Comparison of vaginal and oral misoprostol, for the induction of labour in women with intra-uterine foetal death

Objective: To compare the efficacy of vaginal and oral misoprostol for the induction of labour in women with intra-uterine foetal death (IUFD). Design: A prospective randomised clinical trial, comparing 200μg oral and 200μg vaginal misoprostol, six hourly for a maximum of four doses for the induction of labour in women with IUFD. Setting: Ga-Rankuwa hospital (Department of Obstetrics and Gynaecology), Pretoria, South Africa. It is a tertiary institution serving predominantly black indigenous population. Main outcome measures: The primary outcome measure was the induction to delivery time, and secondary outcome measures were the number of patients requiring augmentation with oxytocin and all complications were noted. Results: Twenty women were randomised to the vaginal route and 18 to the oral route. The induction to delivery time was shorter with vaginal misoprostol (13.5 ± 8.3 hrs) compared to oral misoprostol (21.4 ± 13.9 hrs; p< 0.05). There was no significant difference in the amount of misoprostol needed to achieve successful induction in the two groups. More women (10/18) who received oral misoprostol required oxytocin augmentation to complete the induction of labour compared with 4/20 women in the vaginal group (p< 0.05; Odds Ratio 2.8; 95% CI 1.36-4.24). There were no cases of failed induction. The systemic side effects (shivering, diarrhoea, vomiting and pyrexia) were more common with oral misoprostol (44.5%) compared to vaginal misoprostol (20%). This difference gives an overall Odds Ratio of 2.2 at 95% CI of 1.6-2.8(p<0.05). Conclusion: Vaginal misoprostol achieved successful induction of labour in women with IUFD in a shorter time than oral misoprostol with significantly less side effects.