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Rahimi M, Haghighi L, Baradaran HR, Azami M, Larijani SS, Kazemzadeh P, Moradi Y. Comparison of the effect of oral and vaginal misoprostol on labor induction: updating a systematic review and meta-analysis of interventional studies. Eur J Med Res 2023; 28:51. [PMID: 36707858 PMCID: PMC9881312 DOI: 10.1186/s40001-023-01007-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 01/09/2023] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES This study is aimed to compare the effect of oral misoprostol with vaginal misoprostol to induce labor as a systematic review and meta-analysis. METHODS Electronic databases including PubMed [Medline], Scopus, Web of science, Embase, Ovid, Cochrane library, and ClinicalTrials.gov were searched using the relevant keywords. All RCTs comparing the effect of oral vs vaginal misoprostol on labor induction were considered. The Cochrane Risk of Bias checklist was used for assessing quality of included RCTs. All statistical analyses were completed using STATA (Version 16) and Revman (Version 5). RESULTS Thirty-three RCTs with 5162 patients (1560 in oral and 2602 in vaginal groups) were included in this meta-analysis. Labor induction length did differ significantly between the two routes of misoprostol administration [Standardized Mean Difference: 0.40 h, 95% confidence interval (CI) 0.34, 0.46; I2: 66.35%; P = 0.04]. In addition, the risk of neonatal death, tachysystole, uterine hyperstimulation, preeclampsia, non-FHR and abortion was lower in the oral misoprostol group and the risk of hypertonus, PROM, oxytocin need and cesarean fever was higher in this group than the vaginal misoprostol group. CONCLUSIONS Based on results of this meta-analysis, it can be inferred that currently, clinical specialists can decide to use this drug orally or vaginally on a case-by-case basis, depending on the condition of the pregnant mother and the baby.
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Affiliation(s)
- Maryam Rahimi
- grid.411746.10000 0004 4911 7066Department of Gynecology and Obstetrics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ladan Haghighi
- grid.411746.10000 0004 4911 7066Department of Gynecology and Obstetrics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Baradaran
- grid.7107.10000 0004 1936 7291 Ageing Clinical & Experimental Research Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK ,grid.411746.10000 0004 4911 7066Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Mobin Azami
- grid.484406.a0000 0004 0417 6812Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Samaneh Saghafian Larijani
- grid.411746.10000 0004 4911 7066Department of Gynecology and Obstetrics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Paniz Kazemzadeh
- grid.411746.10000 0004 4911 7066Department of Gynecology and Obstetrics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Yousef Moradi
- grid.484406.a0000 0004 0417 6812Social Determinant of the Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran ,grid.484406.a0000 0004 0417 6812Department of Epidemiology and Biostatistics, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
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Duvillier C, Gams J, Rousseau A, Rozenberg P. [Induction of labour with oral misoprostol versus vaginal misoprostol: A before-after study]. Gynecol Obstet Fertil Senol 2022; 50:475-480. [PMID: 35151915 DOI: 10.1016/j.gofs.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/28/2022] [Accepted: 01/31/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The rate of induction of labor represented 22 % of deliveries in 2016 in France. Oral misoprostol (Angusta®) was marketed in France in the last quarter of 2018. The objective of our study was to compare the efficacy and safety of induction of labor with oral misoprostol compared to vaginal misoprostol in women with an unripe cervix. MATERIAL AND METHODS We carried out a retrospective study before and after the implementation of oral misoprostol including all women with an unripe cervix who benefited from an induction of labor with a viable infant in vertex presentation, without uterine scar. During the first two-year period, women received 50μg of misoprostol in the posterior fornix, repeated 6hours later if needed. If labor had not started after 24hours, women received another dose of 50μg, which was repeated every 4hours until labor was established, up to a total dose of 150μg. During the second two-year period, women received two tablets of oral misoprostol 25μg every four hours if necessary, up to a total dose of 200μg. The primary endpoints were mode of delivery and neonatal safety. RESULTS During the two study periods, 1199 women received vaginal misoprostol and 1199 women received oral misoprostol including. The cesarean delivery rate was 21.8% during the first period and 21,3% during the second period (P=0.83). A 5-minutes Apgar score<7 was observed in 23 (1.9%) and 14 (1.2%) newborns in the vaginal misoprostol and oral misoprostol groups (P=0.14), respectively. An arterial cord pH<7.00 was observed in 6 (0.5%) and 7 (0.6%) newborns (P=0.99), respectively. CONCLUSION Oral misoprostol administered at the dose of 50μg every 4hours (up to a total dose of 200μg) is as effective and safe as the vaginal misoprostol to induce labor in women with an unripe cervix.
