Extraamniotic versus vaginal misoprostol for ripening the unfavorable cervix

Abstract EN

Objective : To compare the efficacy of two different routes of administration of misoprostol for ripening the unfavorable cervix.

Setting : Labor room in Basra Maternity (teaching) Hospital with 400 bed capacity.

Design : A prospective comparative study was conducted to compare two different routes of administration of misoprostol ( Cytotec) for ripening the unfavorable cervix.

Group I (Vaginal misoprostol) : The cervix was ripped using a 2cc of misoprostol solution (25μg) installed into the upper vagina.

Group II (Extramniotic misoprostol) : The cervix was ripped using a Foley`s catheter, which was inserted into the extraamniotic space & 2cc misoprostol solution (25 μg) was infused through the catheter into the extraamniotic space.

Results : The clinical trial involved a total of 180 pregnant women, in method I (92), & method II (98), the success rates in achieving cervical ripening were 100 % for both groups.

The ripening times in group II (primigravidae (6.05 ± 2.25), multiparae (3.97 ± 1.1)) were significantly shorter than those in group I (primigravidae (10.3 ± 1.3), multiparae (9.22 ± 1.32).

The induction delivery times were a slightly different in both groups in primigravidae ; where as it was significantly shorter in multgravidae in group II.

The vast majority of the women (100 % in group I & 97 % in group II) had vaginal delivery.

Conclusions : This study confirms that vaginal and extra-amniotic misoprostol (which was evaluated for first time in this study) were effective in achieving cervical ripening but we recommend the use of vaginal misoprostol in stead of extraamniotic misoprostol because although it takes a longer priming time, it achieves a higher post ripening score, it is easily administered and do not requires special method for application as in the extraamniotic one.

We also recommend that extraamniotic misoprostol is reserved for use in patient in whom quick cervical ripening is indicated.