Oral misoprostol alone, compared with oral misoprostol followed by oxytocin, in women induced for hypertension of pregnancy: A multicentre randomised trial.
| Title: | Oral misoprostol alone, compared with oral misoprostol followed by oxytocin, in women induced for hypertension of pregnancy: A multicentre randomised trial. |
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| Authors: | Mundle, Shuchita, Lightly, Kate, Durocher, Jill, Bracken, Hillary, Tadas, Moushmi, Parvekar, Seema, Shivkumar, Poonam Varma, Faragher, Brian, Easterling, Thomas, Leigh, Simon, Turner, Mark, Alfirevic, Zarko, Winikoff, Beverly, Weeks, Andrew D. |
| Source: | BJOG: An International Journal of Obstetrics & Gynaecology; Oct2024, Vol. 131 Issue 11, p1532-1544, 13p |
| Subject Terms: | FETAL monitoring, FETAL heart rate, HYPERTENSION in pregnancy, INDUCED labor (Obstetrics), NEONATAL death, UTERINE rupture, PREMATURE rupture of fetal membranes |
| Geographic Terms: | INDIA |
| Abstract: | Objective: To assess whether, in those requiring continuing uterine stimulation after cervical ripening with oral misoprostol and membrane rupture, augmentation with low‐dose oral misoprostol is superior to intravenous oxytocin. Design: Open‐label, superiority randomised trial. Setting: Government hospitals in India. Population: Women who were induced for hypertensive disease in pregnancy and had undergone cervical ripening with oral misoprostol, but required continuing stimulation after artificial membrane rupture. Methods: Participants received misoprostol (25 micrograms, orally, 2‐hourly) or titrated oxytocin through an infusion pump. All women had one‐to‐one care; fetal monitoring was conducted using a mixture of intermittent and continuous electronic fetal monitoring. Main outcome measures: Caesarean birth. Results: A total of 520 women were randomised and the baseline characteristics were comparable between the groups. The caesarean section rate was not reduced with the use of misoprostol (misoprostol, 84/260, 32.3%, vs oxytocin, 71/260, 27.3%; aOR 1.23; 95% CI 0.81–1.85; P = 0.33). The interval from randomisation to birth was somewhat longer with misoprostol (225 min, 207–244 min, vs 194 min, 179–210 min; aOR 1.137; 95% CI 1.023–1.264; P = 0.017). There were no cases of hyperstimulation in either arm. The rates of fetal heart rate abnormalities and maternal side effects were similar. Fewer babies in the misoprostol arm were admitted to the special care unit (10 vs 21 in the oxytocin group; aOR 0.463; 95% CI 0.203–1.058; P = 0.068) and there were no neonatal deaths in the misoprostol group, compared with three neonatal deaths in the oxytocin arm. Women's acceptability ratings were high in both study groups. Conclusions: Following cervical preparation with oral misoprostol and membrane rupture, the use of continuing oral misoprostol for augmentation did not significantly reduce caesarean rates, compared with the use of oxytocin. There were no hyperstimulation or significant adverse events in either arm of the trial. [ABSTRACT FROM AUTHOR] |
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| Database: | Complementary Index |
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| Items | – Name: Title Label: Title Group: Ti Data: Oral misoprostol alone, compared with oral misoprostol followed by oxytocin, in women induced for hypertension of pregnancy: A multicentre randomised trial. – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AR" term="%22Mundle%2C+Shuchita%22">Mundle, Shuchita</searchLink><br /><searchLink fieldCode="AR" term="%22Lightly%2C+Kate%22">Lightly, Kate</searchLink><br /><searchLink fieldCode="AR" term="%22Durocher%2C+Jill%22">Durocher, Jill</searchLink><br /><searchLink fieldCode="AR" term="%22Bracken%2C+Hillary%22">Bracken, Hillary</searchLink><br /><searchLink fieldCode="AR" term="%22Tadas%2C+Moushmi%22">Tadas, Moushmi</searchLink><br /><searchLink fieldCode="AR" term="%22Parvekar%2C+Seema%22">Parvekar, Seema</searchLink><br /><searchLink fieldCode="AR" term="%22Shivkumar%2C+Poonam+Varma%22">Shivkumar, Poonam Varma</searchLink><br /><searchLink fieldCode="AR" term="%22Faragher%2C+Brian%22">Faragher, Brian</searchLink><br /><searchLink fieldCode="AR" term="%22Easterling%2C+Thomas%22">Easterling, Thomas</searchLink><br /><searchLink fieldCode="AR" term="%22Leigh%2C+Simon%22">Leigh, Simon</searchLink><br /><searchLink fieldCode="AR" term="%22Turner%2C+Mark%22">Turner, Mark</searchLink><br /><searchLink fieldCode="AR" term="%22Alfirevic%2C+Zarko%22">Alfirevic, Zarko</searchLink><br /><searchLink fieldCode="AR" term="%22Winikoff%2C+Beverly%22">Winikoff, Beverly</searchLink><br /><searchLink fieldCode="AR" term="%22Weeks%2C+Andrew+D%2E%22">Weeks, Andrew D.