Comparison of Intracervical and Intravaginal Misoprostol for Cervical Ripening and Labour Induction in Patients with an Unfavourable Cervix
JATUPOL SRISOMBOON, M.D.*, WIRA WIT PlY AMONGKOL, M.D.*, PIPOP AIEWSAKUL, M.D.*
Affiliation : * Division of Maternal & Fetal Medicine, Department of Obstetrics & Gynaecology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.
Objective: To compare the efficacy of intracervical versus intravaginal misoprostol for cer- vical ripening and labour induction at term in patients with an unfavourable cervix. Method: A total of 100 pregnant women with indications for induction of labour and un- favourable cervix (Bishop score ~ 4) were randomly assigned to receive either 100 ug misoprostol administered intracervically (50 cases) or intravaginally (50 cases). Results: No significant differences were noted between intracervical and intravaginal misoprostol in terms of Bishop score change, (score 7.2 vs score 7.5), interval from gel insertion to vaginal delivery (17.0 hours vs 16.4 hours), meperidine as analge- sic requirement (80% vs 76% ), route of delivery and perinatal outcome. Uterine tachysystole occurred in 24 per cent and 32 per cent in the intracervical and intra- vaginal groups respectively which did not significantly differ, however, all could be rapidly resolved by terbutaline injection. No evidence of fetal distress was noted in these events. Spillage of gel out of the cervix was observed in 70 per cent of patients receiving intracervical misoprostol. Fever was observed in one patient of each group. No other serious side effects were found in both groups. One patient in the intravaginal group had postpartum hemorrhage due to delayed placental separation and uterine atony. Conclusion: The two routes of misoprostol gel application appear to be safe and equally effective in ripening cervix and inducing labour, however, the intravaginal appli- cation is more convenient to administer practically compared with the intra- cervical.
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