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A randomized comparison of Oral misoprostol versus Foley catheter and oxytocin for induction of labor at term
Mediana Sutopo LiedaprajaPPDS Tahap 1 AOBGYN FKUI - RSCM
OBJECTIVE:
Compare the efficacy and safety of oral misoprostol administered to patients with the efficacy and safety in a control group treated with a Foley catheter and oxytocin for induction of labor.
Control
STUDY DESIGN
200 patients
100 PatientsOral Misoprostol
(50mcg with 4 hours interval)*max dose 300mcg
100 Patients Cervical Foley
Catheter + Oxytocin *max 36mU/min
Inclusion Criterias:- Term pregnancy -Singleton live fetus -Cephalic presentation-Intact membrane-Bishop Score 5 or less-Not in Labor ( <3x contractions in 10 minutes)
Exclusion Criterias:- Nonreassuring FHR-Multiple Gestation-Previous SC or uterine surgery-Rupture membrane-Placenta previa-Genital herpes, asthma
Control
DISCUSSION
RCT Misoprostol as effective agents for cx ripening and labor induction
Main concern !!! Excessive uterine contractions
Primary outcome ( Delivery within 24 hours) lower in misoprostol group
Oral Misoprostol SIGNIFICANTLY less effective in nulliparous parturients
200mcg oral every 6 hours
UNACCEPTABLE high rate of
hyperstimulation syndrome
( 44.1%)
50 to 100 mcg at 2-3 hours interval
High Clinical Utility with
ACCEPTABLE rate of
hyperstimulation syndrome.
Oral misoprostol at the dose described is a reasonable alternative to oxytocin–Foley catheter for induction of labor, particularly
in multiparous patients.