Oral Misoprostol alone versus oral misoprostol followed by o
Every year approximately 30,000 women die from the hypertensive disease in pregnancy. Magnesium sulfate and anti-hypertensives reduce morbidity, but delivery is the only cure. Low-dose oral misoprostol, a prostaglandin E1 analog, is a highly effective method for labor induction.

This pragmatic, open-label, randomized trial will compare a misoprostol alone labor induction protocol with the standard misoprostol plus oxytocin protocol in three Indian hospitals. The study will recruit 520 pregnant women being induced for hypertensive disease in pregnancy and requiring augmentation after membrane rupture.

Participants will be randomized to receive either further oral misoprostol 25mcg every 2 h or titrated intravenous oxytocin. The primary outcome will be cesarean birth. Secondary outcomes will assess the efficacy of the induction process, maternal and fetal/neonatal complications, and patient acceptability.

Avoiding oxytocin and continuing low-dose misoprostol into active labor may have a number of benefits for both women and the health care system. Misoprostol is heat stable, oral medication, and thus easy to store, transport, and administer; qualities particularly desirable in low resource settings. An oral medication protocol requires less equipment (e.g. electronic infusion pumps) and may free up health care providers to assist with other aspects of the woman’s care.

BMC Pregnancy and Childbirth
Source: https://doi.org/10.1186/s12884-021-04009-8