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Danilack VA, Siegel-Reamer L, Lum L, Kesselring C, Brousseau EC, Guthrie KM. From "disappointing" to "fantastic": Women's experiences with labor induction in a U.S. tertiary hospital. Birth 2023; 50:959-967. [PMID: 37475194 DOI: 10.1111/birt.12750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/08/2022] [Accepted: 06/29/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVE The series of interventions that comprise labor induction shape patient experiences; however, patient perceptions are not always considered when structuring the process of care. Through qualitative interviews, we elucidated women's expectations and experiences regarding labor induction. METHODS Labor induction patients were recruited from a United States tertiary care hospital's postpartum mother-baby unit and invited to participate in semi-structured qualitative interviews. Interview questions included expectations and experiences of the labor induction process, side effects and health outcomes of concern, reflections on personal tolerance of different interventions, and thoughts about an ideal process. RESULTS Between April and September 2018, 36 women were interviewed. The labor induction process involved a wide range of experiences; when asked to characterize labor induction in one word, responses ranged from horrible, frustrating, and terrifying to simple, fast, and smooth. Inductions were often described as longer than what was expected. The most polarizing induction method was the Foley balloon catheter. Women's concerns regarding side effects largely centered on the health of their baby, and an ideal induction involved fewer interventions. CONCLUSIONS Experiences with labor induction vary greatly and are related to expectations. The way interventions are introduced influences women's perceptions of control and their ultimate level of contentment with the birthing process. Attention to experiences and preferences has the potential to improve quality of care through communication, shared decision-making, and education.
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Affiliation(s)
- Valery A Danilack
- Department of Obstetrics and Gynecology (Research), Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | | | - Liana Lum
- The College, Brown University, Providence, Rhode Island, USA
| | - Cailey Kesselring
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Erin Christine Brousseau
- Department of Obstetrics and Gynecology (Research), Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Kate M Guthrie
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Socha MW, Flis W, Pietrus M, Wartęga M. Results of Induction of Labor with Prostaglandins E1 and E2 (The RIPE Study): A Real-World Data Analysis of Obstetrical Effectiveness and Clinical Outcomes of Pharmacological Induction of Labor with Vaginal Inserts. Pharmaceuticals (Basel) 2023; 16:982. [PMID: 37513894 PMCID: PMC10384291 DOI: 10.3390/ph16070982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023] Open
Abstract
Despite extensive knowledge of the mechanisms responsible for childbirth, the course of labor induction is often unpredictable. Therefore, labor induction protocols using prostaglandin analogs have been developed and tested to assess their effectiveness in labor induction unequivocally. A total of 402 women were collected into two groups-receiving vaginal Misoprostol or vaginal Dinoprostone for induction of labor (IOL). Then, the patients were compared in groups depending on the agent they received and their gestational age. Most patients delivered within 48 h, and most of these patients had vaginal parturition. Patients who received the Dinoprostone vaginal insert required statistically significantly more oxytocin administration than patients who received the Misoprostol vaginal insert. Patients who received the Misoprostol vaginal insert used anesthesia during labor statistically more often. Patients who received Misoprostol vaginal inserts had a statistically significantly shorter time to delivery than those with Dinoprostone vaginal inserts. The prevalence of hyperstimulation was similar in all groups and remained low. Vaginal Misoprostol-based IOL is characterized by a shortened time to delivery irrespective of the parturition type, and a lower need for oxytocin augmentation, but also by an increased demand for intrapartum analgesia administration. A vaginal Dinoprostone-based IOL protocol might be considered a more harmonious and desirable option in modern perinatal care.
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Affiliation(s)
- Maciej W Socha
- Department of Perinatology, Gynecology and Gynecologic Oncology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Łukasiewicza 1, 85-821 Bydgoszcz, Poland
- Department of Obstetrics and Gynecology, St. Adalbert's Hospital in Gdańsk, Copernicus Healthcare Entity, Jana Pawła II 50, 80-462 Gdańsk, Poland
| | - Wojciech Flis
- Department of Perinatology, Gynecology and Gynecologic Oncology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Łukasiewicza 1, 85-821 Bydgoszcz, Poland
- Department of Obstetrics and Gynecology, St. Adalbert's Hospital in Gdańsk, Copernicus Healthcare Entity, Jana Pawła II 50, 80-462 Gdańsk, Poland
| | - Miłosz Pietrus
- Department of Gynecology and Oncology, Jagiellonian University Medical College, 31-501 Kraków, Poland
| | - Mateusz Wartęga
- Department of Pathophysiology, Faculty of Pharmacy, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, M. Curie- Skłodowskiej 9, 85-094 Bydgoszcz, Poland
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Mauri PA, Pilloni E, Stillavato S, Ragusa A, Masturzo B, Trojano G, Piteri G, Pegurri G, Ricci ED, Teodoro MC, Guardalà F, Messina A, Svelato A, Parazzini F, Iurlaro E, Viora E. Role of mode of induction and delivery and women's satisfaction after induction of labour at term: An observational study. Eur J Obstet Gynecol Reprod Biol 2023; 286:47-51. [PMID: 37201318 DOI: 10.1016/j.ejogrb.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/03/2023] [Accepted: 05/11/2023] [Indexed: 05/20/2023]
Abstract
This cross-sectional study aimed at evaluating the impact of different modalities of induction of labour (IOL) and delivery on levels of woman' satisfaction. All women aged 18 years or older, who underwent IOL for at-term pregnancy (≥41 weeks of gestation) in randomly selected days during the study period in 6 participating centres were eligible for the study. The questionnaire investigated women's opinion regarding information about induction, pain control, length of induction, their experience about induction, labour and delivery and their attitude towards induction in a subsequent pregnancy. Women were also asked to fill in the Italian version of the Birth Satisfaction Scale-Revised (BSS-R). A total of 300 women entered the study. The answer to the question about a "positive attitude towards induction in a subsequent pregnancy was "absolutely yes" or "yes" respectively in the 77.8%, 52.8% and 48.6% of women who were induced with oral drugs, vaginal drugs and Cook balloon (heterogeneity chi-square p = 0.05). The corresponding values for women who delivered vaginally or by caesarean section (CS) were 63.3% and 36.4% (chi-square p = 0.0009). The mean BSS-R total score was higher among women who underwent IOL with oral drugs than with vaginal drugs (p < 0.0001) or Cook Balloon (p < 0.0001), and among women who delivered vaginally than in those who delivered by CS (p < 0.0001). Women were asked "What do you think is important for a method of induction?": 47.3% (95% CI 41.7%-53.0%) of women answered that "should make the induction as painless as possible", 47.0% (95% CI 41.4%-52.7%) "should induce labour quickly", 44.3% (95% CI 38.8%-50.0%) "should be safe for baby". This study showed that vaginal delivery was associated with a higher rate of satisfaction among induced women. Considering mode of induction, oral drugs were associated with a higher level of satisfaction. Control of pain and quick induction were the most appreciated characteristics.
