioning

confidence: 99%

Low-Dose Oral Misoprostol Versus Oxytocin Infusion For Induction Of Labor In Pregnant Women With Term Premature Rupture Of Membranes in China: A retrospective Nested Case-Control Study

Yang,

Yu,

Shi

et al. 2024

Preprint

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While the use of oral misoprostol for labor induction in premature rupture of membrane (PROM) women is not prevalent in China, the main aim of this study was to validate the efficacy and safety of low-dose oral misoprostol solution compared to oxytocin infusion for labor induction in term PROM women with unfavorite cervix conditions. A retrospective nested case-control study was conducted at a tertiary general hospital in China from March 2020 to February 2024, comparing the efficacy of oxytocin infusion and oral misoprostol for labor induction in term PROM women with a Bishop score < 6. A total of 449 mothers were included, with 282 assigned to the oxytocin group and 167 assigned to the misoprostol group. The duration of total labor time was shorter in the misoprostol group. There was a markedly higher incidence of postpartum hemorrhage (PPH) and severe PPH observed in oxytocin group. Logistic regression analysis revealed that misoprostol administration demonstrated a negative relationship (aOR: 0.46; 95%CI: 0.21–0.95) with failed labor induction outcomes and occurrence of PPH (aOR: 0.49; 95% CI: 0.27–0.85). Oral low-dose misoprostol has demonstrated both safe and superior efficacy to oxytocin infusion for labor induction and may potentially reduce the incidence of failed induction and associated with a decreased risk of PPH were observed in the misoprostol group in term PROM pregnant women with unfavorable cervical condition.

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Section: Discussionmentioning

confidence: 99%

Low-Dose Oral Misoprostol Versus Oxytocin Infusion For Induction Of Labor In Pregnant Women With Term Premature Rupture Of Membranes in China: A retrospective Nested Case-Control Study

Yang,

Yu,

Shi

et al. 2024

Preprint

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“…Consequently, researchers have been investigating the use of low-dose oral misoprostol, which has demonstrated e cacy in achieving delivery while minimizing hyperstimulation [9,[14][15]. The 2023 SOGC Guidelines recommend the use of oral misoprostol as the preferred method for cervical maturation and induction of labor [3]. Oral misoprostol, when dissolved in plain water, rapidly dissolves and remains stable for 24 hours, allowing for accurate and adjustable oral dosing [16].…”

Section: Discussmentioning

confidence: 99%

“…Therefore, it is important to strike a balance between uterine contractions, delivery time, and the risk of excessive uterine stimulation. Oral misoprostol may offer several advantages over other methods of labor induction, as it is easier to administer, more acceptable to women, and has a lower risk of hyperstimulation compared to vaginal administration [3].…”

Section: Introductionmentioning

confidence: 99%

Is oral misoprostol more effective than vaginal dinoprostone for cervical ripening in women with preeclampsia or gestational hypertension: a retrospective cohort study

Zhang

Jiang

et al. 2023

Preprint

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OBJECTIVE: To compare the effects of oral misoprostol and vaginal dinoprostone on cervical ripening and labor induction among patients with preeclampsia or gestational hypertension. METHODS: A total of 123 women with preeclampsia or gestational hypertension, who had indications for pregnancy termination and no contraindications for vaginal delivery at 37 weeks of gestation or beyond, with Bishop scores below 6, were included in this trial conducted at Hebei General Hospital in Shijiazhuang, Hebei, China, between October 2022 and May 2023. Participants were randomly assigned to receive either oral misoprostol or vaginal dinoprostone. In the oral misoprostol group (n=60), a dose of 25 to 50µg was administered every 2 or 4 hours. In the vaginal dinoprostone group (n=63), the 10mg dinoprostone vaginal insert was administered as per the drug protocol. The efficacy and safety of oral misoprostol were compared to those of vaginal dinoprostone for labor induction in women with preeclampsia or gestational hypertension. RESULTS: The duration of induction to cervical ripening was significantly longer in the oral misoprostol group compared to the vaginal dinoprostone group (32.77 hours vs 16.09 hours, p=0.007). Similarly, the delivery time was longer in the oral misoprostol group compared to the vaginal dinoprostone group (39.15 hours vs 11.57 hours, p=0.019). The time from cervical ripening to delivery was also longer in the oral misoprostol group compared to the vaginal dinoprostone group (10.85 hours vs 4.5 hours, p=0.004). Compared to vaginal dinoprostone, the use of oral misoprostol resulted in a higher need for additional induction methods such as oxytocin, mechanical devices, or amniotomy (43.33% vs 4.76%, p＜0.001). However, there was a lower incidence of hyperstimulation with oral misoprostol compared to vaginal dinoprostone (5% vs 28.57%, p=0.001, RR 0.26, 95% CI 0.08 to 0.74). There was no significant difference in the rate of cesarean delivery between the two groups. Nevertheless, it is worth noting that women who received oral misoprostol had a significantly lower likelihood of undergoing cesarean delivery due to non-reassuring fetal heart rate (20% vs 66.67%, p=0.04, RR 0.25, 95% CI 0.07 to 0.98) compared to those in the vaginal dinoprostone group. No cases of severe neonatal or maternal morbidity were reported, and there were no significant differences in other clinically relevant outcomes. CONCLUSIONS: In terms of induction and delivery time, oral misoprostol appears to be less effective than vaginal dinoprostone. While it results in a lower frequency of tachysystole and non-reassuring fetal heart rate (FHR) changes, the rates of cesarean delivery and maternal and fetal complications are similar between the two groups. Additionally, the oral misoprostol group requires additional methods to achieve vaginal delivery. Therefore, oral misoprostol does not demonstrate superiority in achieving vaginal delivery for patients with preeclampsia or gestational hypertension.

