What is the optimal duration of oral misoprostol treatment for cervical ripening?
- Drakopoulos P a Department of Obstetrics and Gynecology , Faculty of Medicine, Geneva University Hospitals , Geneva , Switzerland.
- Duyck C a Department of Obstetrics and Gynecology , Faculty of Medicine, Geneva University Hospitals , Geneva , Switzerland.
- Gayet-Ageron A c Department of Community Health and Medicine , Clinical Research Center and Division of Clinical Epidemiology, Geneva University Hospitals, University of Geneva , Geneva , Switzerland.
- Fernandez S a Department of Obstetrics and Gynecology , Faculty of Medicine, Geneva University Hospitals , Geneva , Switzerland.
- Irion O a Department of Obstetrics and Gynecology , Faculty of Medicine, Geneva University Hospitals , Geneva , Switzerland.
- Martinez de Tejada B a Department of Obstetrics and Gynecology , Faculty of Medicine, Geneva University Hospitals , Geneva , Switzerland.
- 2016-08-06
Published in:
- The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians. - 2017
Oral misoprostol
cervical ripening
dosing
duration
induction of labor
Administration, Oral
Adult
Cervical Ripening
Delivery, Obstetric
Drug Administration Schedule
Female
Humans
Labor, Induced
Misoprostol
Oxytocics
Pregnancy
Proportional Hazards Models
Retrospective Studies
Time Factors
English
OBJECTIVES
To evaluate the number of misoprostol tablets needed to obtain a Bishop score (BS) ≥ 6 or a significant cervical change (≥2 points in BS) during cervical ripening.
METHODS
Retrospective study of women with term singleton pregnancies and a BS < 6 taking oral misoprostol (20 μg first 2 doses followed by 40 μg every 2 h) for cervical ripening.
RESULTS
We included 400 women, 72% nulliparous, mean age of 31.3 ± 5.9 years and 70% with a baseline BS ≤ 2. During cervical ripening, 61 (15.3%) achieved a BS ≥ 6 and 205 (51.3%) a significant change in BS. The incremental risk to achieve a BS ≥ 6 after 4 tablets was low (+3.25%) with an incremental probability of +12.75% for painful uterine contractions and +0.5% for abnormal fetal tracing (AFT). The incremental probability to achieve a significant change in BS after 7 tablets was low (+2.0%). 24.3% women delivered by cesarean section which likelihood significantly increased with maternal age <35 years, BMI ≥ 30, nulliparity, AFT, and baseline BS ≤ 2.
CONCLUSIONS
The marginal benefit of giving more than 7 misoprostol tablets (14 h) during cervical ripening is very low.
To evaluate the number of misoprostol tablets needed to obtain a Bishop score (BS) ≥ 6 or a significant cervical change (≥2 points in BS) during cervical ripening.
METHODS
Retrospective study of women with term singleton pregnancies and a BS < 6 taking oral misoprostol (20 μg first 2 doses followed by 40 μg every 2 h) for cervical ripening.
RESULTS
We included 400 women, 72% nulliparous, mean age of 31.3 ± 5.9 years and 70% with a baseline BS ≤ 2. During cervical ripening, 61 (15.3%) achieved a BS ≥ 6 and 205 (51.3%) a significant change in BS. The incremental risk to achieve a BS ≥ 6 after 4 tablets was low (+3.25%) with an incremental probability of +12.75% for painful uterine contractions and +0.5% for abnormal fetal tracing (AFT). The incremental probability to achieve a significant change in BS after 7 tablets was low (+2.0%). 24.3% women delivered by cesarean section which likelihood significantly increased with maternal age <35 years, BMI ≥ 30, nulliparity, AFT, and baseline BS ≤ 2.
CONCLUSIONS
The marginal benefit of giving more than 7 misoprostol tablets (14 h) during cervical ripening is very low.
- Language
-
- English
- Open access status
- green
- Identifiers
-
- DOI 10.1080/14767058.2016.1220520
- PMID 27493019
- Persistent URL
- https://sonar.ch/global/documents/194312
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