Single or Multi-Dose Misoprostol for Labor Induction?
BACKGROUND AND PURPOSE:
Misoprostol is a synthetic analogue of prostaglandin E1
25 or 50 µcg vaginally is the commonly recommended dose for cervical ripening
There is limited data on repeat dosing and timing between doses
There is data that a single dose may be more effective than repeat dosing that may extend the latent phase
Pimentel et al. (AJOG, 2018) compared the rate of vaginal delivery within 24 hours between a one-dose and a multiple-dose regimen of misoprostol for induction of labor
Randomized controlled trial
Participants: Women with singleton pregnancies and intact membranes admitted for labor induction
All women received misoprostol 25 μcg vaginally
Patients randomized to either receive
Only the single dose of misoprostol followed by initiation of oxytocin 4 to 6 hours later
Multi-dose regimen of misoprostol every 4 to 6 hours up to 4 doses
Primary outcome: Rate of vaginal delivery within 24 hours
Time to vaginal delivery | Cesarean delivery rate | Maternal and neonatal morbidity
250 women were randomized
Demographics and clinical characteristics were similar between groups
Rate of vaginal delivery within 24 hours
There was no difference between the one-misoprostol group (41.7%) and the multiple-dose group (44.7%)
Time to vaginal delivery
There was no difference between the one-misoprostol group (1187 min) vs. multiple-dose group (1321 min)
When adjusted for Bishop score, parity, gestational age, body mass index, estimated fetal weight, artificial rupture of membrane at < 6 cm and Foley balloon placement, treatment group was no longer associated with cesarean rate
Bishop score of <4 (P=.001) prior to initiating of oxytocin and nulliparity (P=.008) were significantly associated with cesarean rate
One-dose regimen of misoprostol administration is an acceptable alternative for induction for labor
The authors suggest that because of the increased risk for cesarean section, additional doses of misoprostol may be advised in nulliparous women if the Bishop score is <4 at 6 hours after the initial dose
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This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
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presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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