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348: RCT of misoprostol pre-induction ripening vs oxytocin induction
SMFM Abstracts 348
www.AJOG.org
RCT OF MISOPROSTOL PRE-INDUCTION RIPENING VS OXYTOCIN INDUCTION LINDA FONSECA1, MICHAEL LUCAS2, HILAIRE WOOD2, DEEPALI PHAT‘AK2, RAMIN SUSAN2, LARRY GILSTRAP2, EDWARDS YEOMANS2, 1Northwestern University, Feinberg School of Medicine, Obstetrics & Gynecology, Chicago, Illinois, 2University of Texas Health Science Center at Houston, Houston, Texas OBJECTIVE: To compare the vaginal delivery rate in women undergoing labor induction with misoprostol cervical ripening or oxytocin alone. STUDY DESIGN: Women with singleton pregnancies and Bishop score ⬍5 presenting for labor induction at ⬎24 weeks gestation were eligible. Women were randomized to either oxytocin treatment or pre-induction cervical ripening with misoprostol. Vaginal delivery rate, interval to active labor and delivery, anesthesia type, maternal and neonatal outcome were obtained. RESULTS: 168 women were randomized to the oxytocin arm and 167 to misoprostol arm. Maternal demographics, gestational age, Bishop score and anesthesia type were similar between groups. Vaginal delivery rates were similar in each group: 86% (n⫽144) for oxytocin and 80% (n⫽133) for misoprostol (Table 1). Mean time from treatment to delivery was significantly shorter for the oxytocin arm compared with misoprostol arm (13.1 versus 16.3 hrs, P⫽ 0.005). There was no difference between groups with respect to maternal or neonatal outcome. CONCLUSION: Pre-induction cervical ripening with misoprostol does not improve the vaginal delivery rate and results in a longer time interval to active labor and to delivery. We conclude that pre-induction cervical ripening with misoprostol is not necessary. Labor results
Vaginal delivery Not delivered Treatment median Bishop score Interval active labor (hr) Interval active to 2nd stage (hr) Interval 2nd stage to delivery (hr) Interval treatment to delivery (hr)
Oxytocin (n ⫽ 168)
Misoprostol (n ⫽ 167)
P value
144 (86%) 2 (1%) 3 10.3 ⫾ 8.4 3.5 ⫾ 3.2 0.5 ⫾ 0.7 13.1 ⫾ 10.2
133 (80%) 5 (2%) 2 13.1 ⫾ 7.2 3.1 ⫾ 2.8 0.7 ⫾ 0.8 16.3 ⫾ 7.3
0.31 1.00 0.12 0.004 0.28 0.10 0.005
0002-9378/$ - see front matter doi:10.1016/j.ajog.2007.10.364
S106
American Journal of Obstetrics & Gynecology Supplement to DECEMBER 2007
www.AJOG.org
RCT OF MISOPROSTOL PRE-INDUCTION RIPENING VS OXYTOCIN INDUCTION LINDA FONSECA1, MICHAEL LUCAS2, HILAIRE WOOD2, DEEPALI PHAT‘AK2, RAMIN SUSAN2, LARRY GILSTRAP2, EDWARDS YEOMANS2, 1Northwestern University, Feinberg School of Medicine, Obstetrics & Gynecology, Chicago, Illinois, 2University of Texas Health Science Center at Houston, Houston, Texas OBJECTIVE: To compare the vaginal delivery rate in women undergoing labor induction with misoprostol cervical ripening or oxytocin alone. STUDY DESIGN: Women with singleton pregnancies and Bishop score ⬍5 presenting for labor induction at ⬎24 weeks gestation were eligible. Women were randomized to either oxytocin treatment or pre-induction cervical ripening with misoprostol. Vaginal delivery rate, interval to active labor and delivery, anesthesia type, maternal and neonatal outcome were obtained. RESULTS: 168 women were randomized to the oxytocin arm and 167 to misoprostol arm. Maternal demographics, gestational age, Bishop score and anesthesia type were similar between groups. Vaginal delivery rates were similar in each group: 86% (n⫽144) for oxytocin and 80% (n⫽133) for misoprostol (Table 1). Mean time from treatment to delivery was significantly shorter for the oxytocin arm compared with misoprostol arm (13.1 versus 16.3 hrs, P⫽ 0.005). There was no difference between groups with respect to maternal or neonatal outcome. CONCLUSION: Pre-induction cervical ripening with misoprostol does not improve the vaginal delivery rate and results in a longer time interval to active labor and to delivery. We conclude that pre-induction cervical ripening with misoprostol is not necessary. Labor results
Vaginal delivery Not delivered Treatment median Bishop score Interval active labor (hr) Interval active to 2nd stage (hr) Interval 2nd stage to delivery (hr) Interval treatment to delivery (hr)
Oxytocin (n ⫽ 168)
Misoprostol (n ⫽ 167)
P value
144 (86%) 2 (1%) 3 10.3 ⫾ 8.4 3.5 ⫾ 3.2 0.5 ⫾ 0.7 13.1 ⫾ 10.2
133 (80%) 5 (2%) 2 13.1 ⫾ 7.2 3.1 ⫾ 2.8 0.7 ⫾ 0.8 16.3 ⫾ 7.3
0.31 1.00 0.12 0.004 0.28 0.10 0.005
0002-9378/$ - see front matter doi:10.1016/j.ajog.2007.10.364
S106
American Journal of Obstetrics & Gynecology Supplement to DECEMBER 2007