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A dose-finding study of oral misoprostol for labor augmentation

Published:March 07, 2011DOI:https://doi.org/10.1016/j.ajog.2011.02.064

      Objective

      We designed a dose-finding trial of oral misoprostol administered for labor augmentation.

      Study Design

      Healthy, nulliparous women in active labor and diagnosed with arrest of dilation were enrolled in cohorts of 10 at a time. Five regimens were studied: (1) 25 μg every 4 hours, (2) 50 μg every 4 hours, (3) 100 μg every 4 hours, (4) 50 μg every 2 hours, and (5) 75 μg every 4 hours.

      Results

      A total of 46 women were enrolled. Baseline uterine activity approximately doubled with 4 of the regimens and tripled with the highest dosage regimen (100 μg) (P < .001). The 100-μg regimen was truncated due to excessive uterine hyperstimulation (40%).

      Conclusion

      An oral dose of 75 μg of misoprostol given at a 4-hour interval for a maximum of 2 doses is the highest tolerated dose. Randomized, controlled trials will be required before a regimen is employed routinely.

      Key words

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      References

        • Martin J.A.
        • Menacker F.
        Expanded health data from the new birth certificate, 2004.
        Natl Vital Stat Rep. 2007; 55: 1-22
        • American College of Obstetricians and Gynecologists
        ACOG practice bulletin no. 10: induction of labor.
        ACOG, Washington, DC1999
        • American College of Obstetricians and Gynecologists
        ACOG practice bulletin no. 49: dystocia and augmentation of labor.
        ACOG, Washington, DC2003
        • Alfirevic Z.
        • Weeks A.
        Oral misoprostol for induction of labor.
        Cochrane Database Syst Rev. 2006; 2 (CD001338)
        • Lo J.Y.
        • Alexander J.A.
        • McIntire D.D.
        • Leveno K.J.
        Ruptured membranes at term: a randomized, double-blind trial of oral misoprostol for labor induction.
        Obstet Gynecol. 2003; 101: 685-689
        • Tang O.S.
        • Gemzell-Danielsson K.
        • Ho P.C.
        Misoprostol: pharmacokinetic profiles, effects on the uterus and side-effects.
        Int J Gynaecol Obstet. 2007; 99: S160-S167
        • Department of Health and Human Services Food and Drug Administration Center for Drug Evaluation and Research
        US Food and Drug Administration: Center for Drug Evaluation and Research Handbook.
        (Revised March 16, 1998) (Accessed May 1, 2009)
        • Piantadosi S.
        Clinical trials: a methodologic perspective.
        2nd ed. Wiley-Interscience, New York, NY2005
        • Satin A.J.
        • Leveno K.J.
        • Sheman M.L.
        • McIntire D.
        High-dose oxytocin: 20- versus 40-minute dosage interval.
        Obstet Gynecol. 1994; 83: 234-238
        • Hofmeyr G.J.
        • Alfirevic Z.
        • Matonhodze B.
        • Brocklehurst P.
        • Campbell E.
        • Nikodem V.C.
        Titrated oral misoprostol solution for induction of labor: a multi-center, randomized trial.
        BJOG. 2001; 108: 952-959
        • Cheng S.
        Efficacy and safety study of titrated oral misoprostol solution for labor augmentation.
        (Accessed May 1, 2009)