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Dadashaliha M, Fallah S, Mirzadeh M. Labor induction with randomized comparison of cervical, oral and intravaginal misoprostol. BMC Pregnancy Childbirth 2021; 21:721. [PMID: 34706675 PMCID: PMC8549163 DOI: 10.1186/s12884-021-04196-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 10/14/2021] [Indexed: 11/18/2022] Open
Abstract
Background This study attempts to evaluate the safety and effectiveness of 50μgm intracervical misoprostol in comparison with intravaginal and sublingual for the induction of labor at term pregnant women. Methods This study is designed as a parallel clinical trial study. Three hundred and fifteen term pregnancies requiring induction of labor were treated with the maximum used misoprostol intracervical, sublingual, and vaginal doses. Participants were randomly allocated into three groups of 105. The dose was repeated every 4 h until adequate uterine contraction and Bishop Score were achieved. The duration of induction to births, time to the active phase, the rate of births, and the need for caesarean section were compared in three groups. Additionally, labor course and side effects were recorded and analyzed. Data were analyzed using SPSS software. A significance level of p < 0.05 was considered for statistical analyses. Findings Labor was successfully induced in all cases most (63%) of which required a single dose of misoprostol. Ninety-three (93.0%, p < 0.05) cervical participants proceeded to vaginal births. This figure was also the same in the vaginal and sublingual group of 83 cases (83.0%). The other 41 cases received caesarean section with more indications of failure to progress and meconium-stained liquor. The results indicated that 278 (92.7%) births were achieved in less than 10 h. Time from start of medication to the active phase of labor and childbirth was 3.01 ± 0.86 and 6.1 ± 1.3 h in the Cervical group, 4.2 ± 0.66 and 8.4 ± 0.92 h in the sublingual group, and 5.06 ± 1.1 and 9.2 ± 1.5 h in the vaginal group respectively (p < 0.001). The Caesarean rate was lower in the cervical group than in the two other groups (p = 0.05). No significant differences were observed between the study groups in terms of Apgar score and meconium-stained amniotic fluid. Furthermore, no maternal and neonatal complications were observed. Conclusion In addition to the sublingual and intravaginal routes of administration, intracervical misoprostol at a single dose of 50μgm appears to be an effective method for induction of labor in women with an unfavorable cervix. Like all medical interventions, a discussion of the risks, benefits, and alternatives to induction of labor with this medication in each woman should be undertaken before treatment. Trial registration This clinical study was approved by the Iranian Registry of Clinical Trials with IRCT ID: IRCT20190415043278N1. Registration date was on May 13, 2019 and May 27, 2019 respectively (http://www.irct.ir).
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Affiliation(s)
- Masoumeh Dadashaliha
- Obstetrics and Gynecology, Department of Obstetrics and Gynecology, Children Growth Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Somayeh Fallah
- Children Growth Research Center, Research Institute for Prevention of Non-Communicable Diseases, School of Nursing and Midwifery, Qazvin University of Medical Sciences, Qazvin, Iran.
| | - Monirsadat Mirzadeh
- Community Medicine, Metabolic Disease Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
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Rouzi AA, Almansouri N, Sahly N, Alsenani N, Abed H, Darhouse K, Bondagji N. Efficacy of intra-cervical misoprostol in the management of early pregnancy failure. Sci Rep 2014; 4:7182. [PMID: 25418083 PMCID: PMC4241530 DOI: 10.1038/srep07182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 11/06/2014] [Indexed: 11/25/2022] Open
Abstract
The aim of this prospective study was to assess the efficacy of intra-cervical misoprostol in the management of early pregnancy failure. Twenty women with early pregnancy failure received intra-cervical misoprostol via an endometrial sampling cannula. The first dose was 50 μg of misoprostol dissolved in 5 ml of normal saline. The administration was repeated after 12 h if there was no vaginal bleeding or pain. Nine (45%) women received 1 dose and 11 (55%) women received 2 doses of intra-cervical misoprostol. Abortion within 24 h occurred in 16 (80%) women, and complete abortion was achieved in 14 (70%) cases. Two women with incomplete abortion were managed with 600 μg of misoprostol orally (1 case) and surgical intervention (1 case). The mean time interval between the first dose and the abortion was 10.6 ± 6.3 h. Two women did not respond within 24 h of treatment initiation, 1 woman withdrew consent after the first treatment, and 1 woman developed heavy vaginal bleeding after the first dose and underwent surgical management. Intra-cervical misoprostol is a promising method of medical treatment of early pregnancy failure. Further randomized clinical trials are needed to validate its safety and efficacy.
