EXTEMPORANEOUS PREPARATION OF MISOPROSTOL GEL FOR CERVICAL RIPENING -A RANDOMIZED TRIAL

Objective: To compare the safety and efficacy of intravaginal misopros tol gel with that of tablets for ripening the cervix and inducing labo r in women with unfavorable cervices. Methods: Four hundred sixty-seve n gravidas were randomized to receive misoprostol tablets (n = 234) or misoprostol gel (n = 233). The gel was prepared in the antepartum uni t immediately before use by dissolving the tablet in 1 mL normal salin e and mixing with 4 mL hydroxyethylcellulose gel. In both groups, a 50 -mu g dose was applied intravaginally every 8 hours for two doses, the n increased to 100-mu g for a total of six applications or 500 mu g. R esults: The mean interval in hours from drug administration to start i nduction or labor (13.8 versus 18.2) and delivery (22.4 versus 29.0) w as significantly less in the tablet group than in the gel group (P < . 01 for both). Oxytocin and epidural use and the mean number of misopro stol insertions (1.4 versus 1.9) were lower in the tablet group than i n the gel group (P < .05 for all). The incidences of tachysystole (13. 7 versus 7.3%) and hyperstimulation (15.8 versus 7.7%) were significan tly higher in the tablet group than in the gel group. Cesarean deliver y rates and neonatal outcomes were similar between the groups. Conclus ion: Intravaginal misoprostol gel is associated with fewer uterine con tractile abnormalities than the tablet form of the drug but results in a slower time to labor or delivery. (C) 1997 by The American College of Obstetricians and Gynecologists.