What is the optimal duration of oral misoprostol treatment for cervical ripening?. (18th June 2017)

• Record Type: Journal Article
• Authors: Drakopoulos, Panagiotis; Duyck, Céline; Gayet-Ageron, Angèle; Fernandez, Sonia; Irion, Olivier; Martinez de Tejada, Begoña
• Is Part Of: Journal of maternal-fetal & neonatal medicine. Volume 30:Number 12(2017)
• Page Start: 1494
• Page End: 1499
• Publication Date: 2017-06-18
• Subjects: Oral misoprostol -- dosing -- duration -- induction of labor -- cervical ripening; Obstetrics -- Periodicals; Perinatology -- Periodicals; Infants (Newborn) -- Diseases -- Periodicals; Neonatology -- Periodicals; 618.2
• DOI: 10.1080/14767058.2016.1220520
• Languages: English
• ISSNs: 1476-7058

Abstract

Abstract: 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.