A randomised comparison of patient satisfaction with vaginal and sublingual misoprostol for induction of labour at term

Abstract

Objective: To compare patient satisfaction with two routes of misoprostol for term labour induction.

Design: Prospective randomised trial.

Setting: Tertiary care hospital.

Population: A total of 170 women admitted at > or = 37 weeks of gestation for induction of labour.

Methods: Women were randomised to receive 50 micrograms of either sublingual or vaginal misoprostol.

Main outcome measures: Patient satisfaction with the route of administration.

Results: Despite a similar proportion reporting the labour induction as more painful than expected in both groups, a significantly lower proportion mentioned that the pelvic examinations were very painful in the sublingual group (19.7 versus 36.1%, relative risk [RR] 0.5, 95% CI 0.3-0.9). Request for analgesia was similar in both groups. More women in the sublingual group thought that the labour experience was better than expected (RR 2.0, 95% CI 1.2-3.3), had a positive attitude towards induction in subsequent pregnancies (RR 1.6, 95% CI 1.1-2.3) and preferred the same route in subsequent pregnancies (RR 3.1, 95% CI 2.2-4.5). Mean number of misoprostol doses, oxytocin augmentation, tachysystole and hyperstimulation, induction to vaginal delivery interval, vaginal delivery after a single dose, vaginal birth within 12 and 24 hours, and caesarean delivery rates were similar in both groups.

Conclusion: Sublingual misoprostol (50 micrograms) is associated with a significantly higher patient satisfaction rate compared with a similar dose of vaginal misoprostol. Sublingual administration offers additional choice to women, in particular those wishing to avoid vaginal administration.