Oral misoprostol versus intracervical prostaglandin E2 gel for active management of premature rupture of membranes at term

Abstract

Objective: To compare the efficacy and safety of oral misoprostol with intracervical prostaglandin E2 (PGE2) gel for the active management of premature rupture of membranes (PROM) at term.

Methods: Women with pregnancies between 37 and 42 weeks presenting with PROM at term and a Bishop score of 5 or less were randomly assigned to receive either a 4-hourly oral dose of 50 microg of misoprostol up to a maximum of 3 doses or 2 applications of intracervical PGE2 gel at a 6-hour interval. Oxytocin was given if labor had not started after 12 hours.

Results: Twenty women in the misoprostol group (n=31) delivered within 12 hours compared with 5 in the PGE2 group (n=30) (P<0.001). The induction-to-delivery interval in the misoprostol group was shorter than in the PGE2 gel group (615 min vs 1070 min; P<0.001). The mode of delivery was comparable between the 2 groups (P=0.821). Abnormalities in uterine contractions and neonatal outcomes were also comparable. The requirement for oxytocin was lower and patient satisfaction was better in the misoprostol group.

Conclusion: Oral misoprostol is a safe and efficacious alternative to intracervical PGE2 gel in the active management of PROM at term.