The Risk Factors for Failure of Labor Induction: A Cohort Study

Purpose

To assess how some factors may influence the failure of labor induction.

Methods

We conducted a prospective observational study from January 2009 to December 2011 with 248 patients who were admitted to the Obstetrics Unit of Ferrara University for labor induction. We selected only patients with unfavorable characteristics such as nulliparity, maternal and gestational age, and Bishop score and specific obstetric conditions such as mild preeclampsia, isolated oligohydramnios, premature rupture membrane, gestational diabetes, and hypertension for the success of labor induction.

Results

The induction was carried out by rapid-release gel dinoprostone. 200 patients (80.6 %) delivered vaginally (Group A), while 48 (19.4 %) underwent a cesarean section (Group B). Maternal age was one independent significant variable (p = 0.01, OR 1.08) determining the risk of cesarean delivery. Patients affected by mild preeclampsia had a three times higher risk for cesarean section. Despite the several unfavorable characteristics of the patients, the cesarean section rate was comparable to that of the normal population.

Conclusions

Several factors and clinical conditions historically considered as negative predictors of induction result should be reassessed. The success of labor induction is determined by many maternal and fetal variables, which must all be taken into account to avoid unnecessary cesarean sections.     

Comparison between vaginal and sublingual misoprostol 50 µg for cervical ripening prior to induction of labor: randomized clinical trial

Objective

To compare the effectiveness and safety of sublingual versus vaginal misoprostol on improving the Bishop score after 6 h of administration.

Methods

Randomized clinical trial which includes pregnant women in gestational ages from 32/0 to 41/6, with indication of induction of labor with misoprostol. Bishop score was assessed at the time of induction and 6 h after administration of 50 µg misoprostol. Analysis was made over difference in mean Bishop score of 2 points, using a standard deviation of 2, with 90% power, reaching a 95% confidence interval.

Results

102 patients were studied, 51 received sublingual misoprostol, and 51 received vaginal misoprostol. There was a statistically significant difference in cervical modifications in global terms regardless of the administration route at 6 h (P?<?0.05). When analyzing each group, there was no significant difference for the mean and standard deviation for Bishop score for sublingual and vaginal route (P?=?0.761). There was no significant difference in terms of mode of delivery, Apgar score, cord pH, nor in the presence of complications.

Conclusion

There is no statistically significant difference in terms of administration route for cervical ripening using misoprostol 50 µg, whether it was sublingual or vaginal.

Trial registration number

NCT02732522.Registry website: https://clinicaltrials.gov/.

     

Induction of labor at 41 weeks of pregnancy among primiparas with an unfavorable Bishop score

Objective

To determine the rate and factors associated with the successful Induction of Labor (IOL) in nulliparous patients undergoing scheduled IOL at 41 weeks of gestational age (GA) with an unfavorable cervix.

Design

This was a retrospective analysis that included nulliparous patients who presented to the Labor and Delivery unit at the Bronx Lebanon Hospital Center between 2011 and 2012 for elective IOL at 41 weeks of GA. The Bishop score was assessed upon admission and IOL agents were used in compliance with ACOG guidelines in different combinations, based on the obstetrical team preference.

Setting

Labor and Delivery Unit of the Bronx Lebanon Hospital.

Population

Nulliparous patients with 41 weeks of pregnancy for elective induction of labor.

Sample

Seventy-six patients were included in the study. GA was confirmed using a combination of the last menstrual period and a dating sonogram during pregnancy.

Methods

This was a retrospective chart review that included nulliparous patients who presented to the Labor and Delivery unit at the Bronx Lebanon Hospital Center between October 2011 and October 2012 for elective IOL at 41 weeks of gestational age with an unfavorable cervix defined as a Bishop score of 6 or less.

Main outcome measures

The overall successful rate of IOL in a combination of different maternal factors with different agents for induction in nulliparous patients undergoing scheduled IOL with an unfavorable Bishop score at 41 weeks of GA was 51.32 %.

Results

Factors associated with successful IOL were younger age [22.3 years vs. 25.1(p = 0.015)], lower BMI [25 vs. 28.1(p = 0.46)] and lower maternal weight [64.75 kg vs. 74.02 (p = 0.28)]. Maternal height was not a contributing factor; the artificial rupture of membranes, epidural anesthesia and the prostaglandins used did not contribute. Use of cervical balloon and oxytocin was associated with failed IOL.