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Affiliation(s)
- Paola Agnese Mauri
- Midwifery school, Department of Clinical Sciences and Community Health, University of Milan, via Manfredo Fanti 6, 20122 Milan, Italy; SITRA Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via Francesco Sforza 35, 20122 Milan, Italy.
| | - Eleonora Pilloni
- Obstetrics and Gynecology Department 3, Sant' Anna Hospital, Corso Spezia 60, 10126 Turin, Italy.
| | - Silvia Stillavato
- Obstetrics and Gynecology Department 3, Sant' Anna Hospital, Corso Spezia 60, 10126 Turin, Italy.
| | - Antonio Ragusa
- Department of Obstetrics and Gynecology, Università Campus Bio Medico di Roma, Via Álvaro del Portillo, 21, 00128 Rome, Italy.
| | - Bianca Masturzo
- Obstetrics and Gynecology Department, General Hospital, Via dei Ponderanesi 2, 13875 Ponderano, Biella- University of Turin, Italy.
| | - Giuseppe Trojano
- Department of Maternal and Child Health "Madonna delle Grazie" Hospital ASM, Contrada Cattedra Ambulante, 75100 Matera, Italy.
| | - Giulia Piteri
- Midwifery school, Department of Clinical Sciences and Community Health, University of Milan, via Manfredo Fanti 6, 20122 Milan, Italy.
| | - Giorgia Pegurri
- Midwifery school, Department of Clinical Sciences and Community Health, University of Milan, via Manfredo Fanti 6, 20122 Milan, Italy.
| | - Elena Delfina Ricci
- Midwifery school, Department of Clinical Sciences and Community Health, University of Milan, via Manfredo Fanti 6, 20122 Milan, Italy.
| | - Maria Cristina Teodoro
- Department Maternal and Child Health, Obstetrics and Gynecology Unit, Hospital AO for Emergency Cannizzaro, via Messina 829, 95126 Catania, Italy.
| | - Fabio Guardalà
- Department Maternal and Child Health, Obstetrics and Gynecology Unit, Hospital AO for Emergency Cannizzaro, via Messina 829, 95126 Catania, Italy.
| | - Alessandro Messina
- Obstetrics and Gynecology Department, General Hospital, Via dei Ponderanesi 2, 13875 Ponderano, Biella- University of Turin, Italy.
| | - Alessandro Svelato
- Obstetric Pathology Unit Ospedale Fatebenefratelli Hospital, Gemelli-Isola Tiberina, via di Ponte Quattro capi 39, 00186 Rome, Italy.
| | - Fabio Parazzini
- Midwifery school, Department of Clinical Sciences and Community Health, University of Milan, via Manfredo Fanti 6, 20122 Milan, Italy.
| | - Enrico Iurlaro
- Obstetric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via della Commenda 12, 20122 Milan, Italy.
| | - Elsa Viora
- Associazione Ostetrici e Ginecologi Italiani, via Abamonti 1, 20129 Milan, Italy.
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Salvator M, Girault A, Sibiude J, Mandelbrot L, Goffinet F, Cohen E. Failed induction of labor in term nulliparous women with an unfavorable cervix: Comparison of cervical ripening by two forms of vaginal prostaglandins (slow-release pessary and vaginal gel). J Gynecol Obstet Hum Reprod 2023; 52:102546. [PMID: 36740190 DOI: 10.1016/j.jogoh.2023.102546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To compare the rate of failed induction after cervical ripening by two forms of vaginal prostaglandins. MATERIAL AND METHODS This two-year retrospective study (January 1, 2016, through December 31, 2017) in two tertiary maternity units included nulliparous women with a singleton fetus in cephalic presentation and an unfavorable cervix requiring labor induction for prolonged pregnancy. The principal endpoint was the rate of failed induction, defined by the performance of a cesarean delivery before 6 cm of dilation. Cervical ripening was initiated by prostaglandins for 24 h, using a slow-release pessary (unit A) or a vaginal gel (unit B). The care protocol of the two groups after the first 24 h were similar. The women's individual characteristics were compared between the two units. The rates of failed induction were then compared between the two units, first by univariate and then by multivariable analysis adjusted for the characteristics that differed significantly between the units. RESULTS Among the 17,217 women delivered in the two maternity units during the study period, 178 met our inclusion criteria (125 in unit A (slow-release pessary) and 53 in unit B (vaginal gel)). The rate of failed induction was similar: 21.6% in unit A (slow-release pessary) and 17.0% in unit B (vaginal gel) (P = 0.48). The multivariate analysis did not show any difference about failed induction, time from the onset of induction to delivery, and vaginal delivery rate within 24h. CONCLUSION The rate of failed induction of labor did not differ between slow-release pessary and vaginal gel.
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Affiliation(s)
- Marie Salvator
- Université Paris Descartes - Paris V, Faculté de Médecine, Paris, France; Port-Royal Maternity Unit, Department of Obstetrics Paris, Cochin Broca Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
| | - Aude Girault
- Port-Royal Maternity Unit, Department of Obstetrics Paris, Cochin Broca Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM UMR 1153, Obstetrical, Perinatal and Paediatric Epidemiology Research Team (Epopé), Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris, France; DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Jeanne Sibiude
- DHU Risks in Pregnancy, Paris Descartes University, Paris, France; Louis Mourier Hospital, Department of Gynecology and Obstetrics, Colombes, Assistance Publique-Hôpitaux de Paris, University Paris Diderot, Paris, France; INSERM IAME-U1137, Groupe de Recherche Sur Les Infections Pendant la Grossesse (GRIG), Paris, France
| | - Laurent Mandelbrot
- DHU Risks in Pregnancy, Paris Descartes University, Paris, France; Louis Mourier Hospital, Department of Gynecology and Obstetrics, Colombes, Assistance Publique-Hôpitaux de Paris, University Paris Diderot, Paris, France; INSERM IAME-U1137, Groupe de Recherche Sur Les Infections Pendant la Grossesse (GRIG), Paris, France
| | - François Goffinet
- Port-Royal Maternity Unit, Department of Obstetrics Paris, Cochin Broca Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM UMR 1153, Obstetrical, Perinatal and Paediatric Epidemiology Research Team (Epopé), Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris, France
| | - Emmanuelle Cohen
- Department of Gynecology and Obstetrics, Institut Mutualiste Montsouris, Assistance Publique-Hôpitaux de Paris, Paris, France
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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] [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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Robinson D, Campbell K, Hobson SR, MacDonald WK, Sawchuck D, Wagner B. Directive clinique n o 432c : Déclenchement artificiel du travail. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:78-85.e3. [PMID: 36725135 DOI: 10.1016/j.jogc.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIFS Présenter des données probantes et des recommandations sur la maturation cervicale et le déclenchement artificiel du travail. Fournir de l'information aux professionnels accoucheurs et aux personnes enceintes sur les soins périnataux optimaux et la prévention des interventions obstétricales inutiles. POPULATION CIBLE Toutes les patientes enceintes. BéNéFICES, RISQUES ET COûTS: La mise en application interprofessionnelle et cohérente de la présente directive, l'équipement adéquat et le personnel compétent améliorent la sécurité des soins per partum. Les personnes enceintes et leurs personnes de soutien doivent être informées des risques et bénéfices du déclenchement artificiel du travail. DONNéES PROBANTES: La littérature publiée jusqu'en mars 2022 a été passée en revue. Une recherche a été effectuée dans les bases de données PubMed, CINAHL et Cochrane Library pour répertorier des revues systématiques, des essais cliniques randomisés et des études observationnelles sur la maturation cervicale et le déclenchement artificiel du travail. La littérature grise (non publiée) a été obtenue à l'aide de recherches menées dans des sites Web d'organismes s'intéressant à l'évaluation des technologies dans le domaine de la santé et d'organismes connexes, dans des collections de directives cliniques, des registres d'essais cliniques et des sites Web de sociétés de spécialité médicale nationales et internationales. MéTHODES DE VALIDATION: Les auteurs ont évalué la qualité des données probantes et la force des recommandations en utilisant le cadre méthodologique GRADE (Grading of Recommendations, Assessment, Development, and Evaluation). Voir l'annexe A en ligne (tableau A1 pour les définitions et tableau A2 pour l'interprétation des recommandations fortes et conditionnelles [faibles]). PROFESSIONNELS CONCERNéS: Tous les fournisseurs de soins obstétricaux. DÉCLARATIONS SOMMAIRESMISOPROSTOL: OCYTOCINE: RECOMMANDATIONS.
