Induction of labour in term premature rupture of membranes; oxytocin versus sublingual misoprostol; a randomised clinical trial

Abstract

Premature rupture of the membranes (PROM) occurs in about 8-10% of pregnancies and its most important complication is chorioamnionitis, so labour induction has an important role in this situation. This study was performed to compare oxytocin and sublingual Misoprostol for labour induction in PROM cases with term pregnancy. A total of 270 pregnant women who had spontaneous rupture of membrane and unripe cervix were enrolled. The first group underwent Oxytocin infusion according to low-dose standard protocol and the second group received 25 μg sublingual Misoprostol every 4 h. Time interval from induction to the beginning of active phase of labour was similar in both groups. Second stage of labour was significantly shorter in misoprostol group (p < .05). Although, some maternal side-effects were significantly higher in misoprostol group (p < .001), but 5 minute Apgar score was significantly better in this group. In conclusion, sublingual misoprostol was associated with better neonatal outcomes was more effective than oxytocin for labour induction in PROM cases. Impact statement What is already known on this subject: PROM occurs in about 8-10% of pregnancies; about 60% of these cases are term pregnancies. Most experts recommend early induction of labour in term PROM cases with an eye towards avoiding increased morbidity and mortality. Oxytocin is the most frequently used agent that is administered intravenously for the purpose of labour induction. Misoprostol is an alternative to oxytocin and is simpler to use, as it is administered via the oral, buccal, sublingual, rectal and vaginal routes rather than intravenously. What do the results of this study add: Time interval from induction to the beginning of active phase of labour was similar in both groups. Second stage of labour was significantly shorter in the misoprostol group. Although, some maternal side-effects were significantly higher in misoprostol group, the 5 minute Apgar score was significantly better in this group. What are the implications of these finding for clinical practice and/or further research: Sublingual misoprostol for induction of labour in PROM cases is more effective than oxytocin and its neonatal outcomes are better. Due to its easy prescription and better labour outcomes, sub lingual misoprostol may be a better choice for labour induction in PROM cases.

Oxytocin Compared to Buccal Misoprostol for Induction of Labor after Term Prelabor Rupture of Membranes

“…One randomized study found that induction with 25 mcg of sublingual (equivalent to buccal) misoprostol shortens the duration of active labor and the second stage with similar time intervals from induction to the second stage compared with a low-dose oxytocin protocol. 10 This study did not evaluate overall induction-to-delivery times, which makes it difficult to directly compare our results. However, the study also excluded any patients who received oxytocin after sublingual misoprostol and therefore may represent a different patient population from our study, which evaluated only the initial induction agent after PROM.…”

“…8,9 However, limited data are available in the setting of induction after PROM, with a single study suggesting sublingual administration may be more effective than oxytocin. 10 The primary purpose of our study was to compare admission-to-delivery times in nulliparous patients with PROM and unfavorable cervices or unknown cervical dilation when induced with buccal misoprostol versus intravenous oxytocin. Given prior data that suggest oxytocin is equivalent or superior to vaginal prostaglandins and the similar bioavailability between buccal and vaginal misoprostol, we hypothesized that oxytocin would also be associated with faster admission-to-delivery times than buccal misoprostol.…”

The results of different labour induction approaches: A Cross sectional study

“…10 Vaginal or oral misoprostol could improve Bishop score in this patients. 11 In this sense, oral misoprostol seems to have a lower rate of caesarean section. 12 Moreover time to delivery is lower with oral misoprostol.…”

Penggunaan Off-Label Misoprostol Pada Pasien Obstetri-Ginekologi Di Rumah Sakit Swasta Kab. Banyumas

“…Penelitian ini diperkuat oleh hasil beberapa penelitian lain yang menemukan hal serupa, bahwa mayoritas penggunaan off-label Misoprostol adalah untuk menginduksi persalinan [26,27]. Hal tersebut dikarenakan Misoprostol memberikan efek uterotonik dan pelembutan pada rahim [28].…”