米索前列醇阴道后穹窿给药用于足月妊娠引产90例临床分析

目的：探讨小剂量米索前列醇（米索）用于足月妊娠引产的有效性和完全性。方法：A组90例根据宫颈Bishop评分阴道后穹窿首次置米索25－50μg,观察宫缩情况，若无规律宫缩则每3小时置药一次（25μg），直至出现规律宫缩，总量不超过200μg；B组90例，静滴催产素引产作为对照组。结果：两组引产成功率分别为87．78％和80．00％（P＞0．05）。A组从开始用药至临产时间较B组明显缩短（P＜0．05）。初产妇宫颈评分≤5分者，A组引产成功率高于B组（P＜0．05），两组剖宫产率，产时出血量及新生儿窒息的发生率均无显著性。结论：小剂量重复阴道后穹窿给米索用于足月妊娠引产，是一种安全、有效的方法。     

两种剂量米索前列醇用于晚期妊娠引产的比较

米索前列醇（Ｍｉｓｏｐｒｏｓｔｏｌ）用于晚期妊娠引产成功率高,但易发生子宫收缩过频、过强而致胎儿宫内窘迫及急产。为探索米索前列醇用于晚期妊娠引产最安全的有效剂量,本研究设计了２５μｇ与５０μｇ米索前列醇用于晚期妊娠引产的对照研究。一、资料及方法１．对象选择１９９６年３月至１９９８年８月在本院住院的单胎、头位、足月妊娠的初产妇１２２例,均无妊娠合并症及并发症,无阴道分娩及前列腺素禁忌症。受试者随机分成２５μｇ米索前列醇组（第Ⅰ组）６３例及５０μｇ米索前列醇组（第Ⅱ组）５９例。两组孕妇的年龄、孕次、…     

米索前列醇用于晚期妊娠引产效果观察

目的：探讨米索前列醇用于晚期妊娠引产的安全性及效果。方法：对９０ 例妊娠３３ ～４３ 周有引产指征的初产妇,随机分成两组,米索前列醇组（４６ 例） 、对照组（４４ 例） , 分别用米索前列醇５０ μｇ 阴道后穹窿用药引产及用催产素引产。结果：米索前列醇组晚期妊娠引产的有效率为９５ ．６５ ％ ,显著高于对照组的８１ ．８２ ％ （ Ｐ＜ ０ ．０５） , 两组宫颈评分提高程度比较差异有非常显著性意义（ Ｐ＜ ０ ．０１） 。米索前列醇组引产时间、总产程显著短于对照组（ Ｐ ＜ ０ ．０５） 。两组新生儿情况比较无显著性差异（ Ｐ ＞ ０ ．０５） 。结论：阴道后穹窿放置米索前列醇用于晚期妊娠引产能促宫颈成熟及发动子宫收缩,是一种方便、有效、较安全的引产方法。     

米索前列醇舌下含服用于足月妊娠引产的安全性分析

目的探讨米索前列醇用于足月妊娠引产的安全性.方法回顾性分析了216例使用米索前列醇引产和200例使用缩宫素引产的足月妊娠产妇的临床资料.结果米索组产程中出现不协调宫缩63例,占29.2%,过频宫缩43例,占19.9%,而缩宫素未出现异常宫缩.两组羊水混浊发生率分别为21.8%和14.5%,P＜0.01,差异有显著性.两组CST(+)发生率分别为12.0%和6.0%,P＜0.05,差异有显著性.剖宫产原因中,胎儿宫内窘迫均为两组主要手术指征,米索组30例,占78.9%,缩宫素17例,占54.8%,P＜0.05,差异有显著性,提示米索前列醇用于足月妊娠引产,对母亲和胎儿有潜在的不安全因素存在.     

米索前列醇用于足月妊娠引产剂量分析

近年来 ,有不少报道米索前列醇用于足月妊娠引产的临床分析 ,而剂量各家报道不一。为了探讨米索前列醇用于足月妊娠引产最适宜剂量 ,我们对 68例足月妊娠孕妇采用阴道置米索前列醇引产 ,剂量分别为 2 5 μｇ或 5 0 μｇ ,观察其临床效果 ,现总结如下。1　资料与方法1 1　一般资料　我院于 1998年 10月至 1999年 8月间 ,对因各种原因需行引产的单胎头位的足月孕妇共 68例 ,经阴道检查排除产道异常 ,无明显头盆不称 ,无米索前列醇禁忌证者随机分两组 :Ⅰ组 3 3例 (初产妇 3 0例 ,经产妇 3例 )阴道置米索前列醇 2 5 μｇ ;Ⅱ组 3 5例 (初产妇 3…     

米索前列醇用于足月妊娠引产不同给药途径的临床观察

目的为了观察米索前列醇(Misoprostol,米索)用于足月妊娠引产不同给药途径(舌下含服及阴道后穹窿给药)的临床效果.方法选择有引产指征,无引产及米索使用禁忌症的单胎、头位的足月妊娠妇女72例,随机分为A组(舌下含服组)、B组(阴道后穹窿组),分别用米索50μg舌下含服及阴道后穹窿给药,间隔4～6h重复给药,24h内最大剂量为200μg.结果两组的引产成功率分别为95%和93.7%.首次用药至规律宫缩开始时间分别为3.82±1.21h和3.45±1.42h,首次用药至胎儿娩出时间分别为8.60±4.42和8.82±4.87h.两组比较,差异无显著性(P＞0.05).但产后白细胞总数升高B组明显高于A组(P＜0.05).结论采用米索前列醇50μg含服给药法引产,方法更为简便、易行,更为安全有效.     

