Induction of Labor: The Misoprostol Controversy

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

J Midwifery Womens Health. 2003;48(4)

Oral Misoprostol

Although women and their care providers may prefer oral rather than vaginal administration of misoprostol,^[28] the evidence to date suggests that at a given dose, the oral route of administration is less effective than the vaginal route for labor induction.^[24] Using higher doses of misoprostol orally may increase efficacy; however, this may be associated with high-peak serum levels and a higher incidence of adverse effects, including uterine hyperstimulation with the potential for fetal compromise.^[29] In addition, there are less data from randomized controlled trials (13 trials, including approximately 2700 women) to support the use of orally administered misoprostol, rather than vaginally administered, for labor induction at this time.^[24]

Other methods of misoprostol administration, including frequent administration (titration) of a low-dose oral misoprostol solution^[30] and the buccal^[3] and sublingual^[32] routes of administration are promising but currently experimental. Alternative routes of administration are associated with different pharmacokinetic profiles and, therefore, appropriate dosing may differ substantially from the currently accepted vaginal regimen.^[33]

1 2 3 4 5 6 7

Next Section

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

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.

Comments

Commenting is limited to medical professionals. To comment please Log-in.

Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.

processing....

Induction of Labor: The Misoprostol Controversy

Oral Misoprostol

Tables

References

Authors and Disclosures

Authors and Disclosures

Comments

Email This

Feedback