Induction of Labor using One Dose versus Multiple Doses of Misoprostol: RCT

Abstract

ituations arise in obstetrics where it becomes necessary to end a pregnancy in the interest of the mother or baby or both. There is a growing interest in the use of misoprostol, a prostaglandin E1 analogue for labour induction. A large body of data exists on misoprostol use in cervical ripening and labour induction. Vaginal application of misoprostol has been reported in over 9000 women worldwide and seems to have a safety profile similar to that of dinoprostone. Insert full stop doses as high as 200 μg of misoprostol were used for labour induction in initial trials. Due to feto-maternal complications, the dose was titrated to 50 or 25 μg every two to six hours. There is a need to examine whether the reported increase in uterine hyperstimulation leading to a higher caesarean section rate and increased incidence of postpartum haemorrhage can be reduced with single dose or low dose regimens. The dosing interval is also a source of ongoing debate. Lower and less frequent doses cause fewer complications but result in longer insertion delivery interval. Although the use of lower dose (25 μg) vaginal misoprostol every 3 to 6 hours has been recommended the optimal dose and frequency of application is not firmly established.