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“…Approximately 20% of pregnant women may require labor induction 1 and intravenous oxytocin is the most commonly recommended medication according to various clinical guidelines 2–5 . The general recommendations for the oxytocin administration are similar in various guidelines 2–5 : intravenous dosing by infusion pump, starting at a low infusion rate, increasing the after 15–40 min until reaching regular uterine contractions thrice in 10 min.…”

Section: Introductionmentioning

confidence: 99%

Optimal starting dosing regimen of intravenous oxytocin for labor induction based on the population kinetic‐pharmacodynamic model of uterine contraction frequency

Yu,

Chen,

Zhao

et al. 2024

Pharmacotherapy

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BackgroundIntravenous oxytocin is commonly used for labor induction. However, a consensus on the initial dosing regimen is lac with conflicting research findings and varying guidelines. This study aimed to develop a population kinetic‐pharmacodynamic (K‐PD) model for oxytocin‐induced uterine contractions considering real‐world data and relevant influencing factors to establish an optimal starting dosing regimen for intravenous oxytocin.MethodsThis retrospective study included pregnant women who underwent labor induction with intravenous oxytocin at Peking University Third Hospital in 2020. A population K‐PD model was developed to depict the time course of uterine contraction frequency (UCF), and covariate screening identified significant factors affecting the pharmacokinetics and pharmacodynamics of oxytocin. Model‐based simulations were used to optimize the current starting regimen based on specific guidelines.ResultsData from 77 pregnant women with 1095 UCF observations were described well by the K‐PD model. Parity, cervical dilation, and membrane integrity are significant factors influencing the effectiveness of oxytocin. Based on the model‐based simulations, the current regimens showed prolonged onset times and high infusion rates. This study proposed a revised approach, beginning with a rapid infusion followed by a reduced infusion rate, enabling most women to achieve the target UCF within approximately 30 min with the lowest possible infusion rate.ConclusionThe K‐PD model of oxytocin effectively described the changes in UCF during labor induction. Furthermore, it revealed that parity, cervical dilation, and membrane integrity are key factors that influence the effectiveness of oxytocin. The optimal starting dosing regimens obtained through model simulations provide valuable clinical references for oxytocin treatment.

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Guideline No. 432c: Induction of Labour

Cited by 6 publications

References 21 publications

Low-Dose Oral Misoprostol Versus Oxytocin Infusion For Induction Of Labor In Pregnant Women With Term Premature Rupture Of Membranes in China: A retrospective Nested Case-Control Study

Low-Dose Oral Misoprostol Versus Oxytocin Infusion For Induction Of Labor In Pregnant Women With Term Premature Rupture Of Membranes in China: A retrospective Nested Case-Control Study

Is oral misoprostol more effective than vaginal dinoprostone for cervical ripening in women with preeclampsia or gestational hypertension: a retrospective cohort study

Optimal starting dosing regimen of intravenous oxytocin for labor induction based on the population kinetic‐pharmacodynamic model of uterine contraction frequency

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