Efficacy and safety of misoprostol vaginal insert vs. oral misoprostol for induction of labor
-
Katharina Redling
,
Sabine Schaedelin
Abstract
Objectives
To compare the oral application form of misoprostol with the misoprostol vaginal insert (MVI) in a Swiss cohort with special regards to the efficacy and safety.
Methods
We performed a retrospective case series including a historical group induced with oral misoprostol (MO, n=101) and an MVI group (n=101). The primary outcome was time to delivery. Secondary outcomes were mode of delivery, occurrence of tachysystole, use of analgesia and neonatal adverse outcome.
Results
A total of 202 women were included in the analysis (101 in the MVI as well as in the MO group). Time from start of induction to delivery was significantly shorter in the MVI group compared to the MO group (15.91 h vs. 37.68 h, P<0.001). Within the first 24 h, 78.2% of the women in the MVI group had given birth compared to 28.7% in the MO group (P<0.001). Tachysystole occurred more often in the MVI group (22.8% vs. 5.0%, P<0.001). Women in the MVI group more often needed opioid analgesia during the induction before onset of active labor (31.7% vs. 2.0%, P<0.001). There was no significant difference between neonatal outcomes in the two groups.
Conclusion
Time to delivery was significantly shorter in the MVI group with a higher rate of vaginal deliveries within the first 24 h. However, patients needed more opioids for pain relief during induction with MVI. There was no difference in neonatal outcomes.
Acknowledgments
Many thanks to Dorothy Huang, MD, for proofreading as a native English speaker.
Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: None declared.
Employment or leadership: This study was funded by the University Hospital Basel, Department of Obstetrics.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
References
1. Osterman MJ, Martin JA. Recent declines in induction of labor by gestational age. NCHS Data Brief 2014;155:1–8.Search in Google Scholar
2. Gülmezoglu AM, Crowther CA, Middleton P. Induction of labour for improving birth outcomes for women at or beyond term. Cochrane Database Syst Rev 2012;6:CD004945.10.1002/14651858.CD004945.pub3Search in Google Scholar
3. Middleton P, Shepherd E, Flenady V, Mcbain RD, Crowther CA. Planned early birth versus expectant management (waiting) for prelabour rupture of membranes at term (37 weeks or more). In: Middleton P, editor. Cochrane database of systematic reviews. Vol 2017. Chichester, UK: John Wiley & Sons, Ltd; 2017. doi:10.1002/14651858.CD005302.pub3.10.1002/14651858.CD005302.pub3Search in Google Scholar
4. Koopmans CM, Bijlenga D, Groen H, Vijgen SM, Aarnoudse JG, Bekedam DJ, et al. Induction of labour versus expectant monitoring for gestational hypertension or mild pre-eclampsia after 36 weeks’ gestation (HYPITAT): a multicentre, open-label randomised controlled trial. Lancet 2009;374:979–88.10.1016/S0140-6736(09)60736-4Search in Google Scholar
5. Sutton AL, Mele L, Landon MB, Ramin SM, Varner MW, Thorp JM Jr., et al. Delivery timing and cesarean delivery risk in women with mild gestational diabetes mellitus. Am J Obstet Gynecol 2014;211:244.10.1016/j.ajog.2014.03.005Search in Google Scholar PubMed PubMed Central
6. Boers KE, Vijgen SMC, Bijlenga D, van der Post JAM, Bekedam DJ, Kwee A, et al. Induction versus expectant monitoring for intrauterine growth restriction at term: randomised equivalence trial (DIGITAT). Br Med J 2010;341:c7087.10.1136/bmj.c7087Search in Google Scholar PubMed PubMed Central
7. Boulvain M, Senat MV, Perrotin F, Winer N, Beucher G, Subtil D, et al. Induction of labour versus expectant management for large-for-date fetuses: a randomised controlled trial. Lancet 2015;385:2600–5.10.1097/OGX.0000000000000251Search in Google Scholar
8. Mei-Dan E, Asztalos EV, Willan AR, Barrett JFR. The effect of induction method in twin pregnancies: a secondary analysis for the twin birth study. BMC Pregnancy Childbirth 2017;17:9.10.1186/s12884-016-1201-8Search in Google Scholar PubMed PubMed Central
9. Mishanina E, Rogozinska E, Thatthi T, Uddin-Khan R, Khan KS, Meads C. Use of labour induction and risk of cesarean delivery: a systematic review and meta-analysis. Can Med Assoc J 2014;186:665–73.10.1503/cmaj.130925Search in Google Scholar PubMed PubMed Central
10. Alfirevic Z, Aflaifel N, Weeks A. Oral misoprostol for induction of labour. In: Weeks A, editor. The cochrane database of systematic reviews. Vol 6. Chichester, UK: John Wiley & Sons, Ltd; 2014:CD001338. doi:10.1002/14651858.CD001338.pub3.10.1002/14651858.CD001338.pub3Search in Google Scholar PubMed PubMed Central
11. Hofmeyr GJ, Gülmezoglu AM, Pileggi C. Vaginal misoprostol for cervical ripening and induction of labour. Cochrane Database Syst Rev 2010;6:CD000941.10.1002/14651858.CD000941Search in Google Scholar PubMed
12. Zimmermann R, Drack G, Hosli I, Irion O, Surbek D, Hohlfeld P. Expertenbrief No 38: Misoprostol zur Geburtseinleitung.Search in Google Scholar
13. ACOG Practice Bulletin No. 107: Induction of Labor. Obstet Gynecol 2009;114:386–97.10.1097/AOG.0b013e3181b48ef5Search in Google Scholar
14. World Health Organization. WHO recommendations for Induction of labour. World Heal Organ 2011. doi:10.1016/0140-6736(93)92727-B.10.1016/0140-6736(93)92727-BSearch in Google Scholar
15. Leduc D, Biringer A, Lee L, Dy J, Clinical Practice Obstetrics Committee; Special Contributors. Induction of labour. J Obs Gynaecol Can 2013;35:840–60.10.1016/S1701-2163(15)30842-2Search in Google Scholar
16. Wing DA. Misoprostol vaginal insert compared with dinoprostone vaginal insert: a randomized controlled trial. Obstet Gynecol 2008;112:801–12.10.1097/AOG.0b013e318187042eSearch in Google Scholar PubMed
17. Mayer RB, Oppelt P, Shebl O, Pomer J, Allerstorfer C, Weiss C. Initial clinical experience with a misoprostol vaginal insert in comparison with a dinoprostone insert for inducing labor. Eur J Obstet Gynecol Reprod Biol 2016;200:89–93.10.1016/j.ejogrb.2016.03.008Search in Google Scholar PubMed
18. Burnett JE. Preinduction scoring: an objective approach to induction of labor. Obstet Gynecol 1966;28:479–83.Search in Google Scholar
19. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 106: Intrapartum fetal heart rate monitoring: nomenclature, interpretation, and general management principles. Obstet Gynecol 2009;114:192–202.10.1097/AOG.0b013e3181aef106Search in Google Scholar PubMed
20. Wing DA, Brown R, Plante LA, Miller H, Rugarn O, Powers BL. Misoprostol vaginal insert and time to vaginal delivery: a randomized controlled trial. Obstet Gynecol 2013;122:1–9.10.1097/AOG.0b013e31829a2dd6Search in Google Scholar PubMed
21. Bailit JL, Dierker L, Blanchard MH, Mercer BM. Outcomes of women presenting in active versus latent phase of spontaneous labor. Obstet Gynecol 2005;105:77–9.10.1097/01.AOG.0000147843.12196.00Search in Google Scholar PubMed
22. Harper LM, Caughey AB, Roehl KA, Odibo AO, Cahill AG. Defining an abnormal first stage of labor based on maternal and neonatal outcomes. Am J Obstet Gynecol 2014;210:536.e1–e7.10.1016/j.ajog.2013.12.027Search in Google Scholar PubMed PubMed Central
23. Neal JL, Lamp JM, Buck JS, Lowe NK, Gillespie SL, Ryan SL. Outcomes of nulliparous women with spontaneous labor onset admitted to hospitals in preactive versus active labor. J Midwifery Women’s Heal 2014;59:28–34.10.1111/jmwh.12160Search in Google Scholar PubMed PubMed Central
24. Looft E, Simic M, Ahlberg M, Snowden JM, Cheng YW, Stephansson O. Duration of second stage of labour at term and pushing time: risk factors for postpartum haemorrhage. Paediatr Perinat Epidemiol 2017;31:126–33.10.1111/ppe.12344Search in Google Scholar PubMed
25. O’Driscoll K, Meagher D, Robson M. Active management of labour. 4th ed. Edinburgh: Mosby Limited; 2004.Search in Google Scholar
26. Shetty A, Burt R, Rice P, Templeton A. Women’s perceptions, expectations and satisfaction with induced labour – a questionnaire-based study. Eur J Obstet Gynecol Reprod Biol 2005;123:56–61.10.1016/j.ejogrb.2005.03.004Search in Google Scholar PubMed
27. O’Driscoll K. Impact of active management on delivery unit practice. Proc R Soc Med 1972;65:697–8.Search in Google Scholar
28. Stephenson ML, Hawkins JS, Powers BL, Wing DA. Misoprostol vaginal insert for induction of labor: a delivery system with accurate dosing and rapid discontinuation. Womens Health (Lond Engl) 2014;10:29–36.10.2217/WHE.13.49Search in Google Scholar PubMed
29. Ahmed AI, Zhu L, Aldhaheri S, Sakr S, Minkoff H, Haberman S. Uterine tachysystole in spontaneous labor at term. J Matern Neonatal Med 2016;29:3335–9.10.3109/14767058.2015.1125463Search in Google Scholar PubMed