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Affiliation(s)
- C Duvillier
- Université Paris Saclay, UVSQ, Inserm, équipe U1018, épidémiologie clinique, CESP, 78180 Montigny-le-Bretonneux, France; Centre Hospitalier Poissy/Saint-germain, service d'obstétrique et gynécologie, 10, rue du Champ Gaillard, 78300 Poissy, France.
| | - J Gams
- Centre Hospitalier Poissy/Saint-germain, service d'obstétrique et gynécologie, 10, rue du Champ Gaillard, 78300 Poissy, France
| | - A Rousseau
- Université Paris Saclay, UVSQ, Inserm, équipe U1018, épidémiologie clinique, CESP, 78180 Montigny-le-Bretonneux, France
| | - P Rozenberg
- Université Paris Saclay, UVSQ, Inserm, équipe U1018, épidémiologie clinique, CESP, 78180 Montigny-le-Bretonneux, France; Centre Hospitalier Poissy/Saint-germain, service d'obstétrique et gynécologie, 10, rue du Champ Gaillard, 78300 Poissy, France; Réseau maternité en Yvelines et périnatalité Active (MYPA), 20, rue Armagis, Pavillon Courtois, 78100 Saint-Germain-en-Laye, France
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Ratiu O, Ratiu D, Mallmann P, DI Liberto A, Ertan AK, Morgenstern B, Mallmann MR, Ludwig S, Grüttner B, Eichler C, Thangarajah F, Gilman E, Abel JS. Oral Misoprostol for the Induction of Labor: Comparison of Different Dosage Schemes With Respect to Maternal and Fetal Outcome in Patients Beyond 34 Weeks of Pregnancy. In Vivo 2022; 36:1285-1289. [PMID: 35478103 DOI: 10.21873/invivo.12828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/20/2022] [Accepted: 03/08/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Labor is induced in 1 out of 5 pregnancies. This is why we aimed to compare two different protocols of orally administered misoprostol for the induction of labor (IOL), with special regard to maternal and fetal outcome, delivery mode and duration. PATIENTS AND METHODS One hundred and twenty four patients with a medical indication for IOL were divided into two groups: Group A (n=63), which initially received 50 μg misoprostol escalated to 100 and, subsequently, to 200 μg every 4 h with a daily maximum of 600μg, between 11/2007 and 01/2008; and Group B (n=61), which initially received 25 μg misoprostol followed by 100 μg every 4 h with a daily maximum of 300 μg, between 12/2009 and 04/2010. RESULTS The mean administration-delivery interval was significantly lower in Group A (19.0 h) compared to Group B (27.1 h, p<0.05). Overall caesarean section rate, average birth weight, APGAR score, umbilical cord pH and meconium-stained fluid rates were similar between both groups. CONCLUSION A higher dosage protocol of orally administered misoprostol significantly reduces the mean induction-delivery interval without increasing the risk for an adverse maternal or fetal outcome.