Conclusions

Patients undergoing IOL at 41 weeks with an unfavorable cervix had a successful rate of 51.32 %. Younger maternal age, lower weight, and lower BMI were associated with successful IOL.     

Sublingual misoprostol versus intravenous oxytocin in prevention of post-partum hemorrhage

Background

Post-partum hemorrhage (PPH) is the most common direct cause of maternal mortality and timely intervention can save many lives.

Objective

To compare the effectiveness of sublingual misoprostol to intravenous oxytocin in preventing post-partum hemorrhage in low risk vaginal birth.

Methods

One hundred patients with no risk factor for PPH were randomly allocated to receive 600 μg misoprostol administered sublingually or 10 IU of intravenous oxytocin immediately after the delivery of baby. Main outcome measures were post-partum blood loss, drop in hemoglobin in 24 h, duration of third stage of labor, and drug-related adverse effects.

Results

Mean age, parity and gestational age were similar in both groups. Mean blood loss was significantly lower in oxytocin group (114.28 ± 26.75 versus 149.50 ± 30.78 ml; p = 0.00). Drop in hemoglobin was 0.31 ± 0.16 versus 0.49 ± 0.21 g% (p = 0.01) in oxytocin and misoprostol group, respectively. Duration of third stage labor was shorter in oxytocin group (median 5 min, IQR: 4.5–5.5 versus 5.5 min, IQR: 5–6 min, p < 0.01). Although fever and shivering were common adverse effects with misoprostol but were not clinically significant.

Conclusion

Intravenous oxytocin is more efficacious than sublingual misoprostol in preventing PPH in institutional deliveries.     

A Comparison of Vaginal vs. Oral Misoprostol for Induction of Labor–Double Blind Randomized Trial

Objective

To compare efficacy and safety of 50 μgm misoprostol vaginal with oral for labor induction.

Methods

110 women at term gestation, Bishop score ≤4, with various indications for labor induction were randomized and double blinded. After decoding 51 women had received misoprostol orally and 52 vaginally, four hourly (maximum six doses) or till woman went into active labor.

Results

Statistical analysis was done with SPSS 11.0. In vaginal misoprostol group induction delivery interval was significantly less (9.79 vs. 16.47 h) and successful induction was significantly higher (90.38 vs. 74.51%) than oral group, with in 24 h of induction. As for as dose required is concerned in vaginal group 40.38% women needed two doses for delivery, in contrast 35.29% in oral group maximum six doses were required.

Conclusion

Vaginal route of misoprostol is more effective labor inducing agent than oral.     

Type of axial analgesia does not influence time to vaginal delivery in a Proportional Hazards Model

Objective

To create a Proportional Hazards Model of prospective factors associated with time-to-vaginal-delivery (TTVD).

Methods

We analyzed a group of 144 women undergoing childbirth who received one out of two possible axial analgesia techniques, to find-out factors associated with TTVD. The patients were randomly assigned to receive either a levobupivacaine labor epidural (bolus concentration 0.25?% or less; infusion concentration 0.125?% or less) or a combined spinal–epidural procedure (morphine 0.20?mg, fentanyl 25?μg and hyperbaric bupivacaine 2.5?mg as spinal components) for labor analgesia. The factors initially chosen were: mother age, height and weight, parity, gestational age, newborn weight, type of labor, analgesic procedure, levobupivacaine and fentanyl doses, Bromage scale, pain Numeric Rating Scale, and a satisfaction interview. Cesarean section was the censored variable in our model. A systematic multivariate Cox regression was performed.

Results

Our Final Model stated that nulliparous women had 2.5 times more chances of having longer TTVD than primiparous (p?p?=?0.015, CI 1.27–9.25) than multiparous. Women with oxytocin-augmented labor had 2.05 times more chances (p?=?0.001, CI 1.31–3.22) of having longer TTVD than patients without oxytocin. An induced partum had 3.8 times more chances (p?Conclusion Parity, labor augmentation, induction of labor and fetal weight determine TTVD; axial analgesia-related factors do not contribute to the model.     

Sonographic cervical length as a predictor of type of delivery after induced labor

Purpose

This study was undertaken to evaluate the comparative value of sonographic cervical length and the Bishop score in predicting the type of delivery after induced labor.

Methods

The Bishop score was determined by digital examination and cervical length by transvaginal sonography in 177 women.

Results

The best cut-off points for predicting type of delivery found with ROC curves were 25.2?mm for cervical length and 5 for the Bishop score. The Bishop score was not predictive of type of delivery. Cervical length was related to type of delivery in women with Bishop score ≤5. A logistic regression model showed that only cervical length ≥25.2?mm, parity, and body mass index significantly predicted the likelihood of cesarean delivery.

