Buccal Versus Vaginal Misoprostol for Term Induction of Labor: A Retrospective Effectiveness Cohort Study [26K]

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The objective of this study was to compare the efficacy of equivalent doses of buccal and vaginal misoprostol for induction of labor at term.


Pharmacy records of misoprostol route, dose and dosing interval were reviewed for a retrospective cohort of women undergoing term induction of labor for maternal or fetal indications. Time to delivery was calculated for each group and secondary outcomes including tachysystole rate, need for oxytocin, and mode of delivery were evaluated. A logistic regression analysis tested for the predictors of time to delivery.


A total of 207 women were included; 114 women in the vaginal group and 93 women in the buccal group. There was no difference in time to delivery (21.9 h buccal; 19.1 h vaginal, P=.198). Most women delivered vaginally in both groups (84.9% buccal; 82.5% vaginal). There were no differences in rates of tachysystole, fetal category III tracing, or chorioamnionitis. Adjusting for clinical cofactors, logistical regression showed that neither route of administration of misoprostol was associated with delivery in less than 24 hours. There was a correlation between BMI and failure to deliver within 24 hours of starting induction (aOR 0.94, 95% CI 0.90–0.98). Women who presented with premature rupture of membranes were more likely to receive buccal misoprostol (P<.001).


There is no difference in time to delivery in women receiving equivalent doses of misoprostol by buccal route compared to vaginal route for induction of labor.

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