米非司酮配伍米索前列醇足月妊娠引产对胎盘及母婴血生化的影响

目的 :了解小剂量米非司酮配伍小剂量米索前列醇用于足月妊娠引产时胎盘形态、功能及母婴血生化的变化。方法 :将 80例妊娠期无明显并发症及合并症 ,因孕期延长而引产的初产妇随机分成两组 ,A组 36例 ,口服米非司酮 10 0mg ,36h后将米索前列醇 50 μg置于阴道后穹窿 ,间隔 3h如无宫缩再置 ,2 4h内使用米索前列醇不超过 3次 ;B组4 4例单用米索前列醇引产 ,用法同上 ;C组配对 4 0例自然临产者。 3组临产后均取母血检测胎盘功能 ;分娩后取母血及脐血测定肝、肾功能及皮质醇 ;取胎盘行形态学检查并进行定量分析。结果 :A组需用米索前列醇的次数较B组明显减少。 3组产妇肝、肾功能及胎盘功能均正常 ,皮质醇组间无明显差异 ,脐血T -BI增高但组间无明显差异。胎盘绒毛合体细胞结节、纤维素样坏死、血管合体细胞膜形成的发生率 ,3组间无明显差异。结论 :未发现足月孕妇口服米非司酮 10 0mg配伍小剂量米索前列醇引产对胎盘形态及功能产生影响 ,亦未发现母婴血生化指标因此而改变     

米索前列醇引产在早期重度妊高征中的应用

目的观察米索前列醇用于早期发生的重度妊高征终止妊娠的安全性和可行性.方法选择伴有各种严重并发症且发病较早,需要终止妊娠的重度妊高征8例(孕周26～32+5),同期正常足月需引产者13例为对照组.米索前列醇50μg阴道给药,依据宫缩情况3～4h重复给药.监测血压、心率、体温、诱发宫缩时间、用药至临产时间及产程.结果两组用药前后血压、心率、体温变化均无统计学差异(P＞0.05),两组均荻引产成功,妊高征组用药总量及给药次数明显高于对照组(P＜0.001),但临床经过平稳,无副反应.结论米索前列醇用于早期重度妊高征的终止妊娠,尤其是对不期待活产的病例,具有一定的安全性和可行性.     

胎膜早破孕妇直肠内应用米索前列醇促宫颈成熟和引产的临床观察

目的探讨胎膜早破孕妇直肠内应用米索前列醇促宫颈成熟和引产的临床效果及可行性.方法选择足月妊娠、胎膜早破、宫颈Bishop评分≤6分的孕妇共85例,分成I组44人;Ⅱ组41人,分别口服和直肠内应用米索前列醇50μg,每3h一次.观察用药到临产的时间、产程进展、分娩结局及副反应的发生等情况.结果首次用药到规律宫缩的时间I组明显短于Ⅱ组(P＜0.01).宫缩过强致胎儿窘迫的例数Ⅰ组明显多于Ⅱ组.其余指标两组无显著差异.结论与口服用药相比,直肠内应用米索前列醇具有药效稳定、持续时间长、副反应少的优越性.对胎膜早破的孕妇可用其代替阴道局部用药.     

晚期妊娠米索前列醇引产的子宫收缩和产程特点

目的:通过探讨晚期妊娠米索前列醇引产的子宫收缩和产程特点,分析其风险性和可行性。方法:2003年5月至2004年6月我院产科晚期妊娠用米索前列醇引产进入活跃期的产妇134例为观察组,同期自然临产产妇165例为对照组,应用胎儿监护仪观察子宫收缩各项指标(间隔时间、持续时间、强度和曲线类型),观察子宫过度刺激综合征、羊水粪染、急产、产程时间、产后出血等情况。结果:子宫收缩各项指标、子宫过度刺激综合征、羊水粪染、急产发生率、产程时间比较差异均有显著性,产后出血量和产后出血率差异无显著性。结论:晚期妊娠米索前列醇引产易出现子宫收缩过频、过强、子宫过度刺激综合征、急产等。因此,必须在正确掌握指征、有力监护、及早识别和处理产力异常的前提下,应用米索前列醇引产。     

Using of Misoprostol for preinduction and induction of labor in term pregnancy

Labour induction is frequently indicated in women with an unfavourable cervix. Oxytocin and prostaglandins are the most common drugs used for labour induction. Induction of labour with prostaglandins offers the advantage of promoting both cervical ripening and myometrial contractility. The purpose of the study was to evaluate the safety and efficacy intravaginal administration prostaglandin E1 methyl analogue, misoprostol in cervical ripening and induction of labour in term pregnancy and in women with unfavourable cervix (Bishop score < = 4). The approval for this study was given by the Board of Medical Ethics, University Medical School of Lublin in Poland. MATERIALS AND METHODS: 64 women with indication for termination of pregnancy received either misoprostol (Cytotec-Searle) vaginally (group M, n = 30) or intravenous drip infusion of oxytocin(group Ox, n = 34). We evