Comparison Between Vaginal and Sublingual Misoprostol 50 µg for Cervical Ripening Prior to Induction of Labor

Study Overview
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Brief Summary
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To analyze whether there is a statistically significant difference in the modifications present in the uterine cervix 6 hours after administration of misoprostol 50 µg through vaginal versus sublingual routes.

Detailed Description
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A randomized, single blind clinical trial, was performed. Inclusion criteria were all pregnant women admitted at Pereira Rossell Hospital Center with gestational ages between 32/0 and 41/6 according to first trimester sonogram, with a viable fetus in cephalic presentation, with estimated fetal weight lower than 4000 gr, without contraindications for vaginal birth, to whom induction of labor with misoprostol had been previously indicated, from 8 to 20 hours 7 days a week. Protocol counted with approval of the Ethics Commission of the Pereira Rossell Hospital. All participants gave written informed consent before the study began. Once there was confirmation that the patient met the inclusion criteria, information was given and consent form was signed, the patient entered the study and the intervention was randomized. Randomization was computer generated in permuted blocks of 2 by an epidemiologist from our Service, and the result was in a sealed and opaque envelope which was opened at the time of administering the medication. Prior to administration of the medication, an Obstetrician or Obstetrics resident who was not familiar with the administration route assigned to the patient assessed through vaginal examination the characteristics of the cervix in terms of Bishop score. Afterwards, a technician from the investigation team administered the misoprostol according to the assigned route (50 µg misoprostol vaginal or sublingual). Tachysystole was defined as the presence of at least 6 uterine contractions in 10 minutes. Primary result was defined as the clinically significant variation (of at least 2 points) of the Bishop score at 6 hours after administration of 50 µg misoprostol. Secondary results were defined as the presence of tachysystole, frequency of vaginal birth and cesarean section, frequency in which new doses were needed to continue with induction of labor and frequency with which labor was diagnosed at 6 hours of administration of misoprostol. Neonatal results included Apgar score at 1 and 5 minutes and pH value in umbilical cord gasometry. Final analysis was made according to intention to treat. In order to detect a difference in the mean of Bishop score of 2 points, using a standard deviation of 2, with a 90% power, reaching a confidence interval of 95%, a population of 49 patients was required for each group. Randomization was done in permuted blocks of 2, using a table of randomized numbers. Group 1 included those patients who received sublingual misoprostol and group 2 those patients who received vaginal misoprostol. Analysis was done in statistical package SPSS (reg) V16. For continuous variables a mean and standard deviation were described; for categorical variables absolute frequency and percentage were described. For statistical analysis a 2-tiled independent t-test was used, in order to compare the mean of the two groups. Also, chi-squared test and Fisher´s exact test were used to compare proportions among the two groups where it corresponds.

Official Title
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Comparison Between Vaginal and Sublingual Misoprostol 50 µg for Cervical Ripening Prior to Induction of Labor: Randomized Clinical Trial

Conditions
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Cervical Ripening

Intervention / Treatment
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* Drug: Sublingual misoprostol
* Drug: Vaginal misoprostol


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All pregnant women admitted at Pereira Rossell Hospital Center Gestational ages between 32/0 and 41/6 according to first trimester sonogram A viable fetus in cephalic presentation Estimated fetal weight lower than 4000 gr Without contraindications for vaginal birth Whom induction of labor with misoprostol had been previously indicated, from 8 to 20 hours 7 days a week. Exclusion Criteria: Does not meet inclusion criteria.
Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Misoprostol sublingual<br> | Drug: Sublingual misoprostol<br> <br> |
| Active Comparator: Misoprostol vaginal<br> | Drug: Vaginal misoprostol<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Bishop score at 6 hours after administration of misoprostol |  | 6 hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of participants with Tachysystole | Tachysystole was defined as the presence of at least 6 uterine contractions in 10 minutes. | 6 hours | 
| Number of patients who ended their pregnancy by caesarean section |  | From administration of misoprostol to birth, up to 3 days. | 
| Requirement of further doses of misoprostol |  | From administration of misoprostol to birth, up to 3 days. | 
| Labor within 6 hours |  | 6 hours | 
| Apgar score at 1 minute |  | At the first minute after delivery | 
| Apgar score at 5 minutes |  | At the fifth minute after delivery | 
| pH cord blood gas |  | At delivery | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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misoprostol, induction of labor, sublingual