Iranian Society of Gynecology Oncology

Document Type : Original Research Article

Authors

1 Department of Obstetrics and Gynecology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran

2 Department of Obstetrics and Gynecology, Qazvin University of Medical Sciences, Qazvin, Iran

Abstract

Background & Objective: The purpose of this study was to compare the effectiveness of Buccal, Vaginal, and Sublingual misoprostol for induction of labor in term pregnancy.
Materials & Methods: The research was done as an RCT from 2017 to 2018. About 300 participants were randomly allocated to obtain 50 µg Buccal, 25 µg Vaginal, and 50 µg Sublingual misoprostol in Kosar Hospital, Qazvin, Iran. The maternal and fetal complications, Bishop score hour 1, and hour 6 were observed.
Results: There were no differences between fetal complications (P>0.05) and maternal complications (P>0.05) among the three groups. Bishop score hour 1 (P = 0.146), Bishop Score hour 6 (P = 0.704), and total dose (P = 0.15) also were no differences among these groups. Our study found a difference between the three groups (P = 0.015) in achieving standard vaginal delivery within 24 hours, as Buccal, Sublingual and Vaginal groups were performed respectively. The use of Oxytocin in the Buccal group was higher than that of other groups (P = 0.022).
Conclusion: This study found that there is no difference in terms of fetal complications and maternal complications in the three groups, but there was a significant difference in Oxytocin use and vaginal delivery within 24 h from the start of induction.

Highlights

 This study found that there is no difference in terms of fetal complications and maternal complications in the three groups, but there was a significant difference in Oxytocin use and vaginal delivery within 24 h from the start of induction.

