Study of Saftey and Efficacy of Sublingual Versus Vaginal Misoprostol in Primigravida at Term Pregnancy with Poor Bishop’s Score

Introduction: The induction of labour in women with a live fetus at term remains a major challenge in modern obstetrics. Despite a large body of literature on the subject, the optimal agent for this purpose has yet to be established. Induction of labour implies stimulation of uterine contractions before the spontaneous onset of labour, with or without rupture of membranes. It is well recognized that the success of induction of labour which ultimately aims at achieving vaginal delivery, depends to a greater extent on the favourability of cervix, or its readiness to go into labour.

Misoprostol is inexpensive and effective and can be stored at room temperature. American College of Obstetrics and Gynecology [ACOG] supported its usage in 2009 for women who didn’t have previous ceserean delivery or a major uterine surgery. The National Institute for Health And Clinical Excellence [NICE] released a clinical guideline in 2008 in its support. Misoprostol costs less than dinoprostone gel and it does not need refridgeration.

Materials and Methods: This study was conducted in the department of Obstetrics and gynecology in Government Multispeciality Hospital, Chandigarh Sector 16 from may 2019 to august 2020.Patients admitted in the labour room for induction of labour were included in the study. Total 116 patients were enrolled and were given sublingual and vaginal misoprostol after dividing into two groups.

Results: Both groups were statistically similar in terms of age and period of gestation[p value 0.517].Maximum number of patients with post dated pregnancy were induced in both the groups with maximum patients with Bishop’s 3 and 4.37.8% of patients with sublingual [group A]misoprostol and 39.7% patients with per vaginal misoprostol[group B] required only one dose of misoprostol for vaginal delivery.48% patients in group A had vaginal delivery where as 70% patients in group B had vaginal delivery. The difference in duration of induction was not statistically significant. Adverse effect like meconium stained liquor, fetal distress, uterine hyperstimulation was more common in group B.

Conclusion: This study shows that sublingual misoprostol may be better in terms of rate of successful vaginal delivery, number of doses, augmentation requirement, duration of induction, incidence of meconium stained liquor and hyperstimulation syndrome.