Comparison of the efficacy and safety of titrated oral misoprostol solution and conventional oral misoprostol tablet regimen for Induction of labor

Objective: To compare the efficacy and safety of titrated oral misoprostol solution (OMS) and conventional oral misoprostol tablet (OMT) regimen for induction of labor. Material and Methods: A cohort of two hundred pregnant women with term, singleton pregnancies with an indication for induction were included in the study. The study group (OMS) included hundred women who were allocated to receive 20 ml of oral misoprostol solution (1µg/ml) hourly maximum of 4 doses, then titrated to 40 ml (40µg) hourly maximum of 8 doses. In the control group (OMT) hundred women were induced with 50 µg of misoprostol tablet orally, 4 hourly maximum of 6 doses. The induction to delivery interval, requirement of oxytocin, dose of misoprostol used, mode of delivery, maternal and neonatal outcome were analyzed statistically. Results: The number of patients who delivered vaginally were more in study group i. e 81 (81%) patients as compared to control group i. e 73 (73%) patients and the difference was statistically significant (p value=0. 03). The number of patients who had meconium stained liquor with non reassuring fetal heart rate were significantly higher in control group (OMT) as compared with study group (OMS) 26 96% versus 1263% p value =0. 01. Whereas induction to delivery interval, proportion of patient delivered vaginally in 24 hours, need for oxytocin augmentation, maternal adverse reaction and neonatal outcome were not significantly different (p>0. 05). Conclusion: Titrated oral solution is as effective as conventional oral tablet of misoprostol for labor induction in term pregnant women and small doses at frequent intervals seem to be safer in terms of risk of meconium stained liquor with abnormal fetal heart rate and caesarean section. Keywords: Titrated misoprostol, Induction of labor, Cesarean section, Efficacy and safety