Keywords

Main Subjects

1. Aalami-Harandi R, Karamali M, Moeini A. Safety and effectiveness of oral misoprostol versus oxytocin for labor induction in term pregnancy. J North Khorasan Univ Med Sci. 2012;4(3):303-9. [DOI:10.29252/jnkums.4.3.303]
2. Beigi A, Kazemipour S-M, Tabarestani H. Induction of labor in term pregnancy: Sublingual versus vaginal misoprostol. Tehran Univ Med J. 2010;68(3):178-81.
3. Cheng SY, Ming H, Lee JC. Titrated oral compared with vaginal misoprostol for labor induction: a randomized controlled trial. Obstet Gynecol. 2008;111(1):119-25. [DOI:10.1097/01.AOG.0000297313.68644.71] [PMID]
4. Niroomanesh S, Talebzadeh Nori Z, Hossain Pour M. Comparison of oral and sublingual misoprostol in the induction of delivery. J Babol Univ Med Sci. 2005;8(5):20-5.
5. Hofmeyr GJ, Gülmezoglu AM, Pileggi C. Vaginal misoprostol for cervical ripening and induction of labour. Cochrane Database Syst Rev. 2010;1(10):CD000941. [DOI:10.1002/14651858.CD000941.pub2]
6. Tang OS, Gemzell-Danielsson K, Ho PC. Misoprostol: Pharmacokinetic profiles, effects on the uterus and side-effects. Int J Gynecol Obstet. 2007;99:S160-S7. [DOI:10.1016/j.ijgo.2007.09.004] [PMID]
7. Vogel JP, West HM, Dowswell T. Titrated oral misoprostol for augmenting labour to improve maternal and neonatal outcomes. Cochrane Database Syst Rev. 2013;2013(9):CD010648. [DOI:10.1002/14651858.CD010648.pub2]
8. Zieman M, Fong SK, Benowitz NL, Banskter D, Darney PD. Absorption kinetics of misoprostol with oral or vaginal administration. Obstet Gynecol. 1997;90(1):88-92. [DOI:10.1016/S0029-7844(97)00111-7] [PMID]
9. Weeks A, Alfirevic Z. Oral Misoprostol Administration for Labor Induction. Clin Obstet Gynecol. 2006;49(3):658-71. [DOI:10.1097/00003081-200609000-00023] [PMID]
10. Danielsson KG, Marions L, Rodriguez A, Spur BW, Wong PYK, Bygdeman M. Comparison between oral and vaginal administration of misoprostol on uterine contractility. Obstet Gynecol. 1999;93(2):275-80. [DOI:10.1016/S0029-7844(98)00436-0] [DOI:10.1097/00006250-199902000-00022] [PMID]
11. Wang X, Yang A, Ma Q, Li X, Qin L, He T. Comparative study of titrated oral misoprostol solution and vaginal dinoprostone for labor induction at term pregnancy. Arch Gynecol Obstet. 2016;294(3):495-503. [DOI:10.1007/s00404-015-4000-y] [PMID] [PMCID]
12. Cunningham F, Leveno K, Bloom S, Hauth J, Gilstrap L, Wenstrom K. Williams Obstetrics and Gynecology. New York: McGraw-Hill; 2005.
13. Carlan SJ, Blust D, O'Brien WF. Buccal versus intravaginal misoprostol administration for cervical ripening. Am J Obstet Gynecol. 2002;186(2):229-33. [DOI:10.1067/mob.2002.119630] [PMID]
14. Zahran KM, Shahin AY, Abdellah MS, Elsayh KI. Sublingual versus vaginal misoprostol for induction of labor at term: A randomized prospective placebo-controlled study. Am J Obstet Gynecol. 2009;35(6):1054-60. [DOI:10.1111/j.1447-0756.2009.01030.x] [PMID]
15. Goldberg AB, Wing DA. Induction of labor: the misoprostol controversy. J Midwifery Women's Health. 2003;48(4):244-8. [DOI:10.1016/S1526-9523(03)00087-4] [PMID]
16. Bolla D, Weissleder SV, Radan A-P, Gasparri ML, Raio L, Müller M, Surbek D. Misoprostol vaginal insert versus misoprostol vaginal tablets for the induction of labour: a cohort study. BMC Pregnancy Childbirth. 2018;18(1):149. [DOI:10.1186/s12884-018-1788-z] [PMID] [PMCID]
17. Kundodyiwa TW, Alfirevic Z, Weeks AD. Low-dose oral misoprostol for induction of labor: a systematic review. Obstet Gynecol. 2009;113(2 Part 1):374-83. [DOI:10.1097/AOG.0b013e3181945859] [PMID]
18. Chatsis V, Frey N. Misoprostol for Cervical Ripening and Induction of Labour: A Review of Clinical Effectiveness, Cost-Effectiveness and Guidelines. Canadian Agency for Drugs and Technologies in Health, Ottawa (ON); 2018.
19. Kerr RS, Kumar N, Williams MJ, Cuthbert A, Aflaifel N, Haas DM, Weeks AD. Low‐dose oral misoprostol for induction of labour. Cochrane Database Syst Rev. 2021;2021(6):CD014484. [DOI:10.1002/14651858.CD014484] [PMID] [PMCID]
20. Mehta AC. Buccal and oral drugs: induction of labour. Acta Chir Hung. 1986;27(3):157-63.
21. Bartusevicius A, Barcaite E, Krikstolaitis R, Gintautas V, Nadisauskiene R. Sublingual compared with vaginal misoprostol for labour induction at term: a randomised controlled trial. BJOG: Int J Obstet Gynaecol. 2006;113(12):1431-7. [DOI:10.1111/j.1471-0528.2006.01108.x] [PMID]
22. Gupta HP, Singh U, Mehrotra S. Comparative evaluation of 25 μg and 50 μg of intravaginal misoprostol for induction of labor. Indian J Obstet Gynecol Res. 2010;60(1):51-4. [DOI:10.1007/s13224-010-0009-0] [PMCID]
23. Schaff EA, DiCenzo R, Fielding SL. Comparison of misoprostol plasma concentrations following buccal and sublingual administration. Contraception. 2005;71(1):22-5. [DOI:10.1016/j.contraception.2004.06.014] [PMID]
24. Dadashaliha M, Fallah S, Mirzadeh M. Labor induction with randomized comparison of cervical, oral and intravaginal misoprostol. BMC Pregnancy Childbirth. 2021;21(1):721. [DOI:10.1186/s12884-021-04196-4] [PMID] [PMCID]