The time to delivery is similar among patients with obesity taking 50 μg of vaginal misoprostol vs 25 μg of misoprostol, according to a recent study in the American Journal of Obstetrics & Gynecology.1
Takeaways
- Obese patients undergoing induction of labor showed similar time to delivery whether they received 50 μg or 25 μg of vaginal misoprostol, as per a recent study.
- Among multiparous patients, those receiving the higher misoprostol dosage experienced faster delivery times compared to the lower dosage group.
- Patients with a body mass index (BMI) of 40 kg/m2 or higher had a nonsignificant increase in time to delivery compared to those with a BMI of 30 to 39 kg/m2.
- Use of cervical ripening balloon did not significantly affect the time from induction to delivery in obese patients undergoing labor induction.
- Researchers suggest further investigation into the potential benefits of utilizing a higher misoprostol dosage in multiparous obese patients undergoing labor induction.
Approximately 29% of pregnancies are impacted by obesity, defined as a body mass index (BMI) over 30 kg/m2. Adverse pregnancy outcomes associated with obesity include growth abnormalities, diabetes, and pregestational and gestational hypertensive disorders.
Additional risks of obesity include cardiovascular events.2 Hypertensive disorders of pregnancy have been linked to risk factors such as systolic blood pressure and total cholesterol levels, indicating a need for early pregnancy interventions.
Obesity may also lead to a prolonged first stage of labor, increasing risks of cesarean delivery, operative delivery, maternal hemorrhage, and chorioamnionitis.1 Currently, guidelines about cervical ripening regimens do not have specific recommendations for patients with obesity.
Misoprostol is currently used in cervical ripening regimens, and a 25 μg dose is often recommended, with a 50 μg dose employed in certain clinical situations. However, patients with obesity may require an increased dosage.
To evaluate the impact of a 50 μg misoprostol dosage vs a 25 μg dosage on time from induction start to delivery in patients with obesity, investigators conducted a double-blinded, pragmatic randomized controlled trial. Patients aged 18 years and older admitted to the Ascension Seton Medical Center for induction of labor were included in the analysis.
Additional inclusion criteria included near-term singleton gestation, BMI over 30 kg/m2, and cervical dilation of 3 cm or less with an intent to undergo cervical ripening. Exclusion criteria included contraindication to vaginal delivery or misoprostol, fetal demise, major fetal anomaly, and fetal growth restriction under the fifth percentile.
Participants were randomized 1:1 to receive either 50 μg or 25 μg vaginal misoprostol, considered the intervention and control, respectively. Misoprostol was administered every 4 hours for up to 24 hours. The patient’s provider determined when cervical ripening and labor management was needed following the initial misoprostol insertion.
The time to delivery, measured as the time from initiation of induction to delivery, was reported as the primary outcome of the analysis. Secondary outcomes included time to vaginal delivery, time to activate labor, cesarean delivery, delivery within 24 hours, delivery within 12 hours, and indication for cesarean delivery.