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Robinson D, Campbell K, Hobson SR, MacDonald WK, Sawchuck D, Wagner B. Guideline No. 432c: Induction of Labour. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:70-77.e3. [PMID: 36725134 DOI: 10.1016/j.jogc.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES This guideline presents evidence and recommendations for cervical ripening and induction of labour. It aims to provide information to birth attendants and pregnant individuals on optimal perinatal care while avoiding unnecessary obstetrical intervention. TARGET POPULATION All pregnant patients. BENEFITS, RISKS, AND COSTS Consistent interprofessional use of the guideline, appropriate equipment, and trained professional staff enhance safe intrapartum care. Pregnant individuals and their support person(s) should be informed of the benefits and risks of induction of labour. EVIDENCE Literature published to March 2022 was reviewed. PubMed, CINAHL, and the Cochrane Library were used to search for systematic reviews, randomized control trials, and observational studies on cervical ripening and induction labour. Grey (unpublished) literature was identified by searching the websites of health technology assessment and health technology related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations). INTENDED AUDIENCE All providers of obstetrical care. SUMMARY STATEMENTS Misoprostol OXYTOCIN: RECOMMENDATIONS.
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8
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Grasch JL, Daggy J, Yang Z, Bhamidipalli SS, Flannery KM, Quinney SK, Haas DM. Cervical change times during induction in nulliparas using vaginal or buccal misoprostol. J Matern Fetal Neonatal Med 2022; 35:10685-10691. [PMID: 36510345 DOI: 10.1080/14767058.2022.2155039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIM To determine if the time to cervical change and time to active labor were different when misoprostol was administered by a vaginal or buccal route for cervical ripening in nulliparas undergoing labor induction at term. METHODS This was a secondary analysis of nulliparous participants in the IMPROVE Study-A comparison of vaginal versus buccal misoprostol for cervical ripening for labor induction at term: a triple-masked randomized controlled trial (NCT02408315). The parent study was a non-inferiority randomized controlled trial in which patients beginning induction with a modified Bishop score ≤6 received either vaginal or buccal misoprostol and simultaneous placebo via the opposite route. The primary outcome of the parent study was time to delivery. Primary outcomes for this secondary analysis were the time to active labor (at least 6 cm dilated) and time to change in cervical dilation. Kaplan-Meier analysis was used to compare routes for time to active labor and multistate Markov modeling was used to compare sojourn times at each cervical dilation. RESULTS Of the 300 participants enrolled in the parent trial, 124 (41.3%) were nulliparous; 59 (47.6%) nulliparous participants underwent induction with vaginal misoprostol and 65 (52.4%) received buccal dosing. Nulliparas receiving vaginal dosing required fewer doses of misoprostol to reach active labor (median 2 vs 3, p = .003). However, this did not result in shorter time to active labor (median vaginal 23.1 h, 95% CI = [21.6, 27.2 h]; buccal 25.6 h [21.5, 29.3 h], p = .45) or higher rate of vaginal delivery within 24 h; (33.9% vs 35.4%, p = .86). There was also no significant difference in time to active labor after adjusting for covariates (adjusted HR for dose route (buccal vs vaginal) = 0.91 [0.61, 1.36], p = .649). Among people that delivered vaginally, the mean sojourn times, measuring cervical dilation state change, were not significantly different, with mean duration to active labor of 20.5 [17.6, 24.5] h for buccal and 21.8 [17.7, 28.2] h for vaginal dosing (p = .092). Satisfaction and preference for dosing routes were not different between groups. CONCLUSION Buccal and vaginal dosing of misoprostol for cervical ripening in nulliparas appear to have similar times to active labor and progression of cervical change during ripening.
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Affiliation(s)
- Jennifer L Grasch
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Joanne Daggy
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Ziyi Yang
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Kathleen M Flannery
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sara K Quinney
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - David M Haas
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN, USA
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9
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Gattás DSMB, de Amorim MMR, Feitosa FEL, da Silva-Junior JR, Ribeiro LCG, Souza GFA, Souza ASR. Misoprostol administered sublingually at a dose of 12.5 μg versus vaginally at a dose of 25 μg for the induction of full-term labor: a randomized controlled trial. Reprod Health 2020; 17:47. [PMID: 32272959 PMCID: PMC7147027 DOI: 10.1186/s12978-020-0901-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/27/2020] [Indexed: 12/04/2022] Open
Abstract
Background Labor induction is defined as any procedure that stimulates uterine contractions before labor begins spontaneously. The vaginal and oral routes of administration of misoprostol are those most used for the induction of labor in routine practice, with the recommended dose being 25 μg. Nevertheless, the sublingual route may reduce the number of vaginal examinations required, increasing patient comfort and lowering the risk of maternal and fetal infection. Based on a previous systematic review, the objective of this study was to compare the frequency of tachysystole as the main outcome measure when misoprostol is administered sublingually at the dose of 12.5 μg versus vaginally at a dose of 25 μg to induce labor in a full-term pregnancy with a live fetus. Methods A randomized, placebo-controlled, triple-blind clinical trial was conducted at two maternity hospitals in northeastern Brazil. Two hundred patients with a full-term pregnancy, a live fetus, Bishop score ≤ 6 and an indication for induction of labor were included. Following randomization, one group received 12.5 μg misoprostol sublingually and a vaginal placebo, while the other group received a sublingual placebo and 25 μg misoprostol vaginally. The primary outcome was the frequency of tachysystole. Student’s t-test, the chi-square test of association and Fisher’s exact test were used, as appropriate. Risk ratios and their 95% confidence intervals were calculated. Results The frequency of tachysystole was lower in the group using 12.5 μg misoprostol sublingually compared to the group using 25 μg misoprostol vaginally (RR = 0.15; 95%CI: 0.02–0.97; p = 0.002). Failure to achieve vaginal delivery within 12 and 24 h was similar in both groups. Sublingual administration was preferred to vaginal administration by women in both groups; however, the difference was not statistically significant. Conclusion The effectiveness of labor induction with low-dose sublingual misoprostol was similar to that achieved with vaginal administration of the recommended dose; however, the rate of tachysystole was lower in the sublingual group, and this route of administration may prove a safe alternative. Trial registration Registration number: NCT01406392, ClinicalTrials.gov. Date of registration: August 1, 2011.
