Slow‐release vaginal insert of misoprostol versus orally administrated solution of misoprostol for the induction of labour in primiparous term pregnant women: a randomised controlled trial

米索前列醇 医学 阿普加评分 产科 随机对照试验 阴道分娩 毕肖普分数 头位 妊娠期 特布他林 妇科 怀孕 麻醉 胎龄 流产 外科 子宫颈 内科学 哮喘 癌症 生物 遗传学
作者
Tove Wallström,Moa Strandberg,Kristina Gemzell‐Danielsson,Christina Pilo,Hans Järnbert‐Pettersson,M Friman‐Mathiasson,Eva Wiberg‐Itzel
出处
期刊:Bjog: An International Journal Of Obstetrics And Gynaecology [Wiley]
卷期号:126 (9): 1148-1155 被引量:10
标识
DOI:10.1111/1471-0528.15796
摘要

To compare the World Health Organization (WHO) recommended orally administrated dosage of misoprostol (25 μg) with a vaginal slow-release (7 μg/hour) insert of misoprostol regarding time from induction to delivery and safety of the method.Open label, Randomised controlled trial (RCT).Delivery ward at a secondary referral hospital in Stockholm, Sweden, from 1 October 2016 to 21 February 2018.One hundred and ninety-six primiparous women with singletons in cephalic presentation at ≥37 weeks of gestation and with a Bishop score of ≤4.Women were randomised to an oral solution of misoprostol (Cytotec® n = 99) or vaginal slow-release misoprostol (Misodel® [MVI] n = 97).Primary outcome: time from induction to vaginal delivery.mode of delivery; proportion of vaginal deliveries within 24 hours (VD24); neonates with an Apgar score of <7 at 5 minutes; pH < 7.10; postpartum haemorrhage (PPH) of >1000 ml; hyperstimulation; and women's delivery experience (VAS).There was no difference in the time to delivery [corrected] (median 21.1 hours in the MVI group and 23.2 hours in the oral group; Kaplan-Mayer log rank P = 0.31). There was no difference regarding the proportion of VD24 (50.5 versus 55.7%, P = 0.16). Hyperstimulation with non-reassuring cardiotocography (CTG) was more common in the MVI group (14.4 versus 3.0%, P < 0.01). Terbutaline (Bricanyl® ) was used more often for hyperstimulation in the MVI group (22.7 versus 4.0%, P < 0.01). There was no difference in the numbers of children admitted to the neonatal intensive care unit (NICU).Vaginal delivery after induction of labour (IOL) with slow-release misoprostol did not result in a shorter time from induction to vaginal delivery, compared with oral misoprostol solution, but was associated with a higher risk for hyperstimulation and fetal distress. There were no differences in mode of delivery or neonatal outcome.IOL with MVI was similar to oral solution of misoprostol but hyperstimulation and fetal distress were more common.
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