Share This Article:

Efficacy and safety of oral solution dosed misoprostol versus misoprostol vaginally in labour induction

Abstract Full-Text HTML XML Download Download as PDF (Size:83KB) PP. 673-679
DOI: 10.4236/ojog.2013.39123    3,521 Downloads   4,948 Views   Citations

ABSTRACT

Background: Labour induction is one of the most common medical procedures in obstetrics. The aim is to end the pregnancy when continuity is a risk to mother or fetus. Its main side effect is the increase in the cesarean rate, compared to spontaneous onset deliveries. On the other hand, mortality and morbidity in cesareans are higher. The most common pharmacological drugs used for induction are prostaglandins: dinoprostone and misoprostol. The “gold standard” for labour induction is vaginal misoprostol. The oral route is also effective and also has several benefits like faster onset and easear administration. In recent years several publications state that the administration of misoprostol oral solution, given in doses gradually, is associated with a lower cesarean and hyperstimulation rate than the cases where vaginal misoprostol has been used in pregnant women with unripe cervix. Furthermore, being its half life shorter, it may be very useful in case of uterine hyperstimulation and, probably, a high percentage of women prefer this oral administration to the vaginal one. The objective of this study is to compare the efficacy, safety and side effects on mother and fetus on use of oral versus vaginal administration for induction of labour for prolonged gestation (41 weeks) and premature rupture of membranes, both with live fetus. Methods/Design: Design: double blind controlled trial. Study population: Pregnant women whose labour will be induced due to premature rupture of membranes or prolonged gestation. Inclusion Criteria: 1) Bishop Test equal to or less than 7; 2) Single pregnancy; 3) Pregnancy at term (37 - 42 weeks); 4) No history of uterine surgery; 5) Cephalic presentation; 6) Live fetus; 7) No prostaglandins contraindications. Discussion: Nowadays induction rates are very high, ranging from 25% to 30% approximately. In these cases caesarean rates are higher than when the delivery starts spontaneously. That is one of the main reasons why caesareans have increased, mainly in the cases of nuliparous women with immature cervix. If we can prove the hypothetical good results obtained through the use of dosed oral misoprotol, we will be able to reduce the number of induced deliveries by cesarean, and so improve the levels of security for the mother and the foetus, and, as a consequence, provide a higher quality of medical attention to the newborn and the mother.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Velasco, L. , Barroso, M. , García, M. , Acosta, V. , Pedrosa, R. , Ramírez, A. , Martínez, L. and Martínez, E. (2013) Efficacy and safety of oral solution dosed misoprostol versus misoprostol vaginally in labour induction. Open Journal of Obstetrics and Gynecology, 3, 673-679. doi: 10.4236/ojog.2013.39123.

