Comparison of oral and vaginal misoprostol for induction of labor at term: A randomized controlled trial

Objective: To compare the efficacy of oral with vaginal misoprostol for induction of labor at term. Methods: One hundred and fifty-three pregnant women at term with indications for induction of labor and Bishop score less than or equal to6 were randomly assigned to receive misoprostol either 100 mug orally or 50 mug vaginally every 6 h for 48 h. Repeated doses were given until Bishop score greater than or equal to8 was achieved or spontaneous rupture of membranes occurred. Those who were not in labor after 48 h had labor induced with amniotomy and oxytocin. The main outcome measure was induction to delivery time. Results: The median induction to vaginal delivery time in the oral group (14.3 h) was not significantly different from that of the vaginal group (15.8 h). The median number of doses was also not significantly different in the oral group compared with the vaginal group. There was a significant higher incidence of uterine tachysystole in the vaginal group compared to the oral group (17.1%vs 5.3%, P = 0.032). There was no hyperstimulation in either group. There were no significant differences between the groups with respect to oxytocin augmentation, cesarean section rate, analgesic requirement, and neonatal outcomes. Conclusion: Oral administration of 100 mug misoprostol has similar efficacy to intravaginal administration of 50 mug misoprostol for labor induction with less frequent abnormal uterine contractility. 100 mug of misoprostol orally can be used as an alternative to the vaginal route for labor induction.