High-dose vaginal misoprostol versus concentrated oxytocin plus low-dose vaginal misoprostol for midtrimester labor induction: A randomized trial

Francis S. Nuthalapaty, Patrick S. Ramsey, Joseph R. Biggio, John Owen

Research output: Contribution to journalArticle

19 Scopus citations

Abstract

Objective: This study was undertaken to compare the efficacy and side effects of a high-dose vaginal misoprostol regimen to concentrated intravenous oxytocin plus low-dose vaginal misoprostol for midtrimester labor induction. Study design: Women at 14 to 24 weeks, with obstetric or fetal indications for delivery and no prior cesarean, were randomly assigned to receive either vaginal misoprostol 600 μg × 1, then 400 μg every 4 hours × 5 (group 1) or escalating dose-concentrated oxytocin infusions (277-1667 mU/min) plus vaginal misoprostol 400 μg × 1, then 200 μg every 6 hours × 2, then 100 μg × 1 (group 2). Analysis was by intent to treat. Primary outcomes were live birth rate and induction-to-delivery interval. Results: The intended sample size was 70 women per group; however, the trial was terminated at the initial interim analysis because of a highly significant difference in 1 of the primary study outcomes. Twenty women were assigned to group 1 and 18 were assigned to group 2. Median induction-to-delivery interval was significantly shorter in group 1 (12 hours, range 4-44 hours) versus group 2 (18 hours, range 7-36 hours; P = .01). Induction success rate at 12 hours was significantly higher in group 1 (60%) compared with group 2 (22%, P = .02). No significant difference was noted in the live birth rate between groups 1 and 2 (13%, 0%, P = .16). The incidence of retained placenta requiring curettage, chorioamnionitis, intrapartum fever, nausea, emesis, and diarrhea were similar between both groups. Conclusion: Compared with concentrated oxytocin plus low-dose vaginal misoprostol, high-dose vaginal misoprostol significantly shortens midtrimester labor inductions.

Original languageEnglish (US)
Pages (from-to)1065-1070
Number of pages6
JournalAmerican Journal of Obstetrics and Gynecology
Volume193
Issue number3 SUPPL.
DOIs
StatePublished - Sep 1 2005
Externally publishedYes

Keywords

  • Concentrated oxytocin
  • Labor induction
  • Misoprostol
  • Pregnancy termination
  • Prostaglandins

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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