Induction of Labor by Oral Misoprostol Solution

This comparative randomized study was conducted in the Department of Obstetrics and Gynecology, Christian medical college and hospital, Ludhiana for a period of one year beginning from 1st December, 2017 to 30th November, 2018. The study group comprised of all antenatal women admitted in labor room at term for induction of labor. Informed consent was taken for all selected women. Women were subjected to detailed history taking, a complete physical examination including per vaginum examination (to calculate modified bishop's score and to rule out cephalopelvic disproportion), investigations and a NST. Gestational age was established by the first date of the last menstrual period and confirmed by first trimester ultrasound. Presentation was confirmed by palpation and third trimester ultrasound.

Women after randomization were allocated into two groups. The first group (A) was induced with hourly titrated oral misoprostol regimen and the second group (B) received two hourly static oral misoprostol regimen. Once labor had started, vital signs were closely monitored every 2 hours; fetal heart rate (FHR) and uterine activity every 15 minutes during first stage of labor. Per vaginum examination was done 4-hourly or as indicated.

Primary and secondary outcome measures were noted and analyzed to compare safety and efficacy of titrated and oral misoprstol solution.

Inclusion criteria

• Singleton live pregnancy;
• ≥37 weeks gestation;
• Cephalic presentation;
• Reassuring fetal heart rate;
• Modified Bishop'score

Exclusion criteria

• Hypersensitivity to misoprostol;
• Uterine scar due to previous cesarean section or other uterine surgery;
• Grand multipara;
• Multiple gestations;
• High risk pregnanacies • preeeclampsia with severe features • significant maternal cardiac,renal, liver disease
• Any contraindication to induction and vaginal delivery e.g. cephalopelvic disproportion, malpresentation, fetal compromise and ante partum hemorrhage
• Intrauterine fetal demise