Labor induction with vaginal misoprostol achieves vaginal delivery rates comparable to induction with oral misoprostol, according to a study published in the February issue of Obstetrics & Gynecology.
Emily H. Adhikari, M.D., from the University of Texas Southwestern Medical Center in Dallas, and colleagues conducted a single-center, cluster randomized trial involving individuals with a gestational age of 37 weeks or more, cervical dilation of 2 cm or less, intact membranes, and indication for delivery. A total of 1,322 women were randomly assigned to vaginal misoprostol in 33 clusters and 1,224 were randomly assigned to oral misoprostol in 37 clusters between May 24, 2021, and Sept. 19, 2022; misoprostol regimens were followed by a standardized oxytocin protocol.
The researchers found that the primary outcome of vaginal delivery at first induction attempt did not differ between induction regimens and occurred in 78.1 and 77.2 percent of the vaginal and oral misoprostol arms, respectively. Tachysystole with fetal heart rate changes occurred less often in the vaginal versus the oral misoprostol arms (3.5 versus 5.9 percent). There was no significant difference noted between the groups in time to delivery. In the vaginal group, oxytocin was required less often before delivery (68.8 versus 78.4 percent).
“Use of a vaginal misoprostol compared with an oral misoprostol protocol for induction of labor in term gravid patients with intact membranes and cervical dilation of 2 cm or less did not result in increased vaginal delivery,” the authors write.
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