Oral versus vaginal misoprostol for induction of labor: A double-blind randomized controlled trial

OBJECTIVE: To determine the efficacy of oral misoprostol (50 mug) administe red every 3 hours compared to vaginal misoprostol (50 mug) administered eve ry 6 hours for induction of labor. STUDY METHODS: In this double-blind randomized trial, 126 women received mi soprostol (50 mug) either orally every 3 hours or vaginally every 6 hours f or induction of labor. Outcomes included time from induction to delivery, o xytocin augmentation, incidence of hyperstimulation and tachysystole, mode of delivery, and neonatal outcomes. RESULTS: Median time to delivery was shorter in those women who were receiv ing vaginal misoprostol (vaginal 14.3 hours vs oral 23.1 hours; P = .0004) and more women in the oral group required oxytocin augmentation of labor (7 3% vs 42%)(RR, 1.98; 95% Cl, 1.29 to 3.06). The incidence of hyperstimulati on was similar between the groups, but there was an increased incidence of tachysystole in the vaginal group (26.5% vs 9.7%)(RR, 2.74; 95% Cl, 1.16 to 6.51). There was no difference between the groups with respect to mode of delivery or neonatal outcome. CONCLUSION: Vaginal misoprostol administered every 6 hours is more effectiv e for induction of labor than oral misoprostol administered every 3 hours. The higher rates of tachysystole with use of vaginal misoprostol in the cur rent study warrant further investigation.