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Oral Versus Vaginal Misoprostol for Labor Induction

From the Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center at El Paso, El Paso, Texas; and School of Allied Health, The University of Texas at El Paso, El Paso, Texas.

Address reprint requests to: Frederick Harlass, MD, Texas Tech University Health Sciences Center, Department of Obstetrics and Gynecology, 4800 Alberta Avenue, El Paso, TX 79905; E-mail: fharlass{at}ttmcelp.ttuhsc.edu.

OBJECTIVE: To compare the safety and effectiveness of vaginal with oral misoprostol for induction of labor.

METHODS: A total of 107 women with clinical indication for induction were randomly assigned to receive oral or vaginal misoprostol. Doses of 100 µg of oral or 25 µg of vaginal misoprostol were given every 3–4 hours. If cervical ripening or active labor did not occur, repeated doses of oral (100–200 µg) or vaginal (25–50 µg) were given until labor was established.

RESULTS: Fifty-nine women received oral misoprostol, and 48 received vaginal administration. Delivery time was similar for the vaginal and oral arms (1074 ± 488 minutes versus 930 ± 454 minutes, P = .11). Parity was significantly different (P = .04) for the vaginal and oral groups. The cesarean delivery rate was similar for the vaginal and oral arms (17% versus 15%, P = .72). The number of medication administrations was consistent between groups. Birth weight was not different for patients in the control and treatment groups (vaginal 3281 ± 507 g versus oral 3359 ± 541 g, P = .44). Chorioamnionitis and tachysystole were comparable for the oral and vaginal groups. There was no statistical difference in neonatal outcomes. Similar proportions of infants were admitted to the well baby nursery and intermediate care nursery.

CONCLUSION: These findings indicate that, in a closely supervised hospital setting with adequate monitoring, oral misoprostol has the potential to induce labor as safely and effectively as its vaginal analogue.