Conclusions

Our study suggests that both Bishop score and sonographic cervical length can contribute to predicting type of delivery after labor induction, but cervical length is a better predictor of the risk of cesarean delivery.     

Outcomes of pregnancies complicated by hyperemesis gravidarum

Objectives

To evaluate maternal and fetal outcomes among women with hyperemesis gravidarum (HG).

Methods

In a university hospital and a research and training hospital, a retrospective cohort study was conducted among women with singleton deliveries between 2003 and 2011. Maternal outcomes evaluated included gestational diabetes, pregnancy-induced hypertension, cesarean delivery. Neonatal outcomes also determined were 5-min Apgar score of less than 7, low birth weight, small for gestational age (SGA), preterm delivery, fetal sex, and stillbirth.

Results

There were no statistical differences in the mean of age, parity, the number of artificial pregnancy, and smoking between two groups. Infants from HG pregnancies manifested similar birth weight (3,121.5?±?595.4 vs. 3,164?±?664.5?g) and gestational age (38.1?±?2.3 vs. 38.1?±?2.6?weeks), relative to infants from the control group (p?=?0.67 and 0.91, respectively). In addition, no statistical significant differences were found in the rates of SGA birth, preterm birth, gestational diabetes, pregnancy-induced hypertension, and adverse fetal outcome between two groups (p?>?0.05). Cesarean delivery rates were similar in two groups (31.9% in hyperemesis group vs. 27% in control group, p?=?0.49). Comparing the gender of the newborn baby and Apgar scores less than 7 at 5?min, there were no statistically significant differences between two groups (p?=?0.16 and 0.42, respectively).

Conclusion

Hyperemesis gravidarum is not associated with adverse pregnancy outcomes.     

The Bishop Score as a determinant of labour induction success: a systematic review and meta-analysis

Purpose

To evaluate the association between the Bishop Score and successful induction.

Study strategy and selection criteria

We searched the PubMed and the lists of references of relevant studies to identify reports on the association between Bishop Score and achieving active phase of labour or vaginal delivery.

Data collection and analysis

We abstracted crude or adjusted measures of association from studies. Summary odds ratio (OR) and summary hazard ratio (HR), and 95?% confidence interval (95?% CI) were obtained by random effects meta-analysis. Study heterogeneity was assessed using the I ² test.

Results

Fifty-nine studies met the inclusion criteria. Analyses with crude ORs showed that women with higher versus lower Bishop Score were more likely to achieve vaginal delivery either with no time limit for this to occur, or within a certain time interval; the summary ORs according to the Bishop Score cutoff ranged from 1.98 (95?% CI: 1.58?C2.48; I ²?=?36.6?%) to 5.48 (95?% CI: 1.67?C17.96; I ²?=?0.0?%) and from 2.15 (95?% CI: 1.36?C3.40; I ²?=?0.0?%) to 4.22 (95?% CI: 2.48?C7.17; I ²?=?11.0?%), respectively. Summary estimates per unit increase in the Bishop Score, based on adjusted ORs, showed a positive association with achieving vaginal delivery, either with no time limit (OR_summary?=?1.33; 95?% CI: 1.13?C1.56; I ²?=?66.1?%) or within a certain time interval (OR_summary?=?1.52; 95?% CI: 1.37?C1.70; I ²?=?42.4?%). Summary HRs per unit increase in Bishop Score showed an association with induction to vaginal delivery (HR_summary?=?1.28; 95?% CI: 1.21?C1.36; I ²?=?0.0?%), but not with induction to active phase (HR_summary?=?1.21; 95?% CI: 0.88?C1.68; I ²?=?70.7?%) time interval.

Conclusions

Bishop Score seems be a determinant of achieving vaginal delivery and is associated with induction-to-vaginal delivery time interval.     

Effect of vaginal intercourse on spontaneous labor at term: a randomized controlled trial

Objective

This study aimed at evaluating the effect of vaginal intercourse on spontaneous labor onset at term.

Methods

In a randomized controlled trial, patients with singleton, cephalic, term, and low-risk pregnancy were assigned to either vaginal intercourse at least twice a week or abstinence. The following data were assessed: demographics, parity, vaginal coitus frequency before and during pregnancy, Bishop score at 38th weeks, gestational age at delivery, mode of delivery, and days between recruitment and delivery. The primary outcome was spontaneous labor onset.

