INDUCTION OF LABOUR

Determine the efficacy and safety of stepwise oral misoprostol with vaginal misoprostol for cervical ripening forinduction of labour. Study design: Interventional Quasi - Experimental study. Setting and duration: The study was of 15 months (April to 30June) duration conducted at Obstetrics and Gynaecology department Military Hospital Rawalpindi. Subjects and methods: 100 femalesbetween 37-42 weeks of gestation were randomly divided into two groups 1and 2. Patients in group -1 assigned to the stepwise oralmisoprostol arm received 50 μg initially followed by 100 μg every 04 hours upto maximum 04 doses ; group-2 assigned to the vaginalmisoprostol arm received 25 μg every 04 hours up to maximum 04 doses. Subsequent doses of misoprostol were withheld if adequate uterineactivity (≥3 contractions in 10 minutes) or a Bishop score ≥ 8 had been achieved, or active labour had begun. The main outcomes were theinterval from first misoprostol dose to delivery and mode of delivery. Patients were also monitored for adverse events. Results: There was nodifference in the average interval from the first dose of misoprostol to delivery in the oral (21.1 ± 7.9 hrs) and vaginal (21.5 ±11.0 hrs, p = NS)misoprostol groups. 9 patients in the oral group (18%) and 16 patients in the vaginal group (32%) underwent caesarean section (p<0.05). Therewere no significant differences in the occurrence of tachysystole, hypertonus, hyperstimulation or neonatal outcome between two groups.Conclusions: Oral misoprostol appears to be as effective as vaginal misoprostol for cervical ripening with a low incidence of hyperstimulation,no increase in side effects, and is associated with a lower cesarean section rate.