Original Article Oral versus vaginal Misoprostol for labour induction

Objective: To compare the safety and efficacy of oral versus vaginal misoprostol for induction of labour. Methods: Three hundred and ten live singleton term pregnancies with medical or obstetric indication for labour induction were randomly assigned to receive 50 microgram (µg) misoprostol orally or vaginally every 4- 6 hours to a maximum of six doses. Main outcome measures were time of intervention to vaginal birth and number of doses required. Secondary outcome measures included frequency of tachysystole / hyper stimulation, maternal side effects, caesarean section (LSCS) rate, instrumental delivery rate and neonatal outcome (apgar score, need of neonatal intensive care). This study was conducted at Kharadar General Hospital; Karachi. Data was collected on a Performa and analyzed using software SPSS (version 10.0) and p-value was used to test the statistical significance. Results: The mean induction to delivery interval was significantly shorter in the vaginal group compared with the oral group (13.5hrs vs. 20.6hrs p<0.010). In the vaginal group fewer doses of misoprostol were required (1.93 VS 2.52 p<0.001) and there was reduced need for additional oxytocin 65 (44.8%) vs. 89 (53.9%) p< 0.19, but there was an increased incidence of hyperstimulation and tachysystole (8.3 % vs. 1.8%). The modes of delivery were similar in the two groups. A higher incidence of neonatal intensive care unit (NICU) admission in the vaginal group was mainly due to respiratory distress syndrome (RDS). Conclusion: In this study Misoprostol proved to be a safe and effective drug to use for induction of labour (IOL). Vaginal route was more efficacious compared to the oral route. A slightly higher number of patients in the vaginal group had hyper stimulation and neonates required NICU admission (JPMA 57:404:2007)