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Ruptured Membranes at Term: Randomized, Double-Blind Trial of Oral Misoprostol for Labor Induction

From the Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas.

Address reprint requests to: Julie Y. Lo, MD, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, TX 75235-9032; E-mail: julie.lo{at}utsouthwestern.edu.

OBJECTIVE: To determine if oral misoprostol can replace oxytocin for labor stimulation in women with ruptured membranes at term and without evidence of labor.

METHODS: Nulliparous women at 36 to weeks with a singleton, cephalic-presenting fetus and ruptured membranes without evidence of labor were randomized to receive oral misoprostol (100 µg) or a placebo every 4 hours for a maximum of two doses. Intravenous oxytocin was initiated if active labor had not ensued within 8 hours of the initial study drug dose.

RESULTS: Fifty-one women were randomized to oral misoprostol and 51 women to the placebo. Misoprostol reduced the use of oxytocin stimulation of labor from 90% to 37% (P < .001) and was associated with approximately a 7-hour shorter elapsed time in the labor unit. Uterine hyperactivity, defined as six or more contractions in 10 minutes without fetal heart rate decelerations, occurred in 25% of women randomized to misoprostol. However, uterine hyperactivity associated with fetal heart rate decelerations occurred in only three (6%) women, none of whom required emergency cesarean delivery. Route of delivery and infant outcomes were not related to misoprostol use.

CONCLUSION: Oral misoprostol (100 µg) given in a maximum of two doses 4 hours apart significantly reduced the use of oxytocin in the management of women with ruptured membranes without labor at term.

This article has been cited by other articles:

				M. G. Lin, F. S. Nuthalapaty, A. R. Carver, A. S. Case, and P. S. Ramsey Misoprostol for Labor Induction in Women With Term Premature Rupture of Membranes: A Meta-Analysis Obstet. Gynecol., September 1, 2005; 106(3): 593 - 601. [Abstract] [Full Text] [PDF]