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Oral, vaginal and sublingual misoprostol for induction of labor
Author(s) -
Bartusevicius A.,
Barcaite E.,
Nadisauskiene R.
Publication year - 2005
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1016/j.ijgo.2005.07.002
Subject(s) - misoprostol , medicine , labor induction , buccal administration , confidence interval , obstetrics , odds ratio , vaginal delivery , randomized controlled trial , sublingual administration , gynecology , oxytocin , pregnancy , anesthesia , abortion , surgery , genetics , pharmacology , biology
Objective: To evaluate the effectiveness and safety of different administration routes of misoprostol for induction of labor. Method: PubMed, Cochrane Library and EMBASE searches were carried out using the keywords oral, vaginal, sublingual, buccal, misoprostol, labor induction , identifying randomized case–controlled trials comparing different routes for giving misoprostol to induce labor, published in English between 1994 and 2004. Results: Seventeen studies (3549 participants) were included. Compared to vaginal administration, oral misoprostol was associated with higher failure rates for achieving vaginal delivery within 24 h (odds ratio (OR) 1.61, 95% confidence interval (CI) 1.23–2.10), higher rates of uterine hyperstimulation without fetal heart rate (FHR) changes (OR 2.21, 95% CI 1.12 – 4.34) and lower cesarean section rates (OR 0.74, 95% CI 0.56–0.97). A lower dose of oral misoprostol (50 μg) compared to the 25–50 μg administered vaginally was associated with a higher rate of vaginal delivery not being achieved within 24 h (OR 3.60, 95% CI 2.10 – 6.18), more need for oxytocin augmentation (OR 2.19, 95% CI 1.65–2.92), less uterine hyperstimulation both without FHR changes (OR 0.58, 95% CI 0.42–0.80) and with FHR changes (OR 0.34, 95% CI 0.17–0.67) and fewer cesarean sections (OR 0.69, 95% CI 0.51–0.91). Compared to vaginal administration, buccal misoprostol resulted in a higher rate of failure to achieve vaginal delivery after 24 h, more frequent uterine hyperstimulation and lower rates of cesarean section, but these differences were not significant. When 50 μg of misoprostol used sublingually was compared to oral administration, the sublingual misoprostol was associated with less failure to achieve vaginal delivery after 24 h, less oxytocin augmentation and reduced cesarean section, but none of the differences were statistically significant. Conclusions: Vaginal misoprostol appears more effective than the equivalent dosage administered orally. However, the vaginal route appears to be associated with a higher risk of uterine hyperstimulation. Sublingual misoprostol seems an effective route of administration, but a lack of data necessitates more clinical trials to establish the effectiveness and safety of the buccal/sublingual route.