</searchLink> – Name: TitleSource Label: Source Group: Src Data: BJOG: An International Journal of Obstetrics & Gynaecology; Oct2024, Vol. 131 Issue 11, p1532-1544, 13p – Name: Subject Label: Subject Terms Group: Su Data: <searchLink fieldCode="DE" term="%22FETAL+monitoring%22">FETAL monitoring</searchLink><br /><searchLink fieldCode="DE" term="%22FETAL+heart+rate%22">FETAL heart rate</searchLink><br /><searchLink fieldCode="DE" term="%22HYPERTENSION+in+pregnancy%22">HYPERTENSION in pregnancy</searchLink><br /><searchLink fieldCode="DE" term="%22INDUCED+labor+%28Obstetrics%29%22">INDUCED labor (Obstetrics)</searchLink><br /><searchLink fieldCode="DE" term="%22NEONATAL+death%22">NEONATAL death</searchLink><br /><searchLink fieldCode="DE" term="%22UTERINE+rupture%22">UTERINE rupture</searchLink><br /><searchLink fieldCode="DE" term="%22PREMATURE+rupture+of+fetal+membranes%22">PREMATURE rupture of fetal membranes</searchLink> – Name: SubjectGeographic Label: Geographic Terms Group: Su Data: <searchLink fieldCode="DE" term="%22INDIA%22">INDIA</searchLink> – Name: Abstract Label: Abstract Group: Ab Data: Objective: To assess whether, in those requiring continuing uterine stimulation after cervical ripening with oral misoprostol and membrane rupture, augmentation with low‐dose oral misoprostol is superior to intravenous oxytocin. Design: Open‐label, superiority randomised trial. Setting: Government hospitals in India. Population: Women who were induced for hypertensive disease in pregnancy and had undergone cervical ripening with oral misoprostol, but required continuing stimulation after artificial membrane rupture. Methods: Participants received misoprostol (25 micrograms, orally, 2‐hourly) or titrated oxytocin through an infusion pump. All women had one‐to‐one care; fetal monitoring was conducted using a mixture of intermittent and continuous electronic fetal monitoring. Main outcome measures: Caesarean birth. Results: A total of 520 women were randomised and the baseline characteristics were comparable between the groups. The caesarean section rate was not reduced with the use of misoprostol (misoprostol, 84/260, 32.3%, vs oxytocin, 71/260, 27.3%; aOR 1.23; 95% CI 0.81–1.85; P = 0.33). The interval from randomisation to birth was somewhat longer with misoprostol (225 min, 207–244 min, vs 194 min, 179–210 min; aOR 1.137; 95% CI 1.023–1.264; P = 0.017). There were no cases of hyperstimulation in either arm. The rates of fetal heart rate abnormalities and maternal side effects were similar. Fewer babies in the misoprostol arm were admitted to the special care unit (10 vs 21 in the oxytocin group; aOR 0.463; 95% CI 0.203–1.058; P = 0.068) and there were no neonatal deaths in the misoprostol group, compared with three neonatal deaths in the oxytocin arm. Women's acceptability ratings were high in both study groups. Conclusions: Following cervical preparation with oral misoprostol and membrane rupture, the use of continuing oral misoprostol for augmentation did not significantly reduce caesarean rates, compared with the use of oxytocin. There were no hyperstimulation or significant adverse events in either arm of the trial. [ABSTRACT FROM AUTHOR] – Name: Abstract Label: Group: Ab Data: <i>Copyright of BJOG: An International Journal of Obstetrics & Gynaecology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.) |
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| RecordInfo | BibRecord: BibEntity: Identifiers: – Type: doi Value: 10.1111/1471-0528.17839 Languages: – Code: eng Text: English PhysicalDescription: Pagination: PageCount: 13 StartPage: 1532 Subjects: – SubjectFull: INDIA Type: general – SubjectFull: FETAL monitoring Type: general – SubjectFull: FETAL heart rate Type: general – SubjectFull: HYPERTENSION in pregnancy Type: general – SubjectFull: INDUCED labor (Obstetrics) Type: general – SubjectFull: NEONATAL death Type: general – SubjectFull: UTERINE rupture Type: general – SubjectFull: PREMATURE rupture of fetal membranes Type: general Titles: – TitleFull: Oral misoprostol alone, compared with oral misoprostol followed by oxytocin, in women induced for hypertension of pregnancy: A multicentre randomised trial. Type: main BibRelationships: HasContributorRelationships: – PersonEntity: Name: NameFull: Mundle, Shuchita – PersonEntity: Name: NameFull: Lightly, Kate – PersonEntity: Name: NameFull: Durocher, Jill – PersonEntity: Name: NameFull: Bracken, Hillary – PersonEntity: Name: NameFull: Tadas, Moushmi – PersonEntity: Name: NameFull: Parvekar, Seema – PersonEntity: Name: NameFull: Shivkumar, Poonam Varma – PersonEntity: Name: NameFull: Faragher, Brian – PersonEntity: Name: NameFull: Easterling, Thomas – PersonEntity: Name: NameFull: Leigh, Simon – PersonEntity: Name: NameFull: Turner, Mark – PersonEntity: Name: NameFull: Alfirevic, Zarko – PersonEntity: Name: NameFull: Winikoff, Beverly – PersonEntity: Name: NameFull: Weeks, Andrew D. IsPartOfRelationships: – BibEntity: Dates: – D: 01 M: 10 Text: Oct2024 Type: published Y: 2024 Identifiers: – Type: issn-print Value: 14700328 Numbering: – Type: volume Value: 131 – Type: issue Value: 11 Titles: – TitleFull: BJOG: An International Journal of Obstetrics & Gynaecology Type: main |
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