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Affiliation(s)
- Oana Ratiu
- Department of Gynecology and Obstetrics, Leverkusen Municipal Hospital, Leverkusen, Germany
| | - Dominik Ratiu
- Department of Gynecology and Obstetrics, Leverkusen Municipal Hospital, Leverkusen, Germany
| | - Peter Mallmann
- Department of Obstetrics and Gynecology, University Hospital Cologne and Medical Faculty, Cologne, Germany
| | - Alexander DI Liberto
- Department of Obstetrics and Gynecology, University Hospital Cologne and Medical Faculty, Cologne, Germany
| | - A Kubilay Ertan
- Department of Gynecology and Obstetrics, Leverkusen Municipal Hospital, Leverkusen, Germany
| | - Bernd Morgenstern
- Department of Obstetrics and Gynecology, University Hospital Cologne and Medical Faculty, Cologne, Germany
| | - Michael R Mallmann
- Department of Obstetrics and Gynecology, University Hospital Cologne and Medical Faculty, Cologne, Germany
| | - Sebastian Ludwig
- Department of Obstetrics and Gynecology, University Hospital Cologne and Medical Faculty, Cologne, Germany
| | - Berthold Grüttner
- Department of Obstetrics and Gynecology, University Hospital Cologne and Medical Faculty, Cologne, Germany
| | - Christian Eichler
- Department of Obstetrics and Gynecology, University Hospital Cologne and Medical Faculty, Cologne, Germany
| | - Fabinshy Thangarajah
- Department of Obstetrics and Gynecology, University Hospital Cologne and Medical Faculty, Cologne, Germany
| | - Elena Gilman
- Department of Obstetrics and Gynecology, University Hospital Cologne and Medical Faculty, Cologne, Germany
| | - Judith S Abel
- Department of Obstetrics and Gynecology, University Hospital Cologne and Medical Faculty, Cologne, Germany
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Helmig RB, Brogaard L, Hvidman L. Women's body mass index and oral administration of Misoprostol for induction of labor - A retrospective cohort study. Obes Res Clin Pract 2021; 15:509-511. [PMID: 34503935 DOI: 10.1016/j.orcp.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 09/03/2021] [Indexed: 10/20/2022]
Abstract
Pregnant women who are obese are at greater risk of pregnancy complications, including preeclampsia, gestational diabetes, and macrosomia, leading to an increased likelihood of induced labor. Little is known about pregnant women with obesity and the dose of Misoprostol needed for induction of labor (IOL). To investigate whether the cumulative dose of Misoprostol needed for induction of labor (IOL) is associated with women's body mass index (BMI), we conducted a retrospective study of the use of oral Misoprostol for IOL at the Department of Obstetrics and Gynecology, Aarhus University Hospital - a tertiary referral delivery unit with 4800 deliveries a year. Data on IOL among 1637 women with singleton pregnancies was collected in the period January 1st, 2014, to October 4th, 2017. Low-risk women were induced in an outpatient setting. Primary outcomes were Misoprostol dose, time between start of induction (first dose of Angusta®) and completed delivery, and mode of delivery. Secondary outcomes were neonatal data as Apgar score and pH of the umbilical artery. In this study, we found the total dose of Misoprostol needed for induction increased significantly with increasing BMI (p < 0.005). The time to delivery and the risk of Cesarean section increased with rising BMI class. However, 76% of inductions among the women with obesity ended in a vaginal delivery. For the neonatal outcomes, a total of 16 children had an Apgar score below 7 at five minutes and 14 had a pH less than 7.0; none of these results differed significantly between BMI classes. The perinatal and maternal mortality rate was 0%.
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Affiliation(s)
- Rikke Bek Helmig
- Dept. of Obstetrics and Gynecology, Aarhus University Hospital, Skejby, Denmark.
| | - Lise Brogaard
- Dept. of Obstetrics and Gynecology, Aarhus University Hospital, Skejby, Denmark
| | - Lone Hvidman
- Dept. of Obstetrics and Gynecology, Aarhus University Hospital, Skejby, Denmark
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Shaamash AH, Khlifah EA, Esmail AM, Abdelmonem SG. Home-Based Extended Low-Dose Oral Misoprostol in Management of First-Trimester Pregnancy Loss in Low-Resource Communities: A Randomized Trial. J Obstet Gynaecol India 2019; 69:501-8. [PMID: 31844364 DOI: 10.1007/s13224-019-01247-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 06/11/2019] [Indexed: 12/15/2022] Open
Abstract
Objective To investigate the efficacy, safety and tolerability of a home-based extended low-dose oral misoprostol for management of first-trimester pregnancy loss. Materials and Methods A randomized trial that was conducted in the Woman's Health University Hospital and El-eman Maternity Hospital, Assiut, Egypt. One hundred and sixty patients were included. They were randomly assigned to receive four tablets of 200 μg misoprostol vaginally (max. 800 μg-hospital group) or 12 tablets orally, one every 3 h, over 2 consecutive days (max. 2400 μg-extended low-dose home group). For failed first dose, another similar second dose was given. Primary outcome measure was the percentage of patients with 'medically completed miscarriages' in each group (including complete miscarriages + incomplete miscarriages with successful post-miscarriage misoprostol). Results The total number of patients with 'medically completed miscarriages' in home group was 65/79 (82.3%), which was comparable to the hospital group (52/71 or 73.2%) (P = 0.182). However, the majority of patients in home group had significantly successful miscarriages after a single course of low-dose oral misoprostol, experienced much less heavy bleeding attacks and had less systemic side effects. Conclusion In low-resource communities, the home-based extended low-dose oral misoprostol protocol proved high efficacy, safety and tolerability in management of first-trimester pregnancy loss.
