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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Titrated low-dose vaginal and/or oral misoprostol to induce labour for prelabour membrane rupture: A randomised trial
BJOG: An International Journal of Obstetrics and Gynaecology, Volume 115, No. 12, Year 2008
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Description
Objective: To evaluate the clinical effectiveness and safety of titrated low-dose misoprostol for induction of labour (IOL) in the presence of prelabour rupture of membranes (PROM). Design: Randomised controlled trial. Setting: Maternity units in the UK (9) and Egypt (1). Population: Women >34 weeks of gestation with PROM, singleton viable fetus and no previous caesarean section. Methods: Subjects randomised to IOL with a titrated low-dose misoprostol regimen (oral except if unfavourable cervix, where initial dose vaginal) or a standard induction method, namely vaginal dinoprostone followed by intravenous oxytocin if the cervix was unfavourable or intravenous oxytocin alone if the cervix was favourable. Main outcome measures: Primary outcome measures were caesarean section and failure to achieve vaginal delivery within 24 hours. Analysis was by intention to treat. Results: The trial did not achieve the planned sample size of 1890 due to failure in obtaining external funding. Seven hundred and fifty-eight women were randomised (375 misoprostol and 383 standard). There were less caesarean section (14 versus 18%, relative risk [RR] 0.79; 95% CI 0.57-1.09) and less women who failed to achieve vaginal delivery within 24 hours in the misoprostol group (24 versus 31%, RR 0.79; 95% CI 0.63-1.00), but the differences were not statistically significant. Subgroup analysis showed that with unfavourable cervix, misoprostol may be more effective than vaginal dinoprostone. There was no difference in hyperstimulation syndrome. There were more maternal adverse effects with misoprostol, but no significant differences in maternal and neonatal complications. Conclusions: Titrated low-dose misoprostol may be a reasonable alternative for IOL in the presence of PROM, particularly in women with an unfavourable cervix. Safety and rare serious adverse events could not be evaluated in a trial of this size. © 2008 Authors.
Authors & Co-Authors
Bricker, Leanne
United Kingdom, Liverpool
Liverpool Women's Nhs Foundation Trust
Peden, H.
United Kingdom, Liverpool
Liverpool Women's Nhs Foundation Trust
Tomlinson, A. J.
United Kingdom, Bolton
Royal Bolton Hospital
Al-Hussaini, Tarek Khalaf
Egypt, Asyut
Assiut University
Idama, T.
United Kingdom, Prescot
Whiston Hospital
Candelier, C.
United Kingdom, Stockport
Stepping Hill Hospital
Luckas, M.
United Kingdom, Crewe
Leighton Hospital
Furniss, H.
United Kingdom, Warrington
Warrington Hospital
Davies, A.
United Kingdom, Preston
Royal Preston Hospital
Kumar, B.
United Kingdom, Bangor
Ysbyty Gwynedd
Roberts, J.
United Kingdom, Glasgow
Queen Mother's Hospital
Alfirevic, Zarko
United Kingdom, Liverpool
University of Liverpool
Statistics
Citations: 27
Authors: 12
Affiliations: 11
Identifiers
Doi:
10.1111/j.1471-0528.2008.01890.x
ISSN:
14700328
e-ISSN:
14710528
Research Areas
Health System And Policy
Maternal And Child Health
Study Design
Randomised Control Trial
Cross Sectional Study
Study Locations
Egypt
Participants Gender
Female