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Affiliation(s)
- Daniele S M B Gattás
- Postgraduate Program in Comprehensive Healthcare at the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Rua Dom Sebastião Leme 171/ 2702, Graças, Recife, Pernambuco, 52011-160, Brazil.
| | - Melania M R de Amorim
- Postgraduate Program in Comprehensive Healthcare at the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Rua Dom Sebastião Leme 171/ 2702, Graças, Recife, Pernambuco, 52011-160, Brazil.,Department of Obstetrics and Gynecology, Federal University of Campina Grande (UFCG) and Instituto de Pesquisa Professor Joaquim Amorim Neto (IPESq), Campina Grande, Paraíba, Brazil
| | - Francisco E L Feitosa
- Assis Chateaubriand Maternity Teaching Hospital, Federal University of Ceará (UFC), Fortaleza, Ceará, Brazil
| | - José R da Silva-Junior
- Postgraduate Program in Comprehensive Healthcare at the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Rua Dom Sebastião Leme 171/ 2702, Graças, Recife, Pernambuco, 52011-160, Brazil.,Department of Obstetrics and Gynecology, Faculdade Pernambucana de Saúde (FPS), Recife, Pernambuco, Brazil
| | - Lívia C G Ribeiro
- Assis Chateaubriand Maternity Teaching Hospital, Federal University of Ceará (UFC), Fortaleza, Ceará, Brazil
| | - Gustavo F A Souza
- Undergraduate medical student, Centre for Biological Sciences and Health, Catholic University of Pernambuco (UNICAP), Recife, Pernambuco, Brazil
| | - Alex S R Souza
- Postgraduate Program in Comprehensive Healthcare, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Department of Maternal and Child Health, Federal University of Pernambuco (UFPE), Centre for Biological Sciences and Health, Catholic University of Pernambuco (UNICAP), Recife, Pernambuco, Brazil
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A comparison of vaginal versus buccal misoprostol for cervical ripening in women for labor induction at term (the IMPROVE trial): a triple-masked randomized controlled trial. Am J Obstet Gynecol 2019; 221:259.e1-259.e16. [PMID: 31075246 DOI: 10.1016/j.ajog.2019.04.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 04/24/2019] [Accepted: 04/30/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Cervical ripening is commonly needed for labor induction. Finding an optimal route of misoprostol dosing for efficacy, safety, and patient satisfaction is important and not well studied for the buccal route. OBJECTIVE To compare the efficacy and safety of vaginal and buccal misoprostol for women undergoing labor induction at term. STUDY DESIGN The IMPROVE trial was an institutional review board-approved, triple-masked, placebo-controlled randomized noninferiority trial for women undergoing labor induction at term with a Bishop score ≤6. Enrolled women received 25 mcg (first dose), then 50 mcg (subsequent doses) of misoprostol by assigned route (vaginal or buccal) and a matching placebo tablet by the opposite route. The primary outcomes were time to delivery and the rate of cesarean delivery performed urgently for fetal nonreassurance. A sample size of 300 was planned to test the noninferiority hypothesis. RESULTS The trial enrolled 319 women, with 300 available for analysis, 152 in the vaginal misoprostol group and 148 in the buccal. Groups had similar baseline characteristics. We were unable to demonstrate noninferiority. The time to vaginal delivery was lower for the vaginal misoprostol group (median [95% confidence interval] in hours: vaginal: 20.1 [18.2, 22.8] vs buccal: 28.1 [24.1, 31.4], log-rank test P = .006, Pnoninferiority = .663). The rate of cesarean deliveries for nonreassuring fetal status was 3.3% for the vaginal misoprostol group and 9.5% for the buccal misoprostol group (P = .033). The rate of vaginal delivery in <24 hours was higher in the vaginal group (58.6% vs 39.2%, P = .001). CONCLUSION We were unable to demonstrate noninferiority. In leading to a higher rate of vaginal deliveries, more rapid vaginal delivery, and fewer cesareans for fetal issues, vaginal misoprostol may be superior to buccal misoprostol for cervical ripening at term.
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Abstract
Induction of labor is a common procedure undertaken whenever the benefits of prompt delivery outweigh the risks of expectant management. Cervical assessment is essential to determine the optimal approach. Indication for induction, clinical presentation and history, safety, cost, and patient preference may factor into the selection of methods. For the unfavorable cervix, several pharmacologic and mechanical methods are available, each with associated advantages and disadvantages. In women with a favorable cervix, combined use of amniotomy and intravenous oxytocin is generally the most effective approach. The goal of labor induction is to ensure the best possible outcome for mother and newborn.
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Affiliation(s)
- Christina A Penfield
- Department of Obstetrics and Gynecology, University of California, Irvine School of Medicine, 333 City Boulevard West, Suite 1400, Orange, CA 92868, USA.
| | - Deborah A Wing
- Department of Obstetrics and Gynecology, University of California, Irvine School of Medicine, 333 City Boulevard West, Suite 1400, Orange, CA 92868, USA
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Alfirevic Z, Keeney E, Dowswell T, Welton NJ, Medley N, Dias S, Jones LV, Gyte G, Caldwell DM. Which method is best for the induction of labour? A systematic review, network meta-analysis and cost-effectiveness analysis. Health Technol Assess 2018; 20:1-584. [PMID: 27587290 DOI: 10.3310/hta20650] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND More than 150,000 pregnant women in England and Wales have their labour induced each year. Multiple pharmacological, mechanical and complementary methods are available to induce labour. OBJECTIVE To assess the relative effectiveness, safety and cost-effectiveness of labour induction methods and, data permitting, effects in different clinical subgroups. METHODS We carried out a systematic review using Cochrane methods. The Cochrane Pregnancy and Childbirth Group's Trials Register was searched (March 2014). This contains over 22,000 reports of controlled trials (published from 1923 onwards) retrieved from weekly searches of OVID MEDLINE (1966 to current); Cochrane Central Register of Controlled Trials (The Cochrane Library); EMBASE (1982 to current); Cumulative Index to Nursing and Allied Health Literature (1984 to current); ClinicalTrials.gov; the World Health Organization International Clinical Trials Registry Portal; and hand-searching of relevant conference proceedings and journals. We included randomised controlled trials examining interventions to induce labour compared with placebo, no treatment or other interventions in women eligible for third-trimester induction. We included outcomes relating to efficacy, safety and acceptability to women. In addition, for the economic analysis we searched the Database of Abstracts of Reviews of Effects, and Economic Evaluations Databases, NHS Economic Evaluation Database and the Health Technology Assessment database. We carried out a network meta-analysis (NMA) using all of the available evidence, both direct and indirect, to produce estimates of the relative effects of each treatment compared with others in a network. We developed a de novo decision tree model to estimate the cost-effectiveness of various methods. The costs included were the intervention and other hospital costs incurred (price year 2012-13). We reviewed the literature to identify preference-based utilities for the health-related outcomes in the model. We calculated incremental cost-effectiveness ratios, expected costs, utilities and net benefit. We represent uncertainty in the optimal intervention using cost-effectiveness acceptability curves. RESULTS We identified 1190 studies; 611 were eligible for inclusion. The interventions most likely to achieve vaginal delivery (VD) within 24 hours were intravenous oxytocin with amniotomy [posterior rank 2; 95% credible intervals (CrIs) 1 to 9] and higher-dose (≥ 50 µg) vaginal misoprostol (rank 3; 95% CrI 1 to 6). Compared with placebo, several treatments reduced the odds of caesarean section, but we observed considerable uncertainty in treatment rankings. For uterine hyperstimulation, double-balloon catheter had the highest probability of being among the best three treatments, whereas vaginal misoprostol (≥ 50 µg) was most likely to increase the odds of excessive uterine activity. For other safety outcomes there were insufficient data or there was too much uncertainty to identify which treatments performed 'best'. Few studies collected information on women's views. Owing to incomplete reporting of the VD within 24 hours outcome, the cost-effectiveness analysis could compare only 20 interventions. The analysis suggested that most interventions have similar utility and differ mainly in cost. With a caveat of considerable uncertainty, titrated (low-dose) misoprostol solution and buccal/sublingual misoprostol had the highest likelihood of being cost-effective. LIMITATIONS There was considerable uncertainty in findings and there were insufficient data for some planned subgroup analyses. CONCLUSIONS Overall, misoprostol and oxytocin with amniotomy (for women with favourable cervix) is more successful than other agents in achieving VD within 24 hours. The ranking according to safety of different methods was less clear. The cost-effectiveness analysis suggested that titrated (low-dose) oral misoprostol solution resulted in the highest utility, whereas buccal/sublingual misoprostol had the lowest cost. There was a high degree of uncertainty as to the most cost-effective intervention. FUTURE WORK Future trials should be powered to detect a method that is more cost-effective than misoprostol solution and report outcomes included in this NMA. STUDY REGISTRATION This study is registered as PROSPERO CRD42013005116. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Zarko Alfirevic
- Centre for Women's Health Research, University of Liverpool and Liverpool Women's Hospital, Liverpool, UK
| | - Edna Keeney
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Therese Dowswell
- Centre for Women's Health Research, University of Liverpool and Liverpool Women's Hospital, Liverpool, UK
| | - Nicky J Welton
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Nancy Medley
- Centre for Women's Health Research, University of Liverpool and Liverpool Women's Hospital, Liverpool, UK
| | - Sofia Dias
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Leanne V Jones
- Centre for Women's Health Research, University of Liverpool and Liverpool Women's Hospital, Liverpool, UK
| | - Gillian Gyte
- Centre for Women's Health Research, University of Liverpool and Liverpool Women's Hospital, Liverpool, UK
| | - Deborah M Caldwell
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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Huang MC, Hsieh CH, Huang JP, Tsai HT, Lee MS. Comparison of sequential vaginal and sublingual misoprostol after a vaginal loading dose for second-trimester abortion. Taiwan J Obstet Gynecol 2017; 56:312-314. [PMID: 28600039 DOI: 10.1016/j.tjog.2017.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2017] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To evaluate the effects of sequential vaginal and sublingual misoprostol after a vaginal loading dose for second-trimester abortion. MATERIALS AND METHODS From January 2006 to December 2011, 173 women received an 800-μg vaginal loading dose of misoprostol. After the loading dose, 103 patients received 800 mg of misoprostol vaginally and 70 patients received 400 mg of misoprostol sublingually every 12 h until the delivery of the fetus. RESULTS In the vaginal group, the average abortion time was 1.07 ± 1.29 days; that was 0.82 ± 0.66 days in the sublingual group. Sequential sublingual misoprostol after a vaginal loading dose of 800 mg with an administration interval of 12 h had a similar abortion rate and time to abortion. In addition, this protocol reduced unnecessary digital pelvic examinations and speculum examinations. CONCLUSION This sequential sublingual misoprostol regimen might be a suitable regimen for mid-trimester abortion.
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Affiliation(s)
- Ming-Chao Huang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Hsinchu, Taiwan; MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Ching-Hung Hsieh
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; School of Medicine, Fu Jen Catholic University, Taipei, Taiwan
| | - Jian-Pei Huang
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Hsiu-Ting Tsai
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Maw-Sheng Lee
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung, Taiwan; Lee Women's Hospital, Taichung, Taiwan.
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14
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Conde A, Ben S, Tarigo J, Artucio S, Varela V, Grimaldi P, Sosa C, Alonso J. Comparison between vaginal and sublingual misoprostol 50 µg for cervical ripening prior to induction of labor: randomized clinical trial. Arch Gynecol Obstet 2017; 295:839-844. [PMID: 28204882 DOI: 10.1007/s00404-017-4297-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 01/12/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To compare the effectiveness and safety of sublingual versus vaginal misoprostol on improving the Bishop score after 6 h of administration. METHODS Randomized clinical trial which includes pregnant women in gestational ages from 32/0 to 41/6, with indication of induction of labor with misoprostol. Bishop score was assessed at the time of induction and 6 h after administration of 50 µg misoprostol. Analysis was made over difference in mean Bishop score of 2 points, using a standard deviation of 2, with 90% power, reaching a 95% confidence interval. RESULTS 102 patients were studied, 51 received sublingual misoprostol, and 51 received vaginal misoprostol. There was a statistically significant difference in cervical modifications in global terms regardless of the administration route at 6 h (P < 0.05). When analyzing each group, there was no significant difference for the mean and standard deviation for Bishop score for sublingual and vaginal route (P = 0.761). There was no significant difference in terms of mode of delivery, Apgar score, cord pH, nor in the presence of complications. CONCLUSION There is no statistically significant difference in terms of administration route for cervical ripening using misoprostol 50 µg, whether it was sublingual or vaginal. TRIAL REGISTRATION NUMBER NCT02732522. Registry website: https://clinicaltrials.gov/ .
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Affiliation(s)
- Andrés Conde
- Department of Obstetrics and Ginecology, Hospital Pereira Rossell, University of Uruguay, Bulevar Gral, Artigas 1550, Montevideo, 11600, Uruguay. .,, Gabriel Pereira 2845, CP 11300, Montevideo, Uruguay.
