The routine use of oxytocin after oral misoprostol for labour induction in women with an unfavourable cervix is not of benefit

De, Arunangsu; Bagga, Rashmi; Gopalan, Sarala

doi:10.1111/j.1479-828x.2006.00600.x

Cited by 10 publications

(4 citation statements)

References 29 publications

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“…The remaining included study compared a policy of two or six doses of oral misoprostol followed by oxytocin, and the method of concealment used was unclear. 20 Both studies were of good quality according to the Jadad scale 19 (Table 1), being awarded thee 20 and five 25 points. Table 1 shows the characteristics of the included studies.…”

Section: Resultsmentioning

confidence: 99%

Low-Dose Oral Misoprostol for Induction of Labor

Kundodyiwa

Alfirević

Weeks

2009

Obstetrics & Gynecology

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Section: Resultsmentioning

confidence: 99%

Low-Dose Oral Misoprostol for Induction of Labor

Kundodyiwa

Alfirević

Weeks

2009

Obstetrics & Gynecology

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“…Induction regimes using vaginal misoprostol have raised concerns of hyperstimulation and fetal heart rate changes due to the longer half-life and direct effect of misoprostol on the cervix [ 19 , 21 ]. In addition to the route of administration and dosage, it is also apparent that duration and the time interval between doses plays an important role in the efficacy and safety of oral misoprostol in labour induction [ 22 – 24 ]. However, there is still a high rate of heterogenicity between studies comparing the vaginal and oral routes of misoprostol administration [ 25 ], despite many such studies being previously conducted and scrutinised in systemic reviews [ 19 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

Safety and effectiveness of oral misoprostol for induction of labour in a resource-limited setting: a dose escalation study

Morris¹,

Bolnga²,

Verave³

et al. 2017

BMC Pregnancy Childbirth

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BackgroundOral misoprostol as an induction of labour (IOL) agent is rapidly gaining popularity in resource-limited settings because it is cheap, stable at ambient temperatures, and logistically easier to administer compared to dinoprostone and oxytocin. We aim to investigate the safety and effectiveness of a regimen of oral misoprostol in Papua New Guinean women undergoing IOL.MethodsAs part of a prospective dose escalation study conducted at Modilon Hospital in Papua New Guinea, women with a singleton pregnancy in cephalic presentation and an unfavourable cervix who gave written informed consent were administered oral misoprostol, commencing at 25mcg once every 2 h for 4 doses and increased to 50mcg once every 2 h for 8 doses within 24 h. The primary outcomes studied were i) the proportion of women delivering within 24 h of oral misoprostol administration, and ii) rates of maternal and perinatal severe adverse events.ResultsOf 6167 labour ward screened admissions, 209 women (3%) fulfilled the study inclusion criteria and underwent IOL. Overall, 74% (155/209 [95% confidence interval 67.6–79.9]) delivered within 24 h. Most women (90%; 188/209; 95% CI [84.9–93.5]) delivered vaginally with 86% (180/209) having a good outcome for both the mother and baby. Of the 10% (21/209) who failed IOL and underwent caesarean section, a significant proportion of their babies were admitted to special-care nursery compared to babies delivered vaginally (20/21 [95%] versus 8/188 [4%]; Fisher Exact test P < 0.001), but their perinatal mortality rate was not significantly higher (1/21 [5%] versus 2/188 [1%]; P = 0.30). The only maternal death was not study related and occurred in a patient with post-partum haemorrhage, 15 h post-delivery.ConclusionThe oral misoprostol regimen for IOL described in the present study is safe, effective and logistically feasible to administer in a resource-limited setting.

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“…Innumerable regimes have been studied varying from single dose of 200 µg to various titrations of misoprostol solutions. [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] The frequency of administration and the use of oxytocin once cervical ripening is achieved are other variations noted in the literature.…”

Section: Discussionmentioning

confidence: 99%

A Randomised Study of Low-Dose Oral Misoprostol and Intracervical Prostaglandin E2 Gel for Cervical Ripening and Labour Induction in Term Pregnancy

Jain¹,

Pasrija²,

Sakure³

et al. 2018

jemds

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BACKGROUND Labour induction is one of the most frequent interventions all over the world in pregnant women. The rate of induction varies by location and in many centres, it is currently more than 20%. When the benefits of expeditious delivery are greater than the risks of continuing the pregnancy, inducing labour can be justified as a therapeutic intervention. The current study was done with the objective of comparing the efficacy, acceptability and safety of low-dose oral misoprostol tablet (25 ugm PGE1) and intracervical dinoprostone (PGE2) for labour induction and cervical ripening in women at term. In developing countries with low resources, misoprostol could be the preferred drug because of low cost and easy storage; however, monitoring the induced labour is a challenge. Aims and Objectives-To compare efficacy, acceptability and side effects of low-dose oral misoprostol with that of intracervical dinoprostone for cervical ripening and induction of labour. MATERIALS AND METHODS A prospective, randomised, controlled study wherein 100 pregnant women admitted to labour ward at 37 weeks or beyond with a single live foetus for induction of labour were included. The enrolled women were randomly divided into two equal Groups A and B. Group A women received oral tab Misoprostol 25 ugm every 2 hours for a maximum of 6 doses. Group B women received 0.5 mg intracervical dinoprostone gel 6 hourly, for a maximum of 3 doses. Outcomes in terms of improvement in Bishop's score, induction to delivery interval, number of doses required, requirement of any other means of ripening, induction and/or augmentation and mode of delivery were noted. Side effects and complications were compared. Foetal outcomes in terms of Apgar score and need for NICU admission was compared. The results observed were subjected to statistical analysis by SPSS: Chi-square/ Fisher's Exact test and Unpaired t-test. RESULTS The two groups were comparable in terms of age, parity, gravidity, period of gestation at induction and reasons for induction of labour. Successful priming was achieved in 100% women in Group A and 86% women in Group B. The 'p' value was 0.003, which is statistically significant. The number of women with a favourable score (≥ 6) was significantly higher in Group A. Successful induction was achieved in 88% and 66% women in Groups A and B respectively. The mean induction to delivery interval was shorter in Group A. Vaginal delivery was the outcome in 92% women with misoprostol induction and 74% women with dinoprostone induction. Side effects of prostaglandin inductions when compared in two groups showed no statistically significant differences. CONCLUSION Low-dose oral misoprostol is more effective than dinoprostone gel for cervical priming and labour induction without compromising safety. It has an advantage of decreasing the need of additional measures to achieve vaginal delivery, lower cost and patient acceptability as shown by VAS score.

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The routine use of oxytocin after oral misoprostol for labour induction in women with an unfavourable cervix is not of benefit

Abstract: There was no benefit of routine addition of oxytocin after two doses of misoprostol. Reduced oxytocin requirement was observed when it was added only if needed. Both regimens achieved 85-87% vaginal deliveries with low incidence of hypercontractility.

Cited by 10 publications

References 29 publications

Low-Dose Oral Misoprostol for Induction of Labor

Low-Dose Oral Misoprostol for Induction of Labor

Safety and effectiveness of oral misoprostol for induction of labour in a resource-limited setting: a dose escalation study

A Randomised Study of Low-Dose Oral Misoprostol and Intracervical Prostaglandin E2 Gel for Cervical Ripening and Labour Induction in Term Pregnancy

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