Results

Of the 123 patient analyzed, 63 were assigned to study group and 60 to control group. Mean interval between study recruitment and delivery was higher in sexually active women (15.05 days ± 0.8 compared with 14.17 days ± 0.8, p = 0.45) as well as the rate of cesarean delivery (14.3 % compared with 10 %, p = 0.58), but the differences were not statistically significant. The rate of spontaneous labor was similar in both groups (84.1 % in vaginal coitus group; 75 % in control group, p = 0.26).

Conclusion

Our results showed that vaginal intercourse does not hasten spontaneous labor onset at term.     

Predictors of successful labor induction with oral or vaginal misoprostol

Objective: To identify independent predictors of successful labor induction with oral or vaginal misoprostol.

Methods: Women enrolled in four previous randomized trials involving oral or vaginal misoprostol for cervical ripening and labor induction were included in the present cohort study, with dosing of 25–50?μg every 4 to 6?h vaginally (n?=?574) or 50?μg every 4?h orally (n?=?207). Multiple logistic regression was performed to identify factors independently associated with successful labor induction – defined as vaginal delivery within 12?h, vaginal delivery within 24?h and spontaneous vaginal delivery. Predictors of Cesarean birth and the need for only one dose of misoprostol were also identified. Variables included in the models were maternal age, weight, height, parity, gravidity, membrane status, route of misoprostol, gestational age, birth weight, and Bishop score and its individual components.

Results: Maternal age, height, weight, parity, birth weight, dilatation, effacement and cervical station were associated with vaginal delivery within 24?h of induction. Maternal age, height, weight, nulliparity, birth weight and route of misoprostol were associated with Cesarean birth, with oral misoprostol being associated with a lower rate of Cesarean birth. The need for only one dose of misoprostol was predicted by maternal height, weight, parity, gestational age, Bishop score and route of misoprostol.

Conclusion: Characteristics of the woman (height, weight, parity), the fetus (birth weight) and some of the individual components of the Bishop score, were associated with successful labor induction, with oral misoprostol being associated with a lower rate of Cesarean birth.     

A randomized controlled trial comparing parenteral normal saline with and without 5?% dextrose on the course of labor in nulliparous women

Objective

The objective of this study was to compare intravenous normal saline with and without 5?% dextrose on the course of labor in nulliparous women in active phase of spontaneous labor.

Study design

In a randomized controlled trial, term, nulliparous women with singleton pregnancy in active labor were randomized into one of two groups receiving either normal saline or normal saline alternating with 5?% dextrose at rate of 175?ml/h. The primary outcome was total length of labor from onset of study fluid in vaginally delivered women. Maternal and neonatal outcomes were also analyzed.

Results

Of 250 women enrolled, in vaginally delivered subjects, there was significant difference in the duration of labor (p?=?0.0) and prolonged labor (p?=?0.01), with favorable results for women in 5?% dextrose alternating with normal saline. No statistically significant differences were observed in the cesarean section rates between the groups. The cord pH was significantly higher in neonates born to women in 5?% dextrose alternating with normal saline infusion as compared to normal saline alone (p?=?0.01), however, no neonate in the study had acidemia.

Conclusion

Administration of a 5?% dextrose solution alternating with normal saline is a better parenteral fluid for significantly decreasing duration of labor in term vaginally delivered nulliparous women in spontaneous active labor as compared to normal saline alone.     

A comparative study of cost of care and duration of management for first-trimester abortion with manual vacuum aspiration (MVA) and sharp curettage

Objective

This study compared the hospital charges, duration of in-hospital procedures, clinical course and complications between manual vacuum aspiration (MVA) and sharp curettage.

Materials and methods

A prospective observational study was conducted during the May 2007–April 2008 period in Songklanagarind Hospital, Thailand. Forty cases of pregnancy ≤9?weeks of gestation, with conditions of an incomplete abortion, a blighted ovum or missed abortion were treated with either MVA or sharp curettage. Both groups were compared in terms of demographic and obstetric data, hospitalization cost, clinical course and complications.

Results

The obstetric data of both groups showed that the median parity was two, with a median gestation age of 8?weeks. The median total hospital expenditure was 54.67 USD for patients using the MVA technique and 153.97 USD for the sharp curettage group (p?<?0.01). The median duration of in-hospital care in the MVA group was significantly less than that of the sharp curettage group, 4 versus 20?h, respectively (p?<?0.01). 90?% of patients in the MVA group had only one visit compared with 72.5?% in the sharp curettage group (p?=?0.04). No complications needing further curettage or treatment in either group were noted.

