Induction of Labor: The Misoprostol Controversy

Alisa B. Goldberg, MD, MPH, Deborah A. Wing, MD

J Midwifery Womens Health. 2003;48(4)

Evidence Supporting the Use of Misoprostol for Induction of Labor With a Viable Fetus

Many clinical trials have demonstrated that misoprostol is effective for cervical ripening or induction of labor at term for most indications for which labor is induced, including premature rupture of membranes. These trials compared misoprostol with placebo,^[8,9] oxytocin,^[10,11,12] and other prostaglandins, primarily dinoprostone (PGE2) gel^{[13,14,15,16,17,18,19]} or the PGE2 insert (Cervidil).^[20,21] In 1997, the first metanalysis of randomized controlled trials comparing misoprostol primarily to PGE2 gel for cervical ripening or labor induction at term found shorter times to delivery and a lower cesarean delivery rate in the misoprostol group.^[22]

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Cite this: Induction of Labor: The Misoprostol Controversy - Medscape - Jul 01, 2003.

Abstract and Introduction
Why the Controversy?
Evidence Supporting the Use of Misoprostol for Induction of Labor With a Viable Fetus
Vaginal Misoprostol
Oral Misoprostol
Trial of Labor After Cesarean Delivery
Conclusion
References

Table 1. Table 1. Guidelines for Minimizing Risk When Using Misoprostol for Induction of Labor
1. Use a standardized, hospital-based, or institution-based approach, which includes the following:
a. Appropriate indications for use
b. Clear definitions of patients who should be excluded from use ACOG committee opinion states that misoprostol should not be used for patients with a previous cesarean delivery or uterine scar and that there are insufficient data on safety for use in women with multiple gestations or suspected fetal macrosomia.^[3]
c. An evidence-based dosing regimen ACOG committee opinion recommends 25 µg of vaginal misoprostol administered not more frequently than every 3-6 hours.^[3]
d. Criteria for repeated misoprostol doses and maximum allowable number of doses
e. A minimum 4-hour waiting period between the last misoprostol dose and the initiation of oxytocin, if necessary^[3]
f. Continuous fetal heart rate and uterine contractility monitoring
g. Management options for uterine hyperstimulation and fetal heart rate abnormalities
h. Criteria for physician consultation and referral
2. Obtain and document informed consent from the patient.
3. Use a standard approach to pill preparation.
4. Monitor outcomes of women receiving misoprostol in comparison with women receiving other uterotonic agents at your institution.

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Induction of Labor: The Misoprostol Controversy

Evidence Supporting the Use of Misoprostol for Induction of Labor With a Viable Fetus

Tables

References

Authors and Disclosures

Authors and Disclosures

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