Titre du document / Document title

Oral, vaginal and sublingual misoprostol for induction of labor

Auteur(s) / Author(s)

BARTUSEVICIUS A. ⁽¹⁾ ; BARCAITE E. ⁽¹⁾ ; NADISAUSKIENE R. ⁽¹⁾ ;

Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)

⁽¹⁾ Department of Obstetrics and Gynecology, Kaunas University of Medicine, Eiveniu 2, Kaunas 50009, LITUANIE

Résumé / Abstract

Objective: To evaluate the effectiveness and safety of different administration routes of misoprostol for induction of tabor. Method: PubMed, Cochrane Library and EMBASE searches were carried out using the keywords oral, vaginal, sublingual, buccal, misoprostol, labor induction, identifying randomized case-controlled trials comparing different routes for giving misoprostol to induce labor, published in English between 1994 and 2004. Results: Seventeen studies (3549 participants) were included. Compared to vaginal administration, oral misoprostol was associated with higher failure rates for achieving vaginal delivery within 24 h (odds ratio (OR) 1.61, 95% confidence interval (Cl) 1.23-2.10), higher rates of uterine hyperstimulation without fetal heart rate (FHR) changes (OR 2.21, 95% Cl 1.12 - 4.34) and lower cesarean section rates (OR 0.74, 95% Cl 0.56-0.97). A lower dose of oral misoprostol (50 pg) compared to the 25-50 μg administered vaginally was associated with a higher rate of vaginal delivery not being achieved within 24 h (OR 3.60, 95% Cl 2.10 6.18), more need for oxytocin augmentation (OR 2.19, 95% Cl 1.65-2.92), less uterine hyperstimulation both without FHR changes (OR 0.58, 95% Cl 0.42-0.80) and with FHR changes (OR 0.34, 95% Cl 0.17-0.67) and fewer cesarean sections (OR 0.69, 95% Cl 0.51-0.91). Compared to vaginal administration, buccal misoprostol resulted in a higher rate of failure to achieve vaginal delivery after 24 h, more frequent uterine hyperstimulation and lower rates of cesarean section, but these differences were not significant. When 50 μg of misoprostol used sublingually was compared to oral administration, the sublingual misoprostol was associated with less failure to achieve vaginal delivery after 24 h, less oxytocin augmentation and reduced cesarean section, but none of the differences were statistically significant. Conclusions: Vaginal misoprostol appears more effective than the equivalent dosage administered orally. However, the vaginal route appears to be associated with; higher risk of uterine hyperstimulation. Sublingual misoprostol seems an effective route of administration, but a lack of data necessitates more clinical trials t( establish the effectiveness and safety of the buccal/sublingual route.

Revue / Journal Title

International journal of gynaecology and obstetrics   ISSN 0020-7292   CODEN IJGOAL 

Source / Source

2005, vol. 91, n^o1, pp. 2-9 [8 page(s) (article)] (23 ref.)

Langue / Language

Anglais

Editeur / Publisher

Elsevier Science, Shannon, IRLANDE  (1969) (Revue)

Mots-clés anglais / English Keywords

Prostaglandin derivatives ; Obstetrics ; Gynecology ; Labor ; Delivery ; Triggering ; Sublingual ; Vagina ; Oral administration ; Misoprostol ;

Mots-clés français / French Keywords

Prostaglandine dérivé ; Obstétrique ; Gynécologie ; Travail obstétrical ; Accouchement ; Déclenchement ; Sublingual ; Vagin ; Voie orale ; Misoprostol ;

Mots-clés espagnols / Spanish Keywords

Prostaglandina derivado ; Obstétrico ; Ginecología ; Trabajo de parto ; Parto ; Inducción ; Sublingual ; Vagina ; Vía oral ; Misoprostol ;

Mots-clés d'auteur / Author Keywords

Oral ; Vaginal ; Sublingual ; Buccal ; Misoprostol ; Labor induction ;

Localisation / Location

INIST-CNRS, Cote INIST : 15472, 35400013268694.0010