Misoprostol Preferred in Preeclampsia Labor Induction

A new study concludes that low dose misoprostol is preferable for inducing labor in women with preeclampsia in low resource settings.

Researchers at the University of Liverpool (United Kingdom), Government Medical College (Nagpur, India), and Gynuity Health Care (New York, NY, USA) conducted an open-label, randomized trial in two public hospitals in Nagpur (India), involving 602 women who were randomly assigned to induction with misoprostol (302 women) or Foley catheterization (300 women), between Dec 20, 2013, and June 29, 2015. All women were at 20 weeks' gestation or later with a live fetus, and required induced delivery due to preeclampsia or hypertension.

The pregnant women received labor induction with either oral misoprostol (25 μg every two hours for up to 12 hours), or via transcervical silicone Foley catheter; the catheter remained in place until active labor started, fell out, or when 12 hours had elapsed. If the catheter did not fall out within 12 hours, induction continued with artificial membrane rupture and oxytocin administered through a micro-drip gravity infusion set. The primary outcome was vaginal birth within 24 hours.

The results showed that women in the misoprostol arm had a 10% higher rate of vaginal birth within 24 hours, and less need for caesarean section; they were also more satisfied with the outcome than those induced with the catheter method. Rates of uterine hyper-stimulation were low in both the misoprostol and Foley catheter groups, and neonatal deaths did not differ significantly between groups; 17 serious adverse events (3%) were reported during the study, including two stillbirths (both in the Foley catheter group), eight neonatal deaths, and five cases of neonatal morbidity. The study was published on June 28, 2017, in The Lancet.

“As the number of women facing induction increases, and as new evidence from trials emerges, it has become urgent to address questions about which methods for inducing labor are the most effective, safe, and acceptable to women,” said senior author Professor Andrew Weeks, MD, of the University of Liverpool Institute of Translational Medicine (ITM). “In our analysis, the use of low dose oral misoprostol was found to be more effective and more acceptable to women than a transcervical Foley catheter for induction of labor.”

Misoprostol is commonly used for the prevention of NSAID-induced gastric ulcers by inhibiting the secretion of gastric acid by parietal cells. Misoprostol is also commonly used for labor induction by inducing uterine contractions and the ripening of the cervix. As such, it is also used either alone or in conjunction with other medications (such as methotrexate) for medical abortions, which are less invasive and more discreet than surgical abortions.

Related Links:
University of Liverpool
Government Medical College
Gynuity Health Care