A COMPARATIVE STUDY OF THE EFFICACY AND SAFETY PROFILE OF SUBLINGUAL AND VAGINAL MISOPROSTOL FOR CERVICAL RIPENING AT TERM
BACKGROUND: In the course of pregnancy, Induction of labour (IOL) may become necessary to avert adverse obstetric outcomes. The success of IOL requires a favourable and where this is not so, the use of misoprostol has been shown to improve cervical ripening for IOL. However, the appropriate dosage and route for misoprostol administration for this purpose is not well understood in our clinical setting. This study compared the efficacy and safety of sublingual versus vaginal misoprostol for cervical ripening prior to IOL for term pregnancies. It has been found that women prefer to use misoprostol orally or sublingually, claiming that the oral route is more convenient and offers greater privacy. No studies have been carried out in our environment to compare the efficacy and safety of sublingual and vaginal misoprostol.
OBJECTIVE: To compare the outcome of events of labour using two different routes of administration of misoprostol (sublingual and vaginal) for cervical ripening at term.
DESIGN: This was a comparative interventional, open-labelled randomized study.
METHODOLOGY: In this study pregnant women who presented for induction of labour with unfavourable cervices (Bishop Score less than 6) were assigned randomly to vaginal misoprostol or sublingual misoprostol (25 μg tablets every 6 hours for a maximum of four doses). Seventy (70) pregnant women who met the inclusion criteria were randomly assigned to each group. The effectiveness and safety profile of the different routes were determined. Subjects were patients presenting at the labour ward of JUTH who met the set inclusion criteria. Data was analyzed using Statistical Package for Social Sciences (SPSS 20) and the level of significance was set at P value of less than 0.05.
RESULTS: Vaginal delivery rate of 92.9% and 100% were recorded in the vaginal and sublingual groups respectively. APGAR Scores, maternal side effects and intensive care unit admissions were comparable in both groups.
CONCLUSION: Compared to vaginal misoprostol, Sublingual misoprostol is associated with higher vaginal delivery rates, better perinatal outcome and fewer side effects.