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Misoprostol Outpatient Cervical Ripening Without Subsequent Induction of Labor: A Randomized Trial

From the Department of Obstetrics and Gynecology, Wright State University and Wright-Patterson U.S. Air Force Medical Center, Dayton, Ohio.

OBJECTIVE: To estimate the effect of outpatient administration of a single dose of vaginal misoprostol at term on the interval to delivery in women with unfavorable cervices.

METHODS: Randomized, double blind, placebo-controlled trial comparing a single 25-µg outpatient intravaginal dose of misoprostol to placebo in pregnant women with Bishop scores less than 9 at 40 weeks or greater. After placement of the study medication, subjects were permitted to go into spontaneous labor unless an indication for induction developed. Analysis was by intent to treat. The interval to delivery, defined as the time from medication placement to delivery, was compared by Student t test and by survival analysis with the log-rank test.

RESULTS: Thirty-three women were randomly assigned to receive misoprostol, and 35 were assigned to receive placebo. The mean interval to delivery was significantly less in the misoprostol group, 4.2 ± 4.1 compared with 6.1 ± 3.6 days, P = .04. The interval to delivery for only the nulliparous patients was significantly less in the misoprostol group, 4.2 ± 4.0 compared with 7.2 ± 3.7 days, P = .02. The survival curves for the interval to delivery were significantly different (P = .04 by log-rank test) with 4.1 days median interval to delivery for misoprostol compared with 9.2 days for placebo. There were no adverse outcomes in either group.

CONCLUSION: A single 25-µg outpatient intravaginal dose of misoprostol is effective in decreasing the interval to delivery in women with unfavorable cervices at term.

LEVEL OF EVIDENCE: I

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