Oral or vaginal misoprostol administration for induction of labor: a randomized, double-blind trial

• Published in: Obstetrics and gynecology (New York. 1953) Vol. 92; no. 5; pp. 810 - 813
• Main Authors: Adair, C.David, Weeks, Jonathan W, Barrilleaux, Scott, Edwards, Michael, Burlison, Kevin, Lewis, David F
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-11-1998; The American College of Obstetricians and Gynecologists; Elsevier Science
• Subjects: Administration, Intravaginal; Administration, Oral; Adult; Biological and medical sciences; Delivery, Obstetric - methods; Double-Blind Method; Female; Genital system. Reproduction; Humans; Labor, Induced - methods; Medical sciences; Misoprostol - administration & dosage; Pharmacology. Drug treatments; Pregnancy; Uterine Contraction - drug effects; Human; Induction; Oral administration; Labour; Route of administration; Misoprostol; Randomization; Vaginal route; Double blind study; Female; Delivery; Effective dose; Comparative study; Prostaglandin derivatives
• ISSN: 0029-7844; 1873-233X
• DOI: 10.1016/S0029-7844(98)00278-6

Objective: To compare the efficacy and vaginal birth intervals after intravaginal or oral misoprostol for labor induction.
Methods: One hundred seventy-eight women were randomized to one of two double-blind groups: 1) oral misoprostol 200 μg and one-half tablet placebo intravaginal or 2) oral placebo tablet and one-half tablet of a 100-μg misoprostol intravaginal (dose 50 μg). Doses were repeated every 6 hours until labor was established (maximum of three doses).
Results: Ninety-three subjects were assigned to oral misoprostol and 85 to intravaginal administration. Oral administration was accompanied by significantly shorter intervals to the onset of uterine contractility (133 ± 78 minutes versus 168 ± 93,
P < .01) but a higher incidence of abnormal uterine contractile activity (tachysystole 38.7% versus 20.0%,
P < .01; hyperstimulation syndrome 44.1% versus 21.2%,
P < .01). No adverse maternal or neonatal outcomes were noted, nor were there differences in cesarean delivery rates or total lengths of labor.
Conclusion: Oral administration of 200 μg misoprostol has similar efficacy to intravaginal administration of 50 μg but is associated with more frequent abnormal uterine contractility.