At least they asked
the women’s preference. Guess what they chose? MM
Oral
misoprostol for induction of labour at term: randomised controlled trial - BMJ , vol
332, no 7540, 4 March 2006, pp 509-511 Dodd JM; Crowther CA;
Robinson JS - (2006) OBJECTIVE:
To compare oral misoprostol solution with vaginal prostaglandin gel (dinoprostone)
for induction of labour at term to determine whether misoprostol is superior.
DESIGN: Randomized double blind placebo controlled trial. SETTING: Maternity
departments in three hospitals in Australia.Population Pregnant women with a
singleton cephalic presentation at >/=36+6 weeks' gestation, with an
indication for prostaglandin induction of labour. INTERVENTIONS: 20 microg oral
misoprostol solution at two hourly intervals and placebo vaginal gel or vaginal
dinoprostone gel at six hourly intervals and placebo oral solution. MAIN
OUTCOME MEASURES: Vaginal birth within 24 hours; uterine hyperstimulation with
associated changes in fetal heart rate; caesarean section (all); and caesarean
section for fetal distress. RESULTS: 741 women were randomised, 365 to the
misoprostol group and 376 to the vaginal dinoprostone group. There were no
significant differences between the two treatment groups in the primary
outcomes: vaginal birth not achieved in 24 hours (misoprostol 168/365 (46.0%) v
dinoprostone 155/376 (41.2%); relative risk 1.12, 95% confidence interval 0.95
to 1.32; P=0.134), caesarean section (83/365 (22.7%) v 100/376 (26.6%); 0.82,
0.64 to 1.06; P=0.127), caesarean section for fetal distress (32/365 (8.8%) v
35/376 (9.3%); 0.91, 0.57 to 1.44; P=0.679), or uterine hyperstimulation with
changes in fetal heart rate (3/365 (0.8%) v 6/376 (1.6%); 0.55, 0.14 to 2.21;
P=0.401). Although there were differences in the process of labour induction,
there were no significant differences in adverse maternal or neonatal outcomes.
CONCLUSIONS: This trial shows no evidence that oral misoprostol is superior to
vaginal dinoprostone for induction of labour. However, it does not lead to
poorer health outcomes for women or their infants, and oral treatment is preferred by women. Trial
registration National Health and Medical Research Council, Perinatal Trials,
PT0361. (11 references) (Author)