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Mohammadi E, Jayaprakash G, Shiva A, Motallebzadeh N. Comparison of Effectiveness and Patient Satisfaction of Vaginal Versus Oral Misoprostol in Treatment of Missed Miscarriage. Open Access Maced J Med Sci 2019; 7:955-958. [PMID: 30976339 PMCID: PMC6454167 DOI: 10.3889/oamjms.2019.192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 03/14/2019] [Accepted: 03/15/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND In recent years' medical management with misoprostol is an effective alternative to surgical evacuation. But there is a dearth of evidence to reveal the effectiveness of the different routes of misoprostol and satisfaction rate among the patients treated with these routes. AIM This study was conducted to compare the effectiveness and patient's satisfaction rate of vaginal versus oral misoprostol. METHODS It was a prospective non-interventional study. One hundred women of having missed abortion confirmed by ultrasonography examination were enrolled in the trial. Fifty-eight subjects were administered 200 mcg of oral and 42 subjects received 200 mcg of vaginal misoprostol every four hours up to four doses. If complete expulsion did not occur 12 hours after the last dose, the surgical evacuation was done. RESULTS There was no significant statistical difference between the effectiveness of treatment with vaginal (78.57%) and oral misoprostol (79.31%) (p = 0.928). The difference between Patients' satisfaction at the time of discharge for the vaginal group (64.29%) and oral group (65.52%) was not statistically significant (P = 0.991). There was an increase in patients' satisfaction for both groups at the follow-up session, but still, the difference was not significant (P = 0.897). CONCLUSION This study confirms that there is no statistical difference between the effectiveness and patient satisfaction of oral and vaginal misoprostol in the treatment of missed abortion.
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Affiliation(s)
| | - Geetha Jayaprakash
- Department of Pharmacy Practice, RR College of Pharmacy, Chikkabanavara, Bangalore, India
| | - Afshin Shiva
- Department of Pharmacy, Urmia University of Medical Sciences, Urmia, Iran
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Than KK, Mohamed Y, Oliver V, Myint T, La T, Beeson JG, Luchters S. Prevention of postpartum haemorrhage by community-based auxiliary midwives in hard-to-reach areas of Myanmar: a qualitative inquiry into acceptability and feasibility of task shifting. BMC Pregnancy Childbirth 2017; 17:146. [PMID: 28514959 PMCID: PMC5436430 DOI: 10.1186/s12884-017-1324-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 05/08/2017] [Indexed: 11/15/2022] Open
Abstract
Background In Myanmar, postpartum haemorrhage is the leading cause of maternal mortality and contributes to around 30% of all maternal deaths. The World Health Organization recommends training and supporting auxiliary midwives to administer oral misoprostol for prevention of postpartum haemorrhage in resource-limited settings. However, use of misoprostol by auxiliary midwives has not formally been approved in Myanmar. Our study aimed to explore community and provider perspectives on the roles of auxiliary midwives and community-level provision of oral misoprostol by auxiliary midwives. Methods A qualitative inquiry was conducted in Ngape Township, Myanmar. A total of 15 focus group discussions with midwives, auxiliary midwives, community members and mothers with children under the age of three were conducted. Ten key informant interviews were performed with national, district and township level health planners and implementers of maternal and child health services. All audio recordings were transcribed verbatim in Myanmar language. Transcripts of focus group discussions were fully translated into English before coding, while key informants’ data were coded in Myanmar language. Thematic analysis was done using ATLAS.ti software. Results Home births are common and auxiliary midwives were perceived as an essential care provider during childbirth in hard-to-reach areas. Main reasons provided were that auxiliary midwives are more accessible than midwives, live in the hard-to-reach areas, and are integrated in the community and well connected with midwives. Auxiliary midwives generally reported that their training involved instruction on active management of the third stage of labour, including use of misoprostol, but not all auxiliary midwives reported using misoprostol in practice. Supportive reasons for task-shifting administration of oral misoprostol to auxiliary midwives included discussions around the good relationship and trust between auxiliary midwives and midwives, whereby midwives felt confident distributing misoprostol to auxiliary midwives. However, the lack of clear government-level written permission to distribute the drug was perceived as a barrier to task shifting. Conclusion This study highlights the acceptability of misoprostol use by auxiliary midwives to prevent postpartum haemorrhage, and findings suggest that it should be considered as a promising intervention for task shifting in Myanmar. Electronic supplementary material The online version of this article (doi:10.1186/s12884-017-1324-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kyu Kyu Than
- Burnet Institute, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
| | | | - Victoria Oliver
- Monash Institute of Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Theingi Myint
- Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Thazin La
- Burnet Institute, Melbourne, Australia
| | - James G Beeson
- Burnet Institute, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine and Central Clinical School, Monash University, Melbourne, Australia
| | - Stanley Luchters
- Burnet Institute, Melbourne, Australia. .,Department of Epidemiology and Preventive Medicine and Central Clinical School, Monash University, Melbourne, Australia. .,International Centre for Reproductive Health, Department of Uro-Gynaecology, Ghent University, Ghent, Belgium.
