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The Effect of Tablet Moistening on Labor Induction With Intravaginal Misoprostol: A Randomized Trial

From the Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Florida Health Science Center, Jacksonville, Florida.

Address reprint requests to: Luis Sanchez-Ramos, MD, University of Florida Health Science Center, Department of Obstetrics and Gynecology, 653-1 West 8th Street, Jacksonville, FL 32209; E-mail: luis.sanchez{at}jax.ufl.edu.

OBJECTIVE: To estimate whether a dosage of 50 µg of misoprostol tablets moistened with 3% acetic acid and administered intravaginally is more efficacious for labor induction than a similar dosage regimen using dry tablets.

METHODS: A total of 177 women who presented with an indication for cervical ripening and labor induction were randomly assigned to one of two treatment groups: 1) intravaginal misoprostol in dry tablet form, or 2) intravaginal misoprostol moistened with 1 mL of 3% acetic acid solution. The primary outcome assessed was the interval from start of induction to vaginal delivery. To detect at least a 3.5-hour difference in the primary outcome with 80% power, 87 subjects were required in each group.

RESULTS: Among 162 patients evaluated, 80 were allocated to the misoprostol dry group and 82 to the misoprostol moistened group. No significant difference was noted for the mean ± standard deviation interval to vaginal delivery: 1130 ± 636 minutes for the group who received dry tablets and 1004 ± 636 minutes for those who received moistened misoprostol tablets (P = .25). Additionally, no statistically significant differences were noted between the groups with respect to need for oxytocin, proportion of patients delivered after a single dose, intrapartum complications (including tachysystole and uterine hyperstimulation), mode of delivery, or perinatal outcomes.

CONCLUSION: Tablet moistening with 3% acetic acid solution does not seem to improve the efficacy of intravaginally administered misoprostol for labor induction.

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				B. Yilmaz, S. Kelekci, I. E. Ertas, S. Kahyaoglu, M. Ozel, N. Sut, and N. Danisman Misoprostol moistened with acetic acid or saline for second trimester pregnancy termination: a randomized prospective double-blind trial Hum. Reprod., November 1, 2005; 20(11): 3067 - 3071. [Abstract] [Full Text] [PDF]