Conclusion

The use of MVA in the management of a first-trimester abortion is practical, safe, cheap and time-saving.     

Do intrauterine growth restricted fetuses of the hypertensive and normotensive mothers differ from each other?

Purpose

To investigate if normotensive and hypertensive patients with intrauterine growth restricted (IUGR) fetuses were different with respect to maternal and fetal characteristics and Doppler flow.

Methods

The records of patients with IUGR fetuses who had to be delivered before 34th gestational week because of fetal distress were examined. Early Doppler abnormalities were defined as increased umbilical artery resistance and redistribution of blood flow in the middle cerebral artery while late Doppler abnormalities were defined as the absence or reversal of umbilical artery blood flow and Doppler flow changes in venous Doppler. t Test, Chi-square test and Mann–Whitney U test were used for the comparison of data as appropriate. p?<?0.05 was considered statistically significant.

Results

Thirty-six patients were hypertensive while 42 were normotensive. Gestational week at admission for hypertensive and normotensive groups (30.8?±?3.6 vs. 32.3?±?3.1) (p?=?0.057), time to delivery (7.1?±?12.6 vs. 4.3?±?9.1?days) (p?=?0.267) and gestational week at delivery (31.8?±?3.1 vs. 32.9?±?2.9) (p?=?0.117) were similar. Birth weight was significantly lower (1242?±?534 vs. 1516?±?504?g) (p?=?0.02) in the normotensive group. The frequency of having oligohydramnios (64.2?% for normotensive and 44.4?% for hypertensive patients) (p?=?0.079) was similar in both groups. Early Doppler abnormalities were more common in hypertensive group (75 vs. 40.5?%) (p?=?0.001) while late Doppler abnormalities were more common in normotensive group (25 vs. 59.5?%) (p?=?0.001).

Conclusion

Birth weight was lower and late Doppler abnormalities were more common in the normotensive group while early Doppler abnormalities were more common in hypertensive group.     

Sialic acid levels in the blood in pregnant women with impaired glucose tolerance test

Purpose

Gestational diabetes (GDM) is a metabolic disease characterized by the impairment of glucose tolerance during pregnancy. Sialic acid (SA) is a component of glycolipid and glycoproteins found in hormone and enzymes in serum and tissues and high serum SA levels are observed in diabetic patients.

Methods

Serum SA levels were investigated in three groups, namely 61 normal pregnant women with normal 50 gr glucose loading test (group 1: gr 1), 36 patients with high 50 gr test values and normal 100 gr test (group 2: gr 2: group with impaired glucose tolerance test, IGT), and 8 patients with diagnosis of GDM (group 3:gr 3).

Results

According to Kruskal–Wallis test, significant difference was observed in SA levels between gr1 and gr2–gr3 (p?=?0.001). Difference was observed between groups with respect to age (p?p?=?0.001), BMI (p?=?0.001), and diabetes history in the family (p?=?0.001) (Table?1).

Comparison of uterine artery Doppler in pregnant women with thrombophilia treated by LMWHs and without thrombophilia

Objective

The aim of this study was to use uterine artery Doppler ultrasonography to investigate the cases of women with thrombophilia who used LMWH during the 18?C22-week period of gestation.

Methods

This retrospective study was conducted at our university between January 2005 and July 2010. 64 patients were treated with low-dose LMWHs (enoxaparine 40?mg) from the beginning of pregnancy until 36?weeks of gestation. Fifty control subjects were also included in this study. Transabdominal ultrasound examination and bilateral uterine artery Doppler measurements pulsatility index (PI), resistive index (RI), and systole/diastole measurement (S/D) were performed during the 18?C22-weeks period of gestation.

Results

No significant differences were found between the groups with respect to maternal age or gestational age at the time of uterine artery Doppler. However, the mean PI (1.07?±?0.46 for LMWH group and 0.91?±?0.31 for control, p?=?0.036) and the mean RI (0.59?±?0.12 for LMWH group and 0.54?±?0.10 for control, p?=?0.021) were significantly higher in the trombophilia group.

Conclusion

Women with trombophilia still have an increased mean PI and RI, as determined by uterine artery Doppler ultrasonography during the 18-22-week period of gestation, even if they use LMWH.     

