Efficacy of oral and vaginal misoprostol for pre-induction cervical ripening in term primigravida undergoing induction of labor: a prospective study

Background: Induction of labor, traditionally used for fetal demise, now utilizes various mechanical and pharmacological methods like Misoprostol for cervical ripening, crucial for successful induction. This study compares oral and vaginal Misoprostol (25µg) for pre-induction cervical ripening at term, evaluating their efficacy, safety, and associated maternal and neonatal outcomes. Methods: This study assesses and compares the effectiveness of oral and vaginal misoprostol for pre-induction cervical ripening in full-term primigravida women undergoing labor induction. It primarily evaluates the improvement in the Modified Bishop's score, aiming for a score above 6, and secondarily examines induction-to-delivery interval and required misoprostol dosage. Conducted at tertiary care in Pune, this prospective comparative observational study spans from August 2021 to July 2022. Eligible women, divided into two groups based on the obstetrician's preference, receive either oral or vaginal misoprostol, with labor management and outcomes closely monitored and analyzed using IBM SPSS Statistics 26.0. Results: Both oral and vaginal Misoprostol groups, comprising exclusively primigravida patients, had similar mean gestational ages and induction to delivery intervals (21 hours). The oral group achieved a favourable Bishop score (>6) faster (8 hours) than the vaginal group (12 hours), despite requiring more frequent dosing, and both groups showed comparable modes of delivery and indications for Caesarean sections. Conclusion: This study found oral and vaginal Misoprostol equally effective for preinduction cervical ripening, with both showing similar delivery times and modes, despite more frequent dosing in the oral group.