OBJECTIVES:
The aim of this randomized controlled trial is to compare the safety and efficacy of titrated oral misoprostol with vaginal misoprostol for labor induction.
METHODS:
778 patients at term meeting inclusion criteria for induction of labor were randomized by computer generated block randomization sequence. They were allocated into two groups to receive oral drug and vaginal placebo or vaginal drug and oral placebo given every 4 hourly until the patient entered active labor or the bishop score of the cervix was more than 6. The dosage of the oral drug was 50 mcg of misoprostol followed by 2 doses of 100 mcg each and that of the vaginal drug was 25 mcg in all three doses. The results were analyzed using SPSS version 17 software.
RESULTS:
389 women were equally randomized to each arm. Vaginal delivery in 24 hours from induction was achieved in 67% and 66.8% of the vaginal and oral misoprostol group respectively. The rate of cesarean section rate, incidence of uterine hyperstimulation and meconium staining were similar in both the groups. The need for oxytocin augmentation was less in the oral misoprostol group (80.3% versus 73.4%, p=0.02). The incidence of maternal or neonatal outcomes was similar. Our study found that oral misoprostol is as safe and effective as vaginal misoprostol for cervical ripening.
CONCLUSION:
Our study found that oral misoprostol is as effective as vaginal misoprostol for cervical ripening and in achieving vaginal delivery within 24 hours. The rate of hyperstimulation and cesarean section was similar in both the groups. The need for oxytocin augmentation was less in the oral misoprostol group. Oral misoprostol had no increase in the incidence of maternal or neonatal outcomes compared to vaginal misoprostol