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Drakopoulos P, Duyck C, Gayet-Ageron A, Fernandez S, Irion O, Martinez de Tejada B. What is the optimal duration of oral misoprostol treatment for cervical ripening? J Matern Fetal Neonatal Med 2016; 30:1494-1499. [PMID: 27493019 DOI: 10.1080/14767058.2016.1220520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To evaluate the number of misoprostol tablets needed to obtain a Bishop score (BS) ≥ 6 or a significant cervical change (≥2 points in BS) during cervical ripening. METHODS Retrospective study of women with term singleton pregnancies and a BS < 6 taking oral misoprostol (20 μg first 2 doses followed by 40 μg every 2 h) for cervical ripening. RESULTS We included 400 women, 72% nulliparous, mean age of 31.3 ± 5.9 years and 70% with a baseline BS ≤ 2. During cervical ripening, 61 (15.3%) achieved a BS ≥ 6 and 205 (51.3%) a significant change in BS. The incremental risk to achieve a BS ≥ 6 after 4 tablets was low (+3.25%) with an incremental probability of +12.75% for painful uterine contractions and +0.5% for abnormal fetal tracing (AFT). The incremental probability to achieve a significant change in BS after 7 tablets was low (+2.0%). 24.3% women delivered by cesarean section which likelihood significantly increased with maternal age <35 years, BMI ≥ 30, nulliparity, AFT, and baseline BS ≤ 2. CONCLUSIONS The marginal benefit of giving more than 7 misoprostol tablets (14 h) during cervical ripening is very low.
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Affiliation(s)
- Panagiotis Drakopoulos
- a Department of Obstetrics and Gynecology , Faculty of Medicine, Geneva University Hospitals , Geneva , Switzerland.,b Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel , Brussels , Belgium , and
| | - Céline Duyck
- a Department of Obstetrics and Gynecology , Faculty of Medicine, Geneva University Hospitals , Geneva , Switzerland
| | - Angèle Gayet-Ageron
- c Department of Community Health and Medicine , Clinical Research Center and Division of Clinical Epidemiology, Geneva University Hospitals, University of Geneva , Geneva , Switzerland
| | - Sonia Fernandez
- a Department of Obstetrics and Gynecology , Faculty of Medicine, Geneva University Hospitals , Geneva , Switzerland
| | - Olivier Irion
- a Department of Obstetrics and Gynecology , Faculty of Medicine, Geneva University Hospitals , Geneva , Switzerland
| | - Begoña Martinez de Tejada
- a Department of Obstetrics and Gynecology , Faculty of Medicine, Geneva University Hospitals , Geneva , Switzerland
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Musa AO, Ijaiya MA, Saidu R, Aboyeji AP, Jimoh AA, Adesina KT, Abdul IF. Double-blind randomized controlled trial comparing misoprostol and oxytocin for management of the third stage of labor in a Nigerian hospital. Int J Gynaecol Obstet 2015; 129:227-30. [PMID: 25835642 DOI: 10.1016/j.ijgo.2015.01.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 12/18/2014] [Accepted: 03/10/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To compare the efficacy of oral misoprostol with that of oxytocin for active management of the third stage of labor (AMTSL). METHODS A double-blind randomized control trial was undertaken at a center in Ilorin, Nigeria, between January and June 2013. Every other eligible patient (in the first stage of labor at term, to have a spontaneous vaginal delivery, and no/low risk of postpartum hemorrhage [PPH]) were randomly assigned with computer-generated random numbers to receive oral misoprostol (600μg) plus placebo injection or oral placebo plus oxytocin injection (1mL of 10IU) in the third stage of labor. The primary outcome was amount of blood loss during delivery. RESULTS Mean postpartum blood loss was 325.85±164.72mL in the 100 patients given misoprostol and 303.95±163.33mL in the 100 patients given oxytocin (P=0.391). PPH (≥500mL blood loss) was recorded in 15 (15.0%) patients given misoprostol and 14 (14.0%) given oxytocin (P=0.841). Shivering, pyrexia, and diarrhea were all significantly more common in the misoprostol group (P<0.01 for all). CONCLUSION The efficacy of oral misoprostol was similar to that of intramuscular oxytocin. Adverse effects associated with misoprostol were transient and self-limiting. Thus, oral misoprostol is efficacious and a good alternative to oxytocin for AMTSL. Pan African Clinical Trials Registry:PACTR201407000825227.
