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ORIGINAL RESEARCH |
From the Department of Obstetrics and Gynecology, National Naval Medical Center, Bethesda, Maryland; Department of Obstetrics and Gynecology, Division of Maternal/Fetal Medicine, Naval Medical Center, Portsmouth, Virginia; Uniformed Services University of Health Sciences, Bethesda, Maryland; and Pharmacy Department, Naval Medical Center, Portsmouth, Virginia.
Objective: To determine if outpatient cervical ripening using misoprostol can initiate labor within 48 hours of medication administration and to determine if time from medication administration to time of delivery is decreased using outpatient cervical ripening.
Methods: Uncomplicated singleton, vertex pregnancies at 41 weeks’ gestation or later with Bishop score of 4 or less were eligible for enrollment. Other inclusion criteria included intact membranes, less than eight uterine contractions per hour, a reactive nonstress test, and amniotic fluid index (AFI) over 5 cm. After randomization, 25 µcg of misoprostol or placebo was placed within the posterior vaginal fornix. Patients were continuously monitored for 4 hours, then discharged if not in active labor. Patients returned in 24 hours for a repeat administration of the respective medication. Patients not delivered within 48 hours were admitted for inpatient induction of labor. Statistical analysis was performed with the Fisher, Student t, 
2, and Mann-Whitney U tests, with P < .05 considered statistically significant.
Results: Among the 60 patients enrolled, 27 (45%) received misoprostol and 33 (55%) received placebo. The majority (24 of 27, 88.9%) of study group patients entered active labor within 48 hours after dosing, compared with 16.7% (five of 33) of placebo group patients (P < .001). The time from initial dose to delivery was significantly shorter in the misoprostol group (36.9 ± 3.8 compared with 61.3 ± 3.8 hours, P < .001).
Conclusion: Intravaginal misoprostol is effective for outpatient cervical ripening. No adverse effects were encountered, although further study is required to determine the safety of this treatment regimen.
This article has been cited by other articles:
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  M. Meyer, J. Pflum, and D. Howard Outpatient Misoprostol Compared With Dinoprostone Gel for Preinduction Cervical Ripening: A Randomized Controlled Trial Obstet. Gynecol., March 1, 2005; 105(3): 466 - 472. [Abstract] [Full Text] [PDF]
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P. S. Ramsey, L. Meyer, B. A. Walkes, D. Harris, P. L. Ogburn Jr, R. H. Heise, and K. D. Ramin Cardiotocographic Abnormalities Associated With Dinoprostone and Misoprostol Cervical Ripening Obstet. Gynecol., January 1, 2005; 105(1): 85 - 90. [Abstract] [Full Text] [PDF]
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D. S. McKenna, J. B. Ester, M. Proffitt, and K. R. Waddell Misoprostol Outpatient Cervical Ripening Without Subsequent Induction of Labor: A Randomized Trial Obstet. Gynecol., September 1, 2004; 104(3): 579 - 584. [Abstract] [Full Text] [PDF]
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J. F. Perrone, G. Caldito, J. B. Mailhes, A. N. Tucker, W. R. Ford, and S. N. London Oral Misoprostol Before Office Endometrial Biopsy Obstet. Gynecol., March 1, 2002; 99(3): 439 - 444. [Abstract] [Full Text] [PDF]
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L. Sanchez-Ramos, A. M. Kaunitz, M. L. Stitely, J. Browning, and R. B. Gherman OUTPATIENT CERVICAL RIPENING WITH INTRAVAGINAL MISOPROSTOL Obstet. Gynecol., February 1, 2001; 97(2): 325 - 326. [Full Text] [PDF]
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 R. W. Hale and S. Zinberg Use of Misoprostol in Pregnancy N. Engl. J. Med., January 4, 2001; 344(1): 59 - 60. [Full Text] [PDF]
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