| | - Sebastián Ben
- Department of Obstetrics and Ginecology, Hospital Pereira Rossell, University of Uruguay, Bulevar Gral, Artigas 1550, Montevideo, 11600, Uruguay
| | - Josefina Tarigo
- Department of Obstetrics and Ginecology, Hospital Pereira Rossell, University of Uruguay, Bulevar Gral, Artigas 1550, Montevideo, 11600, Uruguay
| | - Santiago Artucio
- Department of Obstetrics and Ginecology, Hospital Pereira Rossell, University of Uruguay, Bulevar Gral, Artigas 1550, Montevideo, 11600, Uruguay
| | - Virginia Varela
- Department of Obstetrics and Ginecology, Hospital Pereira Rossell, University of Uruguay, Bulevar Gral, Artigas 1550, Montevideo, 11600, Uruguay
| | - Pamela Grimaldi
- Department of Obstetrics and Ginecology, Hospital Pereira Rossell, University of Uruguay, Bulevar Gral, Artigas 1550, Montevideo, 11600, Uruguay
| | - Claudio Sosa
- Department of Obstetrics and Ginecology, Hospital Pereira Rossell, University of Uruguay, Bulevar Gral, Artigas 1550, Montevideo, 11600, Uruguay
| | - Justo Alonso
- Department of Obstetrics and Ginecology, Hospital Pereira Rossell, University of Uruguay, Bulevar Gral, Artigas 1550, Montevideo, 11600, Uruguay
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Sheela CN, John C, Preethi R. Comparison of the efficacy and safety of sublingual misoprostol with that of vaginal misoprostol for labour induction at term. J OBSTET GYNAECOL 2016; 35:469-71. [PMID: 25358078 DOI: 10.3109/01443615.2014.970147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To compare the efficacy and safety of 50 mcg of sublingual misoprostol with 25 mcg of vaginal misoprostol for induction of labour at term. METHOD Non blinded randomized prospective control study. 200 women with singleton term pregnancy, admitted for induction of labour, were randomized to receive either 25 mcg of vaginal misoprostol or 50 mcg of sublingual misoprostol. Outcome measures compared were the number of vaginal deliveries, induction-delivery interval, caesarean section for foetal distress, oxytocin for acceleration, number of doses required, side effects and neonatal outcome. RESULT Mean dose was smaller and induction to delivery interval was significantly shorter in the sublingual group (13.1 ± 4.1 h) compared with the vaginal group (17.9 ± 5.4 h), p value 0.001. There were no statistically significant differences in the other secondary outcome measures. CONCLUSION 50 mcg of sublingual misoprostol was more effective than and as safe as 25 mcg vaginal misoprostol for labour induction at term.
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Affiliation(s)
- C N Sheela
- a Department of Obstetrics and Gynaecology , St. Johns Medical College Hospital , Bengaluru , India
| | - C John
- a Department of Obstetrics and Gynaecology , St. Johns Medical College Hospital , Bengaluru , India
| | - R Preethi
- a Department of Obstetrics and Gynaecology , St. Johns Medical College Hospital , Bengaluru , India
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Jahromi BN, Poorgholam F, Yousefi G, Salarian L. Sublingual versus Vaginal Misoprostol for the Induction of Labor at Term: A Randomized, Triple-Blind, Placebo-Controlled Clinical Trial. IRANIAN JOURNAL OF MEDICAL SCIENCES 2016; 41:79-85. [PMID: 26989277 PMCID: PMC4764971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND We sought to compare the effectiveness and safety of sublingual versus vaginal misoprostol for the termination of pregnancy with a live full-term fetus. METHODS This randomized, triple-blind, placebo-controlled clinical trial was performed on 200 primiparous women with normal, singleton, full-term pregnancies candidated for the induction of labor. Sublingual and vaginal tablets containing misoprostol (25 mcg) or placebo in similar shapes were administered every 4 hours until the Bishop score reached above 8. Maternal and neonatal complications and outcomes were compared. RESULTS There were 100 parturient women in each group. The mean maternal age, gestational age, and Bishop score at the commencement of misoprostol had no statistical differences between the sublingual and vaginal groups. The mean time interval between misoprostol commencement and delivery was 497.10±291.49 and 511.67±08.46 minutes for the sublingual and vaginal groups, correspondingly. Twenty-two women had Cesarean deliveries in the sublingual group versus 14 in the vaginal group. Meconium-stained amniotic fluid was seen in 12 women in the sublingual group and 4 in the vaginal group (P=0.03). Late fetal heart rate deceleration was observed in 8 women in the sublingual group and 4 in the vaginal group (P=0.22). The mean neonatal birth weight, blood gas value at birth, Apgar score, and length of admission time in the neonatal intensive care unit were not different between the 2 groups. CONCLUSION Sublingual and vaginal misoprostol had similar effectiveness; however, meconium-stained liquor was observed considerably more frequently with sublingual misoprostol than with vaginal misoprostol. TRIAL REGISTRATION NUMBER IRCT201402096541N3.
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Affiliation(s)
- Bahia Namavar Jahromi
- Maternal-Fetal Medicine Research Center, Infertility Research Center, Department of Gynecology and Obstetrics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran,Correspondence: Bahia Namavar Jahromi, MD; Maternal-Fetal Medicine Research Center, Infertility Research Center, Department of OB/GYN, Shahid Faghihi Hospital, Shiraz, Iran Tel: +98 917 3158723 Fax: +98 71 32332365
| | - Foroogh Poorgholam
- Student Research Center, Department of Gynecology and Obstetrics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Gholamhossein Yousefi
- Department of Pharmaceutics, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Leila Salarian
- Department of Pediatrics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Schwarz C, Gross MM, Heusser P, Berger B. Women's perceptions of induction of labour outcomes: Results of an online-survey in Germany. Midwifery 2016; 35:3-10. [PMID: 27060393 DOI: 10.1016/j.midw.2016.02.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 01/25/2016] [Accepted: 02/02/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE induction of labour (IOL) is a common procedure in high income countries. It may be conducted for medical as well as non-medical reasons. Women's views on induction of labour have not extensively been evaluated as yet. Also, women's preferences for certain methods of induction including alternative and complementary methods need further exploration in order to meet their expectations and needs. DESIGN AND SETTING we published a short online questionnaire on women'views and experiences with IOL. MEASUREMENTS AND FINDINGS we asked for indication and gestational age at induction; method of induction, duration of labour and mode of birth. We also asked for the extent of desired, and experienced support and participation in decision-making. Within four weeks of being online, 698 women answered the questionnaire. Most frequent reasons for induction were postmaturity (51.7%), doctor's recommendation (31.6%) and medical complications (25.6%). Most women were induced with misoprostol or dinoprostone, but nearly half of the respondents were also offered, or asked for, complementary and alternative methods (CAM). 50% or more women would have preferred more information on alternatives to IOL, methods of IOL, side effects of the drugs, information on alternatives (59.2%) and on the medication (55.3%). Many would have wished for more support (49.9%) with decision-making (55.2%), and more time (54.1%). KEY CONCLUSION women' expectations and needs regarding IOL are widely unmet in current clinical practice. IMPLICATIONS FOR PRACTICE there is a need for evidence-based information and decisional support for pregnant women who need to decide how to proceed once term is reached.
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Affiliation(s)
- Christiane Schwarz
- Hannover Medical School, Midwifery Research and Education Unit, Department of Obstetrics, Gynaecology & Reproductive Medicine, Germany; Institute for Integrative Medicine (IfIM), Gerhard Kienle Lehrstuhl für Medizintheorie, Integrative und Anthroposophische Medizin, University Witten/Herdecke, Germany.