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Dey M. Oral misoprostol is an effective and acceptable alternative to vaginal administration for cervical priming before first trimester pregnancy termination. Med J Armed Forces India 2014; 69:27-30. [PMID: 24532930 DOI: 10.1016/j.mjafi.2012.07.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2011] [Accepted: 07/17/2012] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Cervical priming agents mainly prostaglandins in different doses and routes are used during first trimester vaccum aspiration to prevent cervical injury and shorten the abortion procedure. This study was carried out to assess women's acceptability, the efficacy and side effects of oral versus vaginal administration of misoprostol in facilitating cervical dilatation prior to first trimester vaccum aspiration. METHODS A randomised control study where 120 women were divided in oral (51) and vaginal (69) group. Each group received 400 mcg of misoprostol either orally or vaginally 04 h prior to first trimester pregnancy termination. Baseline cervical dilatation, women's acceptability and side effects and complications were noted in both the groups. RESULTS There was no difference between the oral and vaginal misoprostol groups with respect to mean cervical dilatation (5.53 mm vs 5.43 mm; p > 0.05). A total of 88% of women in the oral group expressed satisfaction with the route of misoprostol administration as compared to 74% in the vaginal route. The women in the vaginal group were experienced more preoperative vaginal bleeding (43% vs 25%). CONCLUSION Oral administration of misoprostol is an effective alternative to vaginal administration in preinduction cervical ripening prior to first trimester pregnancy termination.
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Affiliation(s)
- Madhusudan Dey
- On Study Leave (Materno-Fetal Medicine), AIIMS, New Delhi, India
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Jindal P, Avasthi K, Kaur M. A Comparison of Vaginal vs. Oral Misoprostol for Induction of Labor-Double Blind Randomized Trial. J Obstet Gynaecol India 2011; 61:538-42. [PMID: 23024525 DOI: 10.1007/s13224-011-0081-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Accepted: 07/27/2011] [Indexed: 10/16/2022] Open
Abstract
OBJECTIVE To compare efficacy and safety of 50 μgm misoprostol vaginal with oral for labor induction. METHODS 110 women at term gestation, Bishop score ≤4, with various indications for labor induction were randomized and double blinded. After decoding 51 women had received misoprostol orally and 52 vaginally, four hourly (maximum six doses) or till woman went into active labor. RESULTS Statistical analysis was done with SPSS 11.0. In vaginal misoprostol group induction delivery interval was significantly less (9.79 vs. 16.47 h) and successful induction was significantly higher (90.38 vs. 74.51%) than oral group, with in 24 h of induction. As for as dose required is concerned in vaginal group 40.38% women needed two doses for delivery, in contrast 35.29% in oral group maximum six doses were required. CONCLUSION Vaginal route of misoprostol is more effective labor inducing agent than oral.
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Affiliation(s)
- Promila Jindal
- Department of Obstetrics and Gynecology, Dayanand Medical College and Hospital, 20-B, Rishi Nagar, Ludhiana, 141001 Punjab India
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