Oral Misoprostol for Labor Induction Is a Good Substitute for Costlier Vaginal Insert

When inducing labor, hourly titrated oral misoprostol is an effective substitute for dinoprostone vaginal insert, according to the results of a small randomized study published in the American Journal of Obstetrics & Gynecology. 

Pertinent Points

- When inducing labor, hourly titrated oral misoprostol is an effective substitute for dinoprostone
10-mg vaginal insert.

- Compared with two-hour dosing of oral misoprostol, hourly dosing may provide a more steady-state drug level within the range of therapeutic efficacy.

Hourly titration could be superior to two-hour dosing, the authors noted, suggesting that hourly doses provided a steadier drug level within the zone of therapeutic efficacy. Using hourly doses of oral misoprostol may translate to improved clinical outcomes, the authors noted.

The authors also suggested that oral misoprostol would provide a cost savings if used as a substitute to the more costly dinoprostone vaginal insert.

Still, the authors said the results merely “approached statistical significance” and emphasized that more studies of oral misoprostol for labor induction are needed to determine the best regimen for clinical use.

The 160-person, open-label study randomized half the women to receive hourly titrated oral misoprostol and half the women to receive the dinoprostone 10-mg vaginal insert. For the misoprostol group, women received 20 µg hourly for 2 doses and, if needed, increased to 30 µg hourly for 3 doses and then 40 µg for 1 dose, 50 µg for 1 dose, and 60 µg hourly for 4 doses. An additional hour of observation was given to all patients before the 40 and 50 µg doses, explained the study authors.

Vaginal delivery occurred within 24 hours for 100 of the patients, including 44 in the dinoprostone group and 56 in the oral misoprostol group. The oral misoprostol group had a P value of 0.05, with a 95% confidence interval of 0.99 to 2.27.

The frequency of maternal adverse events was similar for both groups, the authors reported.