Elsevier

Seminars in Perinatology

Volume 39, Issue 6, October 2015, Pages 459-462
Seminars in Perinatology

Misoprostol for induction of labor

https://doi.org/10.1053/j.semperi.2015.07.008Get rights and content

Abstract

Labor-induction rates have increased considerably in the United States as well as around the world. With up to half of all induced labors requiring cervical ripening, prostaglandins have been utilized to increase induction success and achieve vaginal delivery. Misoprostol, a synthetic prostaglandin E1 analog has the ability to mimic the changes of spontaneous labor and has been used off label for over 30 years as a labor-induction agent. In the following article, cervical ripening and induction of labor with misoprostol will be discussed. The risks and benefits of misoprostol for ripening and induction and routes of administration will be reviewed, as well as future directions and new developments for its use.

Section snippets

Oral misoprostol

Alfirevic et al.8 published a recent Cochrane review on oral misoprostol including 76 trials that compared this route of administration with placebo and other methods for induction of labor. When compared to placebo, women treated with oral misoprostol were more likely to give birth vaginally within 24 h and need less oxytocin.8 Women who received oral misoprostol had lower cesarean rates when compared to women who received vaginal dinoprostone (RR = 0.88; 95% CI: 0.78–0.99) and when compared to

Vaginal misoprostol

Hofmeyr et al.5 published one of the largest meta-analyses on labor induction, including 121 trials of vaginal misoprostol. Their findings included that compared to placebo, vaginal misoprostol was associated with reduced failure to achieve vaginal delivery in less than 24 h (RR = 0.40; 95% CI: 0.22–0.7; 2 trials, 112 women).5 Compared to vaginal PGE2, intracervical PGE2, and oxytocin, vaginal misoprostol was again associated with reduced failure to achieve vaginal delivery in less than 24 h (RR

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      Tachysystole and indeterminate or abnormal FHR changes have been associated with both the 25-mcg and the 50-mcg doses (Crane, Young, Butt, Bennett, & Hutchens, 2001; Kreft et al., 2014; McMaster et al., 2015; Penfield & Wing, 2017). Higher dosages have been associated with an increased rate of tachysystole (ACOG, 2009b; Kreft et al., 2014; McMaster, Sanchez-Ramos, & Kaunitz, 2015; Penfield & Wing, 2017; Stephenson & Wing, 2015). The incidence of tachysystole with and without indeterminate or abnormal FHR changes was significantly higher with misoprostol than with Cervidil, Prepidil, and oxytocin (Hofmeyr, Gülmezoglu, & Pileggi, 2010; Liu et al., 2014; Penfield & Wing, 2017; Stephenson & Wing, 2015).

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      The incidence of tachysystole with and without indeterminate or abnormal FHR changes was significantly higher with misoprostol than with Cervidil, Prepidil, and oxytocin (Hofmeyr, Gülmezoglu, & Pileggi, 2010; Liu et al., 2014; Penfield & Wing, 2017; Stephenson & Wing, 2015). A 4- to 6-hour interval between doses was associated with less uterine tachysystole than the 3-hour interval (ACOG, 2009b; Penfield & Wing, 2017; Stephenson & Wing, 2015). Uterine rupture is a complication of the use of misoprostol for cervical ripening and labor induction, especially for women who have uterine scars (FDA, 2015; Lydon-Rochelle, Holt, Easterling, & Martin, 2001; Penfield & Wing, 2017; Searle, 2018; Weeks et al., 2007).

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    D.A.W is a consultant for Ferring Pharmaceuticals and was a principal investigator for the multicenter Misoprostol Vaginal Insert Consortium for Ferring Pharmaceuticals.

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