A randomized comparison of Oral misoprostol versus Foley catheter and oxytocin for induction of labor at term

Mediana Sutopo LiedaprajaPPDS Tahap 1 AOBGYN FKUI - RSCM

OBJECTIVE:

Compare the efficacy and safety of oral misoprostol administered to patients with the efficacy and safety in a control group treated with a Foley catheter and oxytocin for induction of labor.

Control

STUDY DESIGN

200 patients

100 PatientsOral Misoprostol

(50mcg with 4 hours interval)*max dose 300mcg

100 Patients Cervical Foley

Catheter + Oxytocin *max 36mU/min

Inclusion Criterias:- Term pregnancy -Singleton live fetus -Cephalic presentation-Intact membrane-Bishop Score 5 or less-Not in Labor ( <3x contractions in 10 minutes)

Exclusion Criterias:- Nonreassuring FHR-Multiple Gestation-Previous SC or uterine surgery-Rupture membrane-Placenta previa-Genital herpes, asthma

Control

Patient Demographic Data

100 PatientsOral Misoprostol

(50mcg with 4 hours interval)*max dose 300mcg

Control

All patients underwent continuous EFM from start induction until delivery

Failed induction

Outcomes

Neonatal Outcomes

DISCUSSION

RCT Misoprostol as effective agents for cx ripening and labor induction

Main concern !!! Excessive uterine contractions

Primary outcome ( Delivery within 24 hours) lower in misoprostol group

Oral Misoprostol SIGNIFICANTLY less effective in nulliparous parturients

200mcg oral every 6 hours

UNACCEPTABLE high rate of

hyperstimulation syndrome

( 44.1%)

50 to 100 mcg at 2-3 hours interval

High Clinical Utility with

ACCEPTABLE rate of

hyperstimulation syndrome.

Oral misoprostol at the dose described is a reasonable alternative to oxytocin–Foley catheter for induction of labor, particularly

in multiparous patients.

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