Study of 2,200 elective inductions: tips on labor induction using oral misoprostol.(Obstetrics)

BIG SKY, MONT. -- Oral misoprostol is far and away the most cost effective labor induction method, Dr. Arthur S. Maslow asserted at a meeting on ob.gyn., gynecologic oncology, and reproductive endocrinology.

"The best part about it is that you can block-schedule your nurses so that you have enough on hand. With a 90% successful induction rate within 8-10 hours, if we start our inductions at 7 a.m., we know that we're going to have X number of patients in labor being admitted by 4 p.m. That's helped our hospital tremendously," said Dr. Maslow, director of maternal and fetal medicine at the Geisinger Health System in Danville, Pa.

Five randomized trials of oral misoprostol (Cytotec) have demonstrated that this off-label labor induction technique is as good as or better than other methods in terms of safety, cost, induction/delivery time, and neonatal and maternal outcomes.

This randomized trial experience has now been supplemented by a soon-to-be-published study by Dr. Maslow and coinvestigators involving 2,200 consecutive elective inductions using oral misoprostol. The inductions were conducted in a private-practice setting in an antepartum diagnostic center located within a hospital in Tacoma, Wash., where Dr. Maslow practiced before his recent move to Geisinger.

Ninety percent of treated patients were ready for artificial rupture of membranes or delivered within 8-10 hours.

"It's a great agent. It works very, very efficiently. It's very safe. We've had no complications, no uterine ruptures. And it's ungodly inexpensive: 27 cents per tablet. At the most we use two or three tablets," Dr. Maslow said at the meeting, sponsored by the Geisinger Health System.

Although intravaginal misoprostol for labor induction has its devotees, Dr. Maslow views the oral route as making "perfect sense." Plasma levels climb rapidly following oral ingestion, peaking at 1 hour and returning to baseline by 2-3 hours. In contrast, peak levels are lower with intravaginal misoprostol and remain elevated for 6 hours or more.