Randomized double-blind placebo controlled study of preinduction cervical priming with 25 µg of misoprostol in the outpatient setting to prevent formal induction of labour

Objective

To compare the efficacy of preinduction outpatient use of a single dose of 25 μg vaginal misoprostol between 38^1/2 and 40 weeks with that of placebo, to decrease the interval from intervention to delivery after stretch and sweep in low-risk gravid women with Bishop’s score <4.

Method

Sixty three women received 25 μg vaginal misoprostol and 63 women received placebo after stretch and sweep.

Results

The duration from intervention to delivery was 3.35 (1.12–9.46) days in the misoprostol group and 5.42 (2.39–10.11) days in the placebo group which was statistically significant (p = 0.029). Spontaneous labor was seen in 39 women (61.9 %) in the misoprostol group and 35 women (55.6 %) in the placebo group (p = 0.531). Eight women in the misoprostol group and 18 in the placebo group had Lower Segment Caesarean Section (LSCS) and this difference was also statistically significant (p = 0.027). There were no major maternal and neonatal complications in both groups.

Conclusion

Preinduction use of 25 μg vaginal misoprostol after stretch and sweep in the outpatient setting decreased the intervention to delivery interval when compared to placebo.

     

Risk factors for postpartum hemorrhage requiring transfusion in cesarean deliveries for Japanese twins: comparison with those for singletons

Objective

The aim of this study was to identify the factors associated with the increased risk of postpartum hemorrhage requiring transfusion in Japanese twin pregnancies in comparison with those in Japanese singleton pregnancies.

Methods

We reviewed the obstetric records of all singleton and twin deliveries after 22?weeks’ gestation at the Japanese Red Cross Katsushika Maternity Hospital from 2003 through 2011. Potential risk factors for transfusion due to hemorrhage after cesarean delivery were selected according to previous studies of postpartum hemorrhage or transfusion or both after delivery: maternal age, parity, previous cesarean deliveries, history of infertility therapies such as in vitro fertilization, gestational age at delivery, neonatal birth weight, placenta previa, uterine myoma ≥6?cm, hypertensive disorders, placental abruption, emergency cesarean deliveries and general anesthesia.

Results

Using multiple logistic regression, the independent risk factors for postpartum hemorrhage requiring transfusion in singleton pregnancies were preterm delivery [odds ratio (OR) 2.40, 95?% confidence interval (CI) 1.2–4.6, p?<?0.01], placenta previa (OR 8.08, 95?% CI 3.9–16, p?<?0.01) and placental abruption (OR 12.8, 95?% CI 2.3–76, p?<?0.01). In twin pregnancies, however, the independent risk factors for postpartum hemorrhage requiring transfusion were gestational age at ≥41?weeks (OR 8.20, 95?% CI 1.3–40, p?<?0.01) and hypertensive disorders (OR 5.45, 95?% CI 2.2–14, p?<?0.01).

Conclusions

The factors associated with postpartum hemorrhage requiring transfusion in cesarean deliveries of twins seemed to be different from those in singleton cesarean deliveries.     

Comparative Study of Efficacy and Safety of Oral Versus Vaginal Misoprostol for Induction or Labour

Objective

To compare the efficacy of oral with vaginal misoprostol for induction of labour.

Design

A randomized trial.

Setting

Tertiary care hospital.

Participants

Two hundred women requiring induction of labour.

Methods

Group A received oral misoprostol 50 mcg 6 hourly maximum 4 doses to 100 patients and Group B received vaginal misoprostol 50 mcg 6 hourly maximum 4 doses to 100 patients. When the patient entered active stage of labour i.e. clinically adequate constractions of 3/10 min of >40 s duration, and cervical dilatation of with 4 cm, further doses of misoprostol were not administered. Statistical analysis was done using chi-square test and t test.

Result

Both groups were comparable with respect to maternal age, gestational age, indication of induction and initial modified Bishops score Mean number of dosage required for successful induction were significantly less in vaginal group than oral group (in oral groups A were 2.73 + 0.58, and in vaginal Group B 2.26 + 0.52, P value < 0.0001 highly significant). The induction delivery interval was significantly less in vaginal group than oral group (Group A 15.24 + 3.47 h Group B 12.74 + 2.60 h, P < 0.0001 highly significant). Oxytocin augmentation required was less in vaginal group. 26 caesarean sections were performed in oral group and 17 caesarean sections were done in vaginal group (P value 0.06 NS). APGAR score, birth weight, NICU admissions showed no difference between the two groups.

Conclusion

This study shows that vaginal route of administration of misoprostol is preferable to oral route for induction of labour when used in equivalent dosage of 50 mcg 6 hourly.