J Med Assoc Thai 1997; 80 (3):189

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Comparison of Intracervical and Intravaginal Misoprostol for Cervical Ripening and Labour Induction in Patients with and Unfavourable Cervix
Srisomboon J Mail, Piyamongkol W , Aiewsakul P

Objective: To compare the efficacy of intracervical versus intravaginal misoprostol for cervical
ripening and labour induction at term in patients with an unfavourable
cervix.
Method: A total of 100 pregnant women with indications for induction of labour and unfavourable
cervix (Bishop score ≤ 4) were randomly assigned to receive either
100 ug misoprostol administered intracervically (50 cases) or intravaginally
(50 cases).
Results: No significant differences were noted between intracervical and intravaginal
misoprostol in terms of Bishop score change, (score 7.2 vs score 7.5), interval from
gel insertion to vaginal delivery (17.0 hours vs 16.4 hours), meperidine as analgesic
requirement (80% vs 76% ), route of delivery and perinatal outcome. Uterine
tachysystole occurred in 24 per cent and 32 per cent in the intracervical and intravaginal
groups respectively which did not significantly differ, however, all could
be rapidly resolved by terbutaline injection. No evidence of fetal distress was
noted in these events. Spillage of gel out of the cervix was observed in 70 per cent
of patients receiving intracervical misoprostol. Fever was observed in one
patient of each group. No other serious side effects were found in both groups.
One patient in the intravaginal group had postpartum hemorrhage due to delayed
placental separation and uterine atony.
Conclusion: The two routes of misoprostol gel application appear to be safe and equally
effective in ripening cervix and inducing labour, however, the intravaginal application
is more convenient to administer practically compared with the intracervical.

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