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Affiliation(s)
- Abdulrahim A Rouzi
- Department of Obstetrics and Gynecology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Nisma Almansouri
- Department of Obstetrics and Gynecology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Nora Sahly
- Department of Obstetrics and Gynecology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Nawal Alsenani
- Department of Obstetrics and Gynecology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hussam Abed
- Department of Obstetrics and Gynecology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Khalid Darhouse
- Department of Obstetrics and Gynecology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Nabil Bondagji
- Department of Obstetrics and Gynecology, King Abdulaziz University, Jeddah, Saudi Arabia
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The Bishop Score as a determinant of labour induction success: a systematic review and meta-analysis. Arch Gynecol Obstet 2012; 286:739-53. [PMID: 22546948 DOI: 10.1007/s00404-012-2341-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Accepted: 04/16/2012] [Indexed: 10/28/2022]
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Agaoglu A, Schäfer-Somi S, Kaya D, Kucukaslan I, Emre B, Gultiken N, Mulazımoglu B, Colak A, Aslan S. The intravaginal application of misoprostol improves induction of abortion with aglepristone. Theriogenology 2011; 76:74-82. [DOI: 10.1016/j.theriogenology.2011.01.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Revised: 01/11/2011] [Accepted: 01/14/2011] [Indexed: 10/18/2022]
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Yolande H, Namory K, Delphine F, Mamadou Hady D, Mamadou Diouldé B, Daniel T, Patrick T. Misoprostol use for labor induction in developing countries: a prospective study in Guinea. Eur J Obstet Gynecol Reprod Biol 2005; 122:40-4. [PMID: 16154037 DOI: 10.1016/j.ejogrb.2004.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2004] [Revised: 11/16/2004] [Accepted: 11/17/2004] [Indexed: 11/15/2022]
Abstract
BACKGROUND The purpose of this study was to assess the efficacy, side effects and cost of misoprostol regimens in various obstetrical situations frequently occurring in developing countries. STUDY DESIGN One hundred and four parturient women with indications for labor induction received different regimens of misoprostol in the range of 50-800 microg according to their gestational age. Misoprostol was administered by the vaginal route, every 6h without exceeding four doses. RESULTS All indications for labor induction concerned women with a gestational age of more than 30 weeks, except in the intrauterine death cases. The mean overall duration of labor was 7.8 h (+/-4.6 h). The mean amount of misoprostol used was 226 microg (+/-196 microg). The difference in the mean labor duration between the four indications for induction was statistically significant (P<0.01). It was also significant for the mean total dose of misoprostol used. Total dose of misoprostol and Bishop score were inversely proportional. Two caesarean deliveries and two uterine ruptures were recorded, but no maternal deaths. The mean Apgar score was 8.0 (+/-1) at 1 min and 9.5 (+/-0.8) at 5 min. In our series, four fetal deaths occurred. The mean cost of misoprostol for labor induction was around US$ 1, with a range of 0.05-4. CONCLUSIONS The use of vaginal misoprostol appears to be relevant in developing countries in cases where labor induction is indicated. Nevertheless, the advantages of misoprostol (low cost, facility of storage) are counter-balanced by side-effects (C-section, uterine rupture) which can be harmful for the mother and also for the newborn.
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Affiliation(s)
- Hyjazi Yolande
- Department of Obstetrics and Gynaecology, University Hospital, Donka, Guinea
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Abstract
Misoprostol is a prostaglandin E1 analog originally intended for use to prevent NSAID-induced gastric ulcers. However, because of its cervical ripening and uterotonic property, misoprostol has become one of the most useful drugs in obstetrics and gynecology. Misoprostol has proven to be a very convenient and flexible drug because of its formulation as a tablet that is stable and that can be administered orally, rectally, vaginally and by the sublingual route. Beginning with its abuse for illegal abortion in the late 1980s, misoprostol has quickly become established as one of the most effective drugs for terminating pregnancies in the first and second trimesters, as well as for inducing labor in the third trimester. Its use for routine prevention of postpartum hemorrhage has not been so successful, partly as the high doses required for this indication often result in troublesome side effects. Despite the large body of medical evidence about its efficacy and relative safety, the use of misoprostol in pregnant women remained off-label until the spring of 2002.
