Comparison of oral and vaginal administration of low-dose misoprostol for labor induction

Abstract

Objective: Comparison of oral and vaginal administration of lowdose misoprostol for induction of labor at term. Materials and methods: Two hundred pregnant women after 37 weeks of gestation with an indication for induction were given 25 μg of misoprostol orally (study group) or vaginally (control group), every 3 hours to a maximum of 8 doses. The induction to delivery interval, requirement of oxytocin, dose of misoprostol used, maternal and neonatal outcome were analyzed statistically. Results: The median induction to delivery interval was significantly shorter in those induced with vaginal misoprostol (p = 0.06). The median induction to delivery interval was 21.35 ± 7.44 hours in study group and 14.64 ± 5.49 hours in control group. Eighty-two percent women in study group and 84% women in control group had vaginal delivery. Cesarean section rate was lower in control group, 16% vs 18% in study group, but the difference was not statistically significant (p = 0.790). Oxytocin augmentation was needed for 80% cases in the study group and 54% cases in control group, which was statistically significant (p = 0.006). The incidence of abnormal FHR was more in control group as compared to study group (30 vs 14%). Hyperstimulation syndrome was observed in 4% cases in control group and 2% cases in study group. Neonatal outcome was found to be similar in both groups. Conclusion: Vaginal misoprostol achieved higher success rate within a short induction interval but was associated with increase in abnormal FHR pattern and abnormal uterine activity as compared to the oral route. Oral route had comparable efficacy, was safe and well-tolerated route of misoprostol administration for induction of labor at term.