References

[1] J. Zhang and W. F. Raiburn, “Rising Rates of Labour Induction: Present Concerns an Future Strategies,” Obstetrics & Gynecology, Vol. 100, No. 1, 2002, pp. 164-167 http://dx.doi.org/10.1016/ S0029-7844(02)02047-1
[2] X. Zhang, K. S. Joseph and M. S. Kramer, “Decreased Term and Postterm Birthweight in the United Sates: Impact of Labour Induction,” American Journal of Obstetrics & Gynecology, Vol. 203, No. 2, 2010, pp. 124.e1-124.e 7
[3] C. S. Ennen, J. A. Bofill, E. F. Magnann, J. D. Bass, S. P. Chauhan and J. C. Morrison, “Risk Factors for Cesarean Delivery in Preterm, Term and Post-Term Induction of Labour Patients Undergoing with an Unfavorable Cervix,” Gynecologic and Obstetric Investigation, Vol. 67, No. 2, 2009, pp. 113-117. http://dx.doi.org/10.1159/000166307
[4] D. B. Ehrenthaln, X. Jiang and D. M. Strobino, “Labour Induction and the Risk of Cesarean Delivery among Nulliparous Women at Term,” Obstetrics & Gynecology, Vol. 116, No. 1, 2010, pp. 35-42 http://dx.doi.org/10.1097/AOG.0b013e3181e10c5c
[5] W. F. Rayburn, “Minimizing the Risks from Elective Induction of Labour,” Journal of Reproductive Medicine, Vol. 52, No. 8, 2007, pp. 671-676
[6] F. P. Vrouenraets, F. J. Roumen, C. J. Dehing, E. S. Van den Akker, M. J. Aarts and E. J. Scheve, “Bishop Score and Risk of Cesrean Delivery after Induction of Labour in Nulliparous Women,” Obstetrics & Gynecology, Vol. 105, No. 4, 2005, pp. 688-689. http://dx.doi.org/10.1097/01.AOG. 0000152338.76759.38
[7] A. Vahratian, J. Zhang and J. F. Troendle, “Labour Progression and Risk of Cesarean Delivery in Electively Induced Nulliparous,” Obstetrics & Gynecology, Vol. 105, No., 2005, pp. 698-704.
http://dx.doi.org/10.1097/01.AOG.0000157436.68847.3b
[8] L. J. Heffner, E. Elkin and R. C. Fretts, “Impact of Labour Induction, Gestational Age and Maternal Age on Cesarean Delivery Rates,” Obstetrics & Gynecology, Vol. 102, No. 2, 2003, pp. 287-293.
http://dx.doi.org/10.1016/S0029-7844(03)00531-3
[9] G. J. Hofmeyr, A. M. Gulmezoglu and C. Pileggi, “Vaginal Misoprostol for Cervical Ripening and Induction of Labour,” Cochrane Database of Systematic Reviews, Vol. 10, 2010, Article ID: CD000941.
[10] S. C. Austin, L. Sanchez Ramos and C. D. Adair, “Labour Induction with Intravaginal Misoprostol Vaginal Insert Compared with Dinoprostone: A Systematic Review and Meta-Analysis,” American Journal of Obstetrics & Gynecology, Vol. 202, No. 6, 2010, pp. 624 e1-e9.
[11] R. Shakya, J. Shrestha and P. Thapa, “Safety and Efficacy of Misoprostol and Dinoprostone as Cervical Ripening Agents,” Journal of Nepal Medical Association, Vol. 49, No. 177, 2010, pp. 33-37
[12] D. B. Silfeler, B. Tandogan, H. Ayvaci, I. Silfeler, I. Yenidede and V. Dayicioglu, “A Comparison of Misoprostol, Controlled-Release Dinoprostone Vaginal Insert for Cervical Ripening and Oxytocin,” Archives of Gynecology and Obstetrics, Vol. 284, No. 6, 2011, pp. 1331-1337. http://dx.doi.org/ 10.1007/s00404-011-1844-7
[13] A. Elati and A. D. Weeks, “The Use of Misoprostol in Obstetrics and Gynecology,” BJOG, Vol. 116, Suppl. 1 2009, pp. 61-69. http://dx.doi.org/10.1111/j.1471-0528.2009.02329.x
[14] A. E. Bartuservicius and R. Nadisauskiene, “Barcaite Oral, Vaginal and Sublingual Misoprostol for Induction of Labour,” International Journal of Gynecology & Obstetrics, Vol. 91, No., 2005, pp. 2-9. http://dx.doi.org/10.1016/j.ijgo.2005.07.002
