@2024 Afarand., IRAN

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ISSN: 2252-0805    The Horizon of Medical Sciences 2016;22(2):103-109

Background
… [1-10] In a study, the first group has been received 5 µg oral misoprostol every six hours up to five doses and the second group has been received 25 µg vaginal misoprostol every six hours up to five doses. The results show that there is no significant difference between two methods (50 µg oral misoprostol and 25 µg vaginal misoprostol) [11]. … [12]
Previous Studies
The effect of 50 µg oral misoprostol has been reported better than the effect of 50 µg vaginal misoprostol [13-15].
Aim(s)
The aim of this study was to compare the effect of oral misoprostol with vaginal misoprostol for labor induction in post-term pregnancies.
Research type
This study is a double blind randomized clinical trial.
Research society, place and time
Pregnant women referring to maternity block of Besat hospital of Sanandaj were studied in 2013 and 2014.
Sampling method and number
180 pregnant women were selected through blocked random sampling. The sample size was estimated 60 patients in each group.
Used devices&materials
The samples were divided into three groups based on randomized blocking method with block size of six. The first group was induced by 50 µg oral misoprostol. The second group was induced by 100 µg oral misoprostol and the third group was induced by 25 µg vaginal misoprostol. Induction of labor in the first group was carried out using oral tablets of misoprostol at a dose of 50 µg. It was done in the second group with oral misoprostol at a dose of 100 µg, and in the third group it was carried out using 25 µg of vaginal misoprostol (located in the posterior fornix). Based on the conditions, the inductions were repeated every 6 hours up to 4 doses. In case of increasing Bishop score, while lacking the uterine contraction, inductions started with low dose of oxytocin and indications for cesarean were induction failure, hyper-stimulation, fetal distress, and disposal of meconium. The interval between the induction with misoprostol and the onset of uterine contractions and the interval between inductions to labor in the three methods, the cesarean rate and natural childbirth and other tests, including tachysystole, hyper-stimulation and other variables were recorded in a checklist. In all cases, immediately after delivery, a piece of 20 cm of umbilical cord was isolated, and the blood of isolated umbilical cord was drawn into the syringe of 2ml having heparin ice. Then, it was transported to the laboratory, and its acidity was measured. During the study, 9 patients of the group receiving oral misoprostol with the dose of 50 µg, 6 cases of the group received oral misoprostol with the dose of 100 µg, and 15 patients of the group received 25 µg of vaginal misoprostol were placed under cesarean due to the disposal of meconium, fetal distress or lack of response to induction. Data were analyzed using SPSS 18 software and descriptive and inferential statistics. One-way ANOVA test was used to compare the interval to the onset of uterine contractions, the interval until the labor, neonatal Apgar score in the first and fifth minutes, tachysystole uterine, and umbilical artery pH level. Also, Chi-square test or Fisher`s exact test were used to compare the uterine hyperstimulation, fetal distress frequency and the frequency of meconium in the three groups.
Findings by Text
The mean age of pregnant women, the number of pregnancy, labor, abortion, and the number of alive neonatal were not significantly different among the groups. The mean Apgar scores in the groups had statistically significant difference in the first minute, but the difference between mean Apgar scores of the groups was not statistically significant in the fifth minute. In addition, in terms of the mean weight of newborns and the umbilical cord pH, no statistically significant difference was observed in the groups. The mean of drug dosage in the studied groups was not statistically significantly different (Table 1). In terms of the frequency of induction, number of inductions, mode of delivery, complications of induced labor, cesarean cause and gender, the groups were the same. However, the groups had statistically significant difference in fetal distress and hospitalized infants (Table 2). The mean interval between the use of misoprostol and the onset of uterine contractions, the interval between the onset of uterine contractions and delivery time, and the interval between the misoprostol usage and the labor time were not statistically significant in the groups (Table 3).
Main comparison to the similar studies
In this study, three groups of oral misoprostol at the doses of 50 and 100 µg and vaginal misoprostol at the dose of 25 µg were compared in terms of labor induction. The mean interval between the use of misoprostol and the time of delivery was 12.6 hours in the group received vaginal misoprostol, 11.6 hours in the group received 100 µg of oral misoprostol, and 11.6 hours in the group received 50 µg of oral misoprostol and three groups were not statistically significantly different. No significant difference is between two methods of oral misoprostol at a dose of 50 µg and vaginal misoprostol at a dose of 25 µg [11]. The labor time in women who have received vaginal misoprostol is less than the labor time in women who have received oral misoprostol [12]. The effectiveness rates of vaginal and oral misoprostol for induction of labor are equal [13]. In the group receiving oral misoprostol, the interval between the onset of induction and the labor is less than the group receiving vaginal misoprostol [16]. The time of labor in the group receiving oral misoprostol is less than the one receiving vaginal misoprostol [15]. The utilization of 25 and 50 µg of misoprostol do not differ in the rate of labor induction success, but its utilization at the dose of 50 µg reduces the duration of the first and the second stages of labor [17]. The findings of most similar studies emphasize better effect of oral misoprostol compared to the vaginal one which is consistent with the results of this study. The numbers of drug doses were different in the studied groups. However, in another study the result was contrary to the present findings [12]. In the current study, the frequency of complication of fetal distress and meconium in the group receiving oral misoprostol at a dose of 50 µg was 25% more than vaginal group (15%), and the group receiving oral misoprostol at a dose of 100 µg (11.7%). In women receiving misoprostol at a dose of 25 µg, meconium and fetal distress is higher [18]. Maternal and fatal complications are similar in the group receiving oral misoprostol and the group receiving vaginal misoprostol [15]. The utilization of misoprostol at the doses of 25 and 50 µg do not differ in fatal complications [17]. The findings are somewhat consistent with our study. Induction and its frequency in the groups were not statistically significantly different, but its frequency was less in the group receiving oral misoprostol at the dose of 100 µg. The rate of induction success in the receptors of oral misoprostol was more than in the receptors of virginal misoprostol [15] that does not comply with our findings. Types of labor was not significantly different in the groups, but the number of cesarean in vaginal group was more than oral group, and the frequency of natural childbirth was reduced in the group receiving oral misoprostol at the dose of 100 µg, the group receiving oral misoprostol at the dose of 50 µg, and the group receiving vaginal, respectively. 70% of women receiving misoprostol have natural delivery [18]. The rate of natural delivery in the oral method has been reported less than vaginal method which is in contract to the present study [11]. … [19, 20] 50 µg dose of oral misoprostol is more effective than vaginal method [21], which is a result in line with the findings of the current study. … [22-24]
Suggestions
In order to compare the misoprostol with the doses of 50 and 100 µg of misoprostol, multi-center studies with larger sample sizes are recommended.
Limitations
A Limitation of the present study was the lack of internal monitoring for appropriate controlling of contractions.
Conclusions
Administration of oral misoprostol at the dose of 100 µg in the pregnant women after the deadline for labor induction and maternal and neonatal outcomes is more appropriate than oral misoprostol at the dose of 50 µg and the vaginal misoprostol at the dose of 25 µg.
Acknowledgments
The Staff of delivery blocks at Besat hospital of Sanandaj are appreciated.
Conflict of interest
There is no conflict of interest.
Ethical Permissions
The study was approved by Ethical Committee of Kurdistan University of Medical Sciences.
Funding Sources
This study was funded by Research Department of Kurdistan University of Medical Sciences.

TABLES and CHARTS

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