| | - Mechthild M Gross
- Hannover Medical School, Midwifery Research and Education Unit, Department of Obstetrics, Gynaecology & Reproductive Medicine, Germany
| | - Peter Heusser
- Institute for Integrative Medicine (IfIM), Gerhard Kienle Lehrstuhl für Medizintheorie, Integrative und Anthroposophische Medizin, University Witten/Herdecke, Germany
| | - Bettina Berger
- Institute for Integrative Medicine (IfIM), Gerhard Kienle Lehrstuhl für Medizintheorie, Integrative und Anthroposophische Medizin, University Witten/Herdecke, Germany
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Oral versus vaginal misoprostol for induction of labor in Enugu, Nigeria: a randomized controlled trial. Arch Gynecol Obstet 2014; 291:537-44. [PMID: 25138128 DOI: 10.1007/s00404-014-3429-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 08/12/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The study aimed at comparing the effectiveness and maternal satisfaction of oral misoprostol with vaginal misoprostol for induction of labor at term. MATERIALS AND METHODS A randomized controlled trial of 140 term pregnant women at the University of Nigeria Teaching Hospital Enugu, Nigeria, was conducted from April 2011 to May 2012. The women were equally randomized into two groups (A and B) to receive oral and vaginal misoprostol, respectively. RESULTS The vaginal route reduced the mean induction-vaginal delivery interval by four-and-half hours (20.7 ± 12.1 vs. 16.2 ± 10.4; mean difference: 4.50, 95% CI 0.63-0.82; p = 0.02). Furthermore, the mean dose of misoprostol required to achieve induction of labor and the mean duration of oxytocin augmentation when indicated were significantly less in the vaginal group than in the oral group (2.5 ± 1.3 vs. 2.0 ± 1.1; mean difference: 0.50, 95% CI 0.10-0.90; p = 0.02 and 4.6 ± 3.2 vs. 3.4 ± 3.1; mean difference: 1.20, 95% CI 0.15-0.23; p = 0.03 respectively). However, neonatal complications and maternal satisfaction were similar between the two groups. CONCLUSION Both routes of administration are effective in the induction of labor at term and have comparable maternal satisfaction. However, the vaginal route has the added advantage of shorter induction-delivery interval among others, and thus should be highly considered when induction of labor is indicated at term.
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Abstract
OBJECTIVE To review the most current literature in order to provide evidence-based recommendations to obstetrical care providers on induction of labour. OPTIONS Intervention in a pregnancy with induction of labour. OUTCOMES Appropriate timing and method of induction, appropriate mode of delivery, and optimal maternal and perinatal outcomes. EVIDENCE Published literature was retrieved through searches of PubMed, CINAHL, and The Cochrane Library in 2010 using appropriate controlled vocabulary (e.g., labour, induced, labour induction, cervical ripening) and key words (e.g., induce, induction, augmentation). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. There were no date or language restrictions. Searches were updated on a regular basis and incorporated in the guideline to the end of 2010. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. VALUES The evidence in this document was rated using criteria described in the Report of the Canadian Task Force on Preventative Health Care (Table 1). SUMMARY STATEMENTS: 1. Prostaglandins E(2) (cervical and vaginal) are effective agents of cervical ripening and induction of labour for an unfavourable cervix. (I) 2. Intravaginal prostaglandins E(2) are preferred to intracervical prostaglandins E(2) because they results in more timely vaginal deliveries. (I).
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Vogel JP, West HM, Dowswell T. Titrated oral misoprostol for augmenting labour to improve maternal and neonatal outcomes. Cochrane Database Syst Rev 2013; 2013:CD010648. [PMID: 24058051 PMCID: PMC9634341 DOI: 10.1002/14651858.cd010648.pub2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Labour dystocia is associated with a number of adverse maternal and neonatal outcomes. Augmentation of labour is a commonly used intervention in cases of labour dystocia. Misoprostol is an inexpensive and stable prostaglandin E1 analogue that can be administered orally, vaginally, sublingually or rectally. Misoprostol has proven to be effective at stimulating uterine contractions although it can have serious, and even life-threatening side-effects. Titration refers to the process of adjusting the dose, frequency, or both, of a medication on the basis of frequent review to achieve optimal outcomes. Studies have reported on a range of misoprostol titration regimens used for labour induction and titrated misoprostol may potentially be effective and safe for augmentation of labour. OBJECTIVES To examine the effects and safety of titrated oral misoprostol compared with placebo, oxytocin, other interventions, or no active treatment, in women with labour dystocia. SEARCH METHODS The Trials Search Co-ordinator of the Cochrane Pregnancy and Childbirth Group searched the Cochrane Pregnancy and Childbirth Group's Trials Register; date of search: 29 May 2013. We also searched the reference lists of retrieved studies SELECTION CRITERIA Randomised trials (including quasi-randomised and cluster-randomised trials) comparing titrated oral misoprostol with placebo, other interventions (e.g. oxytocin, other prostaglandins), or no treatment in women requiring augmentation of labour were eligible for inclusion. DATA COLLECTION AND ANALYSIS Two review authors independently assessed eligibility for inclusion, carried out data extraction and assessed risk of bias in included studies. Data were entered by one author and checked for accuracy. MAIN RESULTS We included two randomised trials with a total of 581 women each comparing different regimens of titrated oral misoprostol with intravenous oxytocin. One study compared 20 mcg doses of misoprostol dissolved in water (repeated every hour up to four hours, after which the dose was increased to 40 mcg per hour up to a maximum total dose of 1600 mcg), while the second study gave women 75 mcg doses (repeated after four hours provided there were no adverse effects observed).Neither trial reported maternal death, severe maternal morbidity, or fetal/neonatal mortality outcomes, and only a few fetal/neonatal morbidity outcomes were considered, none of which were significantly different between groups. For several outcomes (such as maternal side-effects, instrumental birth, maternal blood transfusion for hypovolaemia and epidural analgesia), the number of events was generally too low for sufficient statistical power to be achieved. Maternal satisfaction was not reported in either trial. One trial reported a slight reduction in the median duration of labour from the start of augmentation to vaginal delivery in the oxytocin group.Neither trial reported significantly higher rates of caesarean section (CS) in the oral misoprostol group. Rates of vaginal delivery within 12 and 24 hours of commencing augmentation were not significantly different in the trial using a 20 mcg misoprostol dose. Neither trial had significantly higher rates of uterine hyperstimulation with fetal heart rate changes in the titrated oral misoprostol group. However, the rates of this outcome varied so greatly between the two studies as to suggest that other factors were at play. The only significant differences between groups related to uterine hyperstimulation (without fetal heart rate changes), and results were not consistent in the two trials. In the trial examining the higher dose of misoprostol, more women in the misoprostol group experienced hyperstimulation of labour measured over a 10-minute period compared with those receiving oxytocin (risk ratio (RR) 1.17, 95% confidence interval (CI) 1.02 to 1.35, 350 women). In the study examining the lower titrated dose of misoprostol, there was a lower incidence of tachysystole when labour was augmented with titrated oral misoprostol than with oxytocin (RR 0.39, 95% CI 0.17 to 0.91, 231 women) with no occurrences of hypertonus in either group of women. AUTHORS' CONCLUSIONS Important uncertainties still exist on the safety and acceptability of titrated oral misoprostol compared with intravenous oxytocin regimens in women with dystocia following spontaneous onset of labour. Although in facilities where electronic oxytocin infusion is not available, low-dose titrated misoprostol may offer a better alternative to an uncontrolled oxytocin infusion to avoid hyperstimulation. Further research is needed in both high- and low-resource settings More trials should be conducted to evaluate the effect of a standard titration oral misoprostol regimen, both following spontaneous labour and labour induction. Comparisons with other augmentation methods are also warranted, as are any effects on women's birth experiences.