[15] A. Goldberg, B. S. Greenberg and P. Darney, “Misoprostol and Pregnancy,” The New England Journal of Medicine, Vol. 344, No. 1, 2001, pp. 38-47. http://dx.doi.org/10.1056/NEJM200101043440107
[16] ACOG Committee on Obstetric Practice, “ACOG Committee Opinion Number 283, May 2003: New U.S. Food and Drug Administration Labelling on Cytotec (Misoprostol) Use and Pregnancy,” Obstetrics & Gynecology, Vol. 101, No. 5, 2003, pp. 1049-1050. http://dx.doi.org/10.1016/S0029-7844(03)00396-X
[17] Z. Alfirevic and A. Weeks, “Oral Misoprostol for Induction of Labour,” Cochrane Database of Systematic Reviews, Vol. 2, No., 2006, Article ID: CD0001338
[18] R. U. Khan, H. El Rafaey, S. Sharma, D. Sooranna and M. Stafford, “Oral, Rectal and Vaginal Pharmacokinetics of Misoprostol,” Obstetrics & Gynecology, Vol. 103, No., 2004, pp. 866-870. http://dx.doi.org/10.1097/01.AOG.0000124783.38974.53
[19] M. C. Williams, J. C. Tsibris, G. Davis, J. Baiano and W. F. O’Brien, “That Variation Dose is Associated with Approximated One-Quarter Tablet Doses of Misoprostol,” American Journal of Obstetrics & Gynecology, Vol. 187, No. 3, 2002, pp. 615-619. http://dx.doi.org/10.1067/mob.2002.124959
[20] G. J. Hofmeyr, Z. Alfirevic, B. Matonhodze, P. Brocklehurst, E. Campbell and V. C. Nikodem, “Titrated Oral Misoprostol Solution for Induction of Labour: A Multi-Center, Randomized Trial,” BJOG, Vol. 108, No. 9, 2001, pp. 952-959.
[21] Y. Chong, S. Chua, L. Shen and S. Arulkumaran, “Does the Route of Administration of Misoprostol Make a Difference? The Uterotonic Effect and Side Effects of Misoprostol Given by Different Routes after Vaginal Delivery,” European Journal of Obstetrics & Gynecology and Reproductive Biology, Vol. 113, No., 2004, pp. 191-198. http://dx.doi.org/10.1016/j.ejogrb.2003.09.011
[22] O. S. Tang, H. Gemzell-Danielsson and P. C. Misoprostol, “Pharmacokinetic Profiles, Effect on the Uterus ans Side-Effects,” International Journal of Gynecology & Obstetrics, Vol. 99, No., 2007, pp. S160-S167. http://dx.doi.org/10.1016/j.ijgo.2007.09.004
[23] M. Zieman, S. Fong, N. D. Benowitz and P. Darney, “Banskter Absorption Kinetics of Misoprostol with Vaginal Ortal or Administration,” Obstetrics & Gynecology, Vol. 90, No. 1, 1997, pp. 88-92.
http://dx.doi.org/10.1016/S0029-7844(97)00111-7
[24] S. Y. Cheng, H. Ming and J. C. Lee, “Compared with Vaginal Oral Titrated Misoprostol for Labour Induction: A Randomized Controlled Trial,” Obstetrics & Gynecology, Vol. 111, No. 1, 2008, pp. 119-125. http://dx.doi.org/10.1097/01.AOG.0000297313.68644.71
[25] T. W. Kundodyiwa, Z. Alfrevic and A. D. Weeks, “Low-Dose Oral Misoprostol for Induction of Labour,” Obstetrics & Gynecology, Vol. 113, No. 2, 2009, pp. 374-383.
[26] A. S. Souza, A. Scavuzzi, D. C. Rodrigues, R. D. Oliveira, F. E. Feitosa and M. M. Armorim, “Titrated Oral Misoprostol Solution of Labour for Induction: A Pilot Study,” Rev Bras Obstetrics & Gynecology, Vol. 32, No. 5, 2010, pp. 208-213. http://dx.doi.org/10.1590/S0100-72032010000500002
[27] S. H. Cheng, C. S. Hsue, G. H. Hwang, W. Chen and T. Ch. Li, “Comparison of Labour Induction with Titrated Oral Misoprostol Solution and Multiparous between Nulliparous Women,” Journal of Obstetrics and Gynaecology Research, Vol. 36, No. 1, 2010, pp. 72-78. http://dx.doi.org/10.1111/ j.1447-0756.2009.01118.x

  
comments powered by Disqus

Copyright © 2019 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.