Buccal Versus Vaginal Misoprostol Combined With Foley Cathet
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The BEGIN trial was an institutional review board-approved, randomized clinical trial comparing identical dosages (25?g) of buccal and vaginal misoprostol in combination with a foley. Randomization was stratified by parity. Labor management was standardized among participants. Individuals undergoing induction at ?37 weeks with a singleton gestation and needing cervical ripening were included. Our primary outcome was time to delivery. A sample size of 216 was planned to detect a 4-hour reduction in delivery time.

215 women (108 Buccal, 107 Vaginal) were randomized. Vaginal drug administration achieved a faster median time to delivery than the buccal route, (vaginal drug with foley: 19.7hrs vs. buccal drug with foley: 24.1hrs, p< 0.001). A greater percentage of women in the vaginal administration group delivered within 24hrs (65% versus 49%, p=0.02). There was no difference in the cesarean delivery rate between the two groups (vaginal drug with foley: 17% versus buccal drug with foley: 21%, p=0.6). Individuals receiving vaginal misoprostol delivered two times faster than women who received buccal drug with foley after censoring for Cesarean delivery and adjusting for parity,

We found that vaginal misoprostol was superior to buccal drug administration in combination with a foley catheter. Vaginal administration of misoprostol resulted in twice the chance of delivering before a similar dose of buccal misoprostol with no difference in cesarean delivery rates. Therefore, vaginal route of misoprostol administration should be preferred among individuals undergoing a combined pharmacologic and mechanical induction.

Read more : https://www.ajog.org/article/S0002-9378(21)00105-8/fulltext?rss=yes
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