30. Bofill JA, Darby MM, Castillo J, Sawardecker SU, Magann EF, Morrison JC. Tachysystole following cervical ripening and induction of labor is not associated with adverse outcomes. Gynecol Obstet Invest 2017;82:487–93.10.1159/000452666Search in Google Scholar PubMed
31. Rugarn O, Tipping D, Powers B, Wing DA. Induction of labour with retrievable prostaglandin vaginal inserts: outcomes following retrieval due to an intrapartum adverse event. BJOG 2017;124:796–803.10.1111/1471-0528.14147Search in Google Scholar PubMed PubMed Central
32. Seeger S, Jäger Y, Beyer J, Abou-Dakn M, Schlembach D, Schleußner E. Misodel zur Geburtseinleitung am Termin – Daten einer deutschen prospektiven Kohortenstudie (AGG1) [Misodel for induction of labor at term – Data from a German prospective cohort study (AGC1)]. Geburtshilfe Frauenheilkd 2016;76:FV051.10.1055/s-0036-1593288Search in Google Scholar
©2019 Walter de Gruyter GmbH, Berlin/Boston
Articles in the same Issue
- Frontmatter
- Editorial
- Ultrasound Doppler waveform assessment: the story continues
- Review
- Association between increased antenatal vaginal pH and preterm birth rate: a systematic review
- Mini Review
- Update on uterine tachysystole
- Research Articles – Obstetrics
- First trimester prediction of gestational diabetes mellitus using plasma biomarkers: a case-control study
- Emergency peripartal hysterectomy – a single-center analysis of the last 13 years at a tertiary perinatal care unit
- Efficacy and safety of misoprostol vaginal insert vs. oral misoprostol for induction of labor
- Vitamin A and β-carotene in pregnant and breastfeeding post-bariatric women in an urban population
- Effect of dual tocolysis with fenoterol and atosiban in human myometrium
- Antecedents of red cell transfusion in a large contemporary obstetric cohort
- Effect of n-3 long-chain polyunsaturated fatty acids supplementation in healthy mothers on DHA and EPA profiles in maternal and umbilical blood: a randomized controlled trial
- Research Articles – Fetus
- Effect of psychotropic drugs on fetal behavior in the third trimester of pregnancy
- Prognostic value of the aortic isthmus Doppler assessment on late onset fetal growth restriction
- Doppler evaluation of the fetal pulmonary artery pressure
- Mechanisms of death in structurally normal stillbirths
- The diagnostic value of a detailed first trimester anomaly scan in fetuses with increased nuchal translucency thickness
- Research Articles – Newborn
- Small for gestational age and extremely low birth weight infant outcomes
- Does heart rate variability improve prediction of failed extubation in preterm infants?
Articles in the same Issue
- Frontmatter
- Editorial
- Ultrasound Doppler waveform assessment: the story continues
- Review
- Association between increased antenatal vaginal pH and preterm birth rate: a systematic review
- Mini Review
- Update on uterine tachysystole
- Research Articles – Obstetrics
- First trimester prediction of gestational diabetes mellitus using plasma biomarkers: a case-control study
- Emergency peripartal hysterectomy – a single-center analysis of the last 13 years at a tertiary perinatal care unit
- Efficacy and safety of misoprostol vaginal insert vs. oral misoprostol for induction of labor
- Vitamin A and β-carotene in pregnant and breastfeeding post-bariatric women in an urban population
- Effect of dual tocolysis with fenoterol and atosiban in human myometrium
- Antecedents of red cell transfusion in a large contemporary obstetric cohort
- Effect of n-3 long-chain polyunsaturated fatty acids supplementation in healthy mothers on DHA and EPA profiles in maternal and umbilical blood: a randomized controlled trial
- Research Articles – Fetus
- Effect of psychotropic drugs on fetal behavior in the third trimester of pregnancy
- Prognostic value of the aortic isthmus Doppler assessment on late onset fetal growth restriction
- Doppler evaluation of the fetal pulmonary artery pressure
- Mechanisms of death in structurally normal stillbirths
- The diagnostic value of a detailed first trimester anomaly scan in fetuses with increased nuchal translucency thickness
- Research Articles – Newborn
- Small for gestational age and extremely low birth weight infant outcomes
- Does heart rate variability improve prediction of failed extubation in preterm infants?