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Affiliation(s)
- Joshua P Vogel
- World Health OrganizationUNDP/UNFPA/UNICEF/WHO/Word Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and ResearchAvenue Appia 20GenevaSwitzerlandCH‐1211
- University of Western AustraliaSchool of Population Health, Faculty of Medicine, Dentistry and Health Sciences35 Stirling HighwayCrawleyPerthWestern AustraliaAustralia6009
| | - Helen M West
- The University of LiverpoolCochrane Pregnancy and Childbirth Group, Department of Women's and Children's HealthFirst Floor, Liverpool Women's NHS Foundation TrustCrown StreetLiverpoolUKL8 7SS
| | - Therese Dowswell
- The University of LiverpoolCochrane Pregnancy and Childbirth Group, Department of Women's and Children's HealthFirst Floor, Liverpool Women's NHS Foundation TrustCrown StreetLiverpoolUKL8 7SS
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Women's acceptance of a double-balloon device as an additional method for inducing labour. Eur J Obstet Gynecol Reprod Biol 2013; 168:30-5. [DOI: 10.1016/j.ejogrb.2012.12.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 11/28/2012] [Accepted: 12/13/2012] [Indexed: 11/22/2022]
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Enabudoso E, Isara AR. Determinants of patient satisfaction after cesarean delivery at a university teaching hospital in Nigeria. Int J Gynaecol Obstet 2011; 114:251-4. [PMID: 21696726 DOI: 10.1016/j.ijgo.2011.03.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Revised: 03/16/2011] [Accepted: 05/13/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To assess the prevalence of satisfaction, and associated factors, among parturients who had recently delivered by cesarean. METHODS In a descriptive cross-sectional study, women who delivered by cesarean at the University of Benin Teaching Hospital, Nigeria, were enrolled between April and July 2010. A simple, qualitative, semi-structured researcher-administered questionnaire was used for data collection. Data analysis was done via SPSS version 16. RESULTS Among 220 women who delivered by cesarean, 211 women were enrolled in the study and were interviewed 2-5 days after delivery. The mean age was 30.8 ± 5.1 years, and the median parity was 1. An initial negative reaction to the decision for cesarean delivery was reported by 76% of respondents, 19% were indifferent, and 5% reported an initial positive reaction. Satisfaction with delivery by cesarean was reported by 80% of the respondents. Satisfaction with cesarean delivery was significantly associated with age, level of education, initial reaction to the decision for cesarean delivery, and elective cesarean. CONCLUSION Most parturients expressed overall satisfaction after delivery by cesarean. There is a need for in-depth studies in low-income countries to further evaluate satisfaction with regard to various aspects of the cesarean delivery experience.
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Affiliation(s)
- Ehigha Enabudoso
- Department of Obstetrics and Gynecology, University of Benin Teaching Hospital, Benin, Nigeria.
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Geels YP, de Gouberville MCG, Visser L, van Asten HA. Comparing vaginal and sublingual administration of misoprostol for labour induction in women with intra-uterine fetal death. Trop Doct 2010; 40:77-80. [PMID: 20305098 DOI: 10.1258/td.2009.090339] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The objective of this study was to compare complications and effectiveness of induction after vaginal and sublingual administration of misoprostol for labor induction in women with intra-uterine fetal death (IUFD). In a district hospital in Ghana, 23 women with IUFD who underwent labor induction with sublingual misoprostol were compared with a control group of 21 women who received vaginal misoprostol. In the vaginal group 28.6% had one or more complications compared to 21.7% in the sublingual group. In the sublingual group three inductions did not lead to delivery within 48 hours (13%), compared to four in the other group (19%). The mean induction-to-delivery time in the sublingual group was 13 hours and 17 hours in the vaginal group. In this study, both sublingual and vaginal misoprostol were safe and efficient for labor induction in women with IUFD. However, more research on larger numbers of patients is needed, in order to compare complications.
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Affiliation(s)
- Yvette Pernella Geels
- Radboud University Nijmegen Medical Centre, Nijmegen Institute for International Health, Nijmegen, The Netherlands.
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Zahran KM, Shahin AY, Abdellah MS, Elsayh KI. Sublingual versus vaginal misoprostol for induction of labor at term: A randomized prospective placebo-controlled study. J Obstet Gynaecol Res 2009; 35:1054-60. [DOI: 10.1111/j.1447-0756.2009.01030.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Souza ASR, Amorim MMR, Feitosa FEL. Comparison of sublingual versus vaginal misoprostol for the induction of labour: a systematic review. BJOG 2008; 115:1340-9. [DOI: 10.1111/j.1471-0528.2008.01872.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Muzonzini G, Hofmeyr GJ. Buccal or sublingual misoprostol for cervical ripening and induction of labour. Cochrane Database Syst Rev 2004; 2004:CD004221. [PMID: 15495088 PMCID: PMC8768472 DOI: 10.1002/14651858.cd004221.pub2] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND This is one of a series of reviews of cervical ripening and labour induction using standardised methodology. Misoprostol administered by the oral and sublingual routes have the advantage of rapid onset of action, while the sublingual and vaginal routes have the advantage of prolonged activity and greatest bioavailability. OBJECTIVES To determine the effectiveness and safety of misoprostol administered buccally or sublingually for third trimester cervical ripening and induction of labour. SEARCH STRATEGY We searched the Cochrane Pregnancy and Childbirth Group trials register (8 December 2003), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 4, 2003), and bibliographies of relevant papers. SELECTION CRITERIA Randomised controlled trials comparing buccal or sublingual misoprostol used for third trimester cervical ripening or labour induction with placebo/no treatment or other methods listed above it on a predefined list of labour induction methods. DATA COLLECTION AND ANALYSIS A generic strategy was developed to deal with the large volume and complexity of trial data relating to labour induction. Data were extracted onto standardized forms, checked for accuracy, and analysed using RevMan software. MAIN RESULTS Three studies (502 participants) compared buccal/sublingual misoprostol respectively with a vaginal regimen (200 microg versus 50 microg) and with oral administration (50 versus 50 microg and 50 versus 100microg).The buccal route was associated with a trend to fewer caesarean sections than with the vaginal route (18/73 versus 28/79; relative risk (RR) 0.70; 95% confidence interval (CI) 0.42 to 1.15). There were no significant differences in any other outcomes. When the same dosage was used sublingually versus orally, the sublingual route was associated with less failures to achieve vaginal delivery within 24 hours (12/50 versus 19/50; RR 0.63, 95% CI 0.34 to 1.16), reduced oxytocin augmentation (17/50 versus 23/50; RR 0.74, 95% CI 0.45 to 1.21) and reduced caesarean section (8/50 versus 15/50; RR 0.53, 95% CI 0.25 to 1.14), but the differences were not statistically significant. When a smaller dose was used sublingually than orally, there were no differences in any of the outcomes. REVIEWERS' CONCLUSIONS Based on only three small trials, sublingual misoprostol appears to be at least as effective as when the same dose is administered orally. There are inadequate data to comment on the relative complications and side-effects. Sublingual or buccal misoprostol should not enter clinical use until its safety and optimal dosage have been established by larger trials.
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Affiliation(s)
- G Muzonzini
- Effective Care Research Unit, University of the Witwatersrand/University of Fort Hare, Frere/Cecilia Makiwane Hospitals, Private Bag X 9047, East London 5200, Eastern Cape, South Africa.
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