Maternal and neonatal outcome of labour induction at term comparing two regimens of misoprostol

Abstract

Aim: To compare the efficacy and safety of two misoprostol dosing regimens for induction of labour in primiparous (1P) and multiparous ( > 1P) women. Methods: Retrospective study of induction of labour using vaginal misoprostol 25 μg vs. 50 μg every 6 h in 942 women at a tertiary centre. The main outcome variables are induction-to-delivery interval, latency period duration, vaginal delivery within 24 h, and maternal and foetal safety outcome. Results: With the 50 μg regimen, induction-to-delivery intervals were significantly shorter: 18.4 h vs. 24.6 h (1P) and 14 h vs. 17.9 h ( > 1P), as was latency period duration (by 5.4 and 4 h, respectively). Vaginal delivery within 24 h was significantly more frequent, as were non-reassuring foetal heart rate (1P: 20% vs. 14%) and tachysystole (1P: 31% vs. 11%; > 1P: 21% vs. 7%). No uterine rupture was reported. Neonatal outcomes were similar except for significantly more frequent infant referral to neonatal intensive care in the > 1P group receiving the 50 μg regimen (11% vs. 4%). Conclusion: Vaginal misoprostol 25 μg seems to maintain efficacy with more acceptable maternal and neonatal safety. As induction of labour is an off-label use for misoprostol, safety should be prioritised with the lower dosage regimen despite the longer induction-to-delivery interval.

A comparative study of 25µg versus 50µg vaginal misoprostol for induction of labour at term premature rupture of membrane

“…Neonatal outcome were comparable. Similar to this study neonatal outcome (APGAR and NICU admission) was comparable in lower and higher dose vaginal misoprostol groups in the study by Makbib Diro et al, Ozsoy M, Meydanli MM et al and Kreft M. 10,11,14,15 …”

Comparison of 25 and 50 microgram of misoprostol for induction of labour in nulliparous women with postdate pregnancy in Port Harcourt

“…Gastrointestinal side-effects, especially vomiting was significantly more in the 50 μg group, which is consistent with findings from other studies. [24] Despite studies linking misoprostol use to the high incidence of uterine rupture, there was none observed in this study similar to the findings by Kreft et al [17] The absence of uterine rupture; a dreaded complication from misoprostol administration could still be explained by low incidences of tachysystole and hyperstimulation, as well as prompt intervention at onset of these complications and the fact that only nulliparous women were used in the study and those with scared uterus were excluded.…”

“…According to some studies, the mean interval from induction to vaginal delivery was significantly shorter in the 50 μg group compared with those that received the 25 μg dose. [14,[16][17][18] However, in a randomized controlled trial comparing effectiveness of 25 μg versus 50 μg of intravaginal misoprostol every 4 h for induction of labor, it was reported that induction-delivery interval was not significantly different between the two groups (685 ± 201 min in 25 μg group vs. 625 ± 177 min in 50 μg group). [15] Similarly, in another randomized clinical trial by Rahman et al…”

Randomized controlled trial between sublingual and vaginal misoprostol for induction of labour at term

“…Induction of labour implies artificial initiation of regular uterine contraction before their spontaneous onset, resulting in progressive effacement and dilatation of cervix, with an aim to secure safe vaginal delivery (Kreft et al, 2014).…”

“…Misoprostol binds selectively to prostanoid receptors, increases intracellular calcium and contracts myometrium while also softening the cervix by collagen disintegration and dissolution. As a result, it shortens the inductionto-delivery interval compared to placebo, oxytocin or other induction agents in women with an unfavourable cervix (Kreft et al, 2014).…”