DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20195352

Sublingual versus vaginal use of Misoprostol for induction of labor

Mamta Bansal, Indu Sharma, Jyoti Lagoo, Harish Jadhav

Abstract


Background: Induction of labor is one of the great challenges for obstetric care provider. Misoprostol is used for induction of labor by various routes with the advantages in being cheap and stable at room temperature and widely available even in resource-poor settings.

Methods: A randomized controlled study was conducted in the obstetrics and gynecology department of Govt. Medical College and associated Maharani Hospital, Bastar, Chhattisgarh, India over a period of 1.75 years from September 2014 to May 2016. Study has comprised of 200 pregnant women admitted in the department for induction of labor fulfilling the inclusion and exclusion criteria. Data was collected and analyzed by SPSS 16.0. z-test and chi-square test to compare the safety and efficacy of both the routes of misoprostol use for IOL.

Results: There were insignificant differences in number of doses required for induction with satisfactory maternal and neonatal outcome but shorter (12 hours) induction delivery interval with sublingual Misoprostol induction. Most of the cases of both the groups were delivered by vaginal route (86% and 62%) within 12 hours of induction(58% and 42%) yet significant (p value < 0.001) number of cases had undergone caesarean in group of vaginal misoprostol administration (29%) with major indications of meconium stained liquor (3% and 12%) and non assuring fetal heart rate (1% and 10%).

Conclusions: Although both the routes of induction by Misoprostol are well tolerated by the women with satisfactory neonatal outcome, sublingual Misoprostol has an added advantage of quicker delivery, less caesarean and ease of administration indicates better safety and effectiveness.


Keywords


Effectiveness, Induction of labor, Misoprostol, Safety, Sublingual, Vaginal

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References


Danilack VA, Triche EW, Dore DD, Muri JH, Phipps MG, Savitz DA. Comparing expectant management and spontaneous labor approaches in studying the effect of labor induction on cesarean delivery. Ann Epidemiol. 2016;26(6):405.e1-411.e1.

Davey MA, King J. Caesarean section following induction of labour in uncomplicated first births- a population-based cross-sectional analysis of 42,950 births. BMC Preg Childbirth. 2016;16(1):Article no.92.

Vogel JP, West HM, Dowswell T. Titrated oral Misoprostol for augmenting labour to improve maternal and neonatal outcomes. The Cochrane Database Syst Rev. 2013;9:CD010648.

Tang J, Kapp N, Dragoman M, de Souza JP. WHO recommendations for Misoprostol use for obstetric and gynecologic indications. Int J Gynecol Obstet. 2013;121(2):186-9.

Sanchez-Ramos L, Kaunitz AM, Wears RL, Delke I, Gaudier FL. Misoprostol for cervical ripening and labor induction: a meta-analysis. Obstet Gynecol. 1997;89:633-42.

Muzonzini G, Hofmeyr GJ. Buccal or sublingual Misoprostol for cervical ripening and induction of labour. Cochrane Database Syst Rev. 2004;4:CD004221.

Wolf SB, Sanchez-Ramos L, Kaunitz AM. Sublingual Misoprostol for labor induction: a randomized clinical trial. Obstet Gynecol. 2005;105:365-71.

Rodney KE. Preinduction cervical assessment. Clin Obstet Gynecol. 2000;43(3):440-6.

Acharya I, Thapa S, Chaudhary P. Efficacy and safety of sublingual versus vaginal misoprostol for pre-induction cervical ripening among primigravida. MJSBH. 2018;17(1):18-24.

Ayati S, Vahidroodsari F, Farshidi F, Shahabian M, Aghaee MA. vaginal versus sublingual misoprostol for labor induction at term and post term: a randomized prospective study. Iran J Pharm Res. 2014;13(1):299-304.

Shetty A, Danilien P, Templeton A. A comparison of oral and vaginal Misoprostol in induction of labor at term. Br J Obstet Gynaecol. 2001;108:218-24.

Ahmad B, Shekhar C, Jindal S, Gupta S. Misoprostol for induction of labor: a comparative study of various routes of administration. Int J Reprod Contracept Obstet Gynecol. 2017;6:4583-8.

Feitosa FEL, Sampaio ZS, Alencar CA, Amorim MMR, Passini R. Sublingual versuss vaginal Misoprostol for induction of labor. Int J Gynecol Obst. 2006;94(2):91-5.

Kattan El, Eman A, Moety A, Ghada A, AbdEl R, Rahman A. Sublingual versus vaginal Misoprostol for induction of labor in term primi gravidas: a randomized study. J Evidence-Based Women’s Health J Society. 2013;3(3):111-4.

Zahran KM, Shahin AY, Abdellah MS, Elsayh KI. Sublingual versus vaginal Misoprostol for induction of labor at term: a randomized prospective placebo-controlled study. J Obstet Gynaecol Res. 2009;35:1054-60.

Wing DA, Ham D, Paul RH. A comparison of orally administered Misoprostol with vaginally administered Misoprostol for cervical ripening and labour induction. Am J Obst Gynaecol. 1999;180(5):1155-60.

Bartusevicius A, Barcaite E, Krikstolaitis R, Gintautas V, Nadisauskiene R. Sublingual compared with vaginal Misoprostol for labour induction at term: a randomized controlled trial. BJOG. 2006;113:1431-7.

Wing DA, Paul RH. A comparison of differing dosing regimens of vaginally administered Misoprostol for pre induction cervical ripening and labour induction. Am J Obst Gynaecol. 1996;175:158-64.

Fisher SA, Mackenzie VP, Davies GAL. Oral versus vaginal Misoprostol for induction of labor: A double-blind randomized controlled trial. AJOG. 2001;185(4):906-10.

Nassar AH, Awwad J, Khalil AM, Abu-Musa A, Mehio G, Usta IM. A randomized comparison of patient satisfaction with vaginal and sublingual Misoprostol for induction of labor at term. BJOG. 2007;114:1215-21.

Zieman M, Fong SK, Benowitz NL, Banskter D, Darney PD. Absorption kinetics of Misoprostol with oral or vaginal administration. Obstet Gynecol. 1997;90:88-92.

Danielsson KG, Marions L, Rodriguez A, Spur BW, Wong PYK, Bygdeman M. Comparison between oral and vaginal administration of Misoprostol on uterine contractility. Obstet Gynecol. 1999;93:275-80.

Caliskan E, Bodur H, Ozeren S, Corakci A, Ozkan S, Yucesoy I. Misoprostol 50 μg sublingually versus vaginally for labor induction at term: a randomized study. Gynecol Obstet Invest. 2005;59:155-61.