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Affiliation(s)
- Yap-Seng Chong
- Department of Obstetrics & Gynaecology, National University of Singapore, Singapore
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Ding DC, Su HY, Chu TW. Intravaginal and intracervical misoprostol for cervical ripening of labor in primiparas. Int J Gynaecol Obstet 2003; 82:209-11. [PMID: 12873783 DOI: 10.1016/s0020-7292(03)00135-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- D-C Ding
- Department of Obstetrics and Gynecology, Armed Forces Hualien General Hospital, Hualien, Taiwan.
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Hernandez-Valencia M. Cervical ripening with prostaglandin E1: how an ambulatory method decreases the hospital stay in abortus with intrauterine fetal demise. Fetal Diagn Ther 2003; 18:54-8. [PMID: 12566778 DOI: 10.1159/000066386] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2002] [Accepted: 05/03/2002] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study was designed to determine whether use of prostaglandin E(1 )(PGE(1)) is justified to improve the known clinical outcome of prostaglandin E(2) (PGE(2)) gel, because PGE(2) gel preparations are more costly than PGE(1) tablets in most countries, and data to support the use of the gel in clinical practice is not conclusive. The aim was to compare the safety and efficacy of PGE(1) gel when applied in both an in-hospital or ambulatory setting to oxytocin infusion in those women with unfavorable cervical conditions prior to surgical abortion for either medical or obstetrical indications with intrauterine fetal demise. Surgical dilatation of the unripe cervix may result in cervical injury of uterine perforation which could prolong the hospital stay. METHODS We used PGE(1) gel prepared from tablets and administered in the ambulatory form (group 1), the same PGE(1) gel administered in the labor room (group 2) and intravenously administered oxytocin in the labor room (group 3) for the induction of abortus in women complicated with intrauterine fetus death and missed abortion. Patients requesting abortion were eligible for inclusion, with >8 and <13 weeks of gestation. Eighty-nine women with unfavorable cervices (Bishop score </=4) were included in this study. Comparisons between the three groups for such variables were done by ANOVA. RESULTS The statistical test did reveal significant differences in the cervical changes, doses of PGE(1) used and maternal labor stay between the three groups. The difference in effect on cervical ripening was seen following PGE(1) application in both of these groups, but no difference was seen with the oxytocin use. Cervical score changed in 100% of both groups with the PGE(1) gel and 89.6% of the group with oxytocin use, within 6 days in the latter group. The mean number of days of maternal labor stay were 1.5, 4.6 and 6.2 respectively. There was no difference regarding the effect on clinical characteristics of the women on the final Bishop score. The number, initial and final Bishop score, vaginal bleeding and other complications were not different. CONCLUSIONS Duration of hospital stay may be decreased by applying PGE(1) gel in an ambulatory setting when compared to in-hospital PGE(1) gel applications or intravenous oxytocin infusion for cervical ripening. Further research is necessary to determine the safety of PGE(1) gel application for preabortion cervical ripening prior to surgical abortion.
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Affiliation(s)
- Marcelino Hernandez-Valencia
- Department of Obstetrics and Gynecology, General Hospital Dr. José Ma. Rodriguez, ISEM-SSA, Mexico City, Mexico.
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Chang YK, Chen WH, Yu MH, Liu HS. Intracervical misoprostol and prostaglandin E2 for labor induction. Int J Gynaecol Obstet 2003; 80:23-8. [PMID: 12527456 DOI: 10.1016/s0020-7292(02)00333-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To compare the safety and efficacy of misoprostol with PGE(2) for induction of labor by intracervical administration. METHODS Eighty-six women with indications for labor induction at term were randomly assigned to two groups. Each woman received either 50 microg of misoprostol or 0.5 mg of prostaglandin E(2) intracervically. If labor was not initiated after 4 h, the same dose was repeated every 4 h to a maximum of 200 microg of misoprostol or 1.5 mg of PGE(2) until adequate labor was achieved. RESULTS Forty-three women were allocated to the misoprostol group and 43 to the prostaglandin E(2) group. Misoprostol was more effective than PGE(2) in producing cervical changes (P<0.025). Delivery within 12 h after the first administration occurred more often in the misoprostol group than in the PGE(2) one (85% vs. 56%, P<0.05). Less patients in the misoprostol group required oxytocin augmentation than in the PGE(2) one (16.3% vs. 39.5%, P<0.05). Uterine tachysystole and hyperstimulation occurred more frequently in the misoprostol group (44.1%) than in the PGE(2) group (18.7%) (P<0.05). Nevertheless, no statistically significant differences were noted between the two groups including mode of delivery and neonatal or maternal adverse outcome. The interval from induction to vaginal delivery was significantly shorter in the misoprostol group (480+/-172 min vs. 657+/-436 min, P<0.01). CONCLUSIONS Compared with prostaglandin E(2), intracervical misoprostol is more effective in cervical ripening and labor induction at term. The higher frequency of uterine hypercontractility associated with the use of misoprostol did not increase the risk of adverse intrapartum and neonatal outcomes.
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Affiliation(s)
- Y-K Chang
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Alan M, Taşal I. Efficacy of prostaglandin F2alpha and misoprostol in the induction of parturition in goats. Vet Rec 2002; 150:788-9. [PMID: 12135076 DOI: 10.1136/vr.150.25.788] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- M Alan
- Department of Obstetrics and Gynaecology, Faculty of Veterinary Medicine, Yüzüncü Yil University, Van, Turkey
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Adekanmi OA, Purmessur S, Edwards G, Barrington JW. Intrauterine misoprostol for the treatment of severe recurrent atonic secondary postpartum haemorrhage. BJOG 2001; 108:541-2. [PMID: 11368143 DOI: 10.1111/j.1471-0528.2001.00110.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- O A Adekanmi
- Department of Obstetrics and Gynaecology, Torbay Hospital, Torquay, UK
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Intrauterine misoprostol for the treatment of severe recurrent atonic secondary postpartum haemorrhage. ACTA ACUST UNITED AC 2001. [DOI: 10.1016/s0306-5456(00)00110-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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El-Sherbiny MT, El-Gharieb IH, Gewely HA. Vaginal misoprostol for induction of labor: 25 vs. 50 microg dose regimen. Int J Gynaecol Obstet 2001; 72:25-30. [PMID: 11146073 DOI: 10.1016/s0020-7292(00)00308-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To compare the efficacy and safety of two regimens of vaginal misoprostol for induction of labor. METHOD In a randomized study, 185 women undergoing induction of labor were allocated to Group A (n=93), to be given 25 microg misoprostol and Group B (n=92), to be given 50 microg misoprostol. Intravaginal misoprostol was given every 4 h until the onset of labor. A maximum of six doses was administered. RESULTS Abnormal uterine contractions were more common in Group B compared to Group A: 33 (35.86%) vs. 10 (10.75%) cases, and significantly more women in Group B required tocolysis (9.78 vs. 3.23%). The induction-delivery interval (mean+/-S.D.) was 17.18+/-8.48 h in Group A and 9.37+/-5.87 h in Group B (P<0.05). Oxytocin infusion was used in 37.63% of women in Group A and 26.08% in Group B (P>0.05). The cesarean section rate was 17.20% in Group A and 14.13% in Group B (P>0.05). Cesarean for failed IOL was more common in Group A: 7 of 16 (43.8%) vs. 3 of 13 (23.1%) cesarean deliveries (P<0.05). Postpartum hemorrhage occurred in 9.78% of women in Group B compared to 2.15% in Group A (P<0.05). There was a trend for more neonatal complications in Group B, but this did not reach significance. CONCLUSIONS Although a dose of 50 microg of misoprostol results in a significantly shorter induction-delivery interval with less need for labor augmentation, there was an increased risk of uterine contractile abnormalities and postpartum hemorrhage. A regime using 25 microg of misoprostol every 4 h can induce labor safely and effectively.
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Affiliation(s)
- M T El-Sherbiny
- Department of Obstetrics and Gynecology, El-Sherbiny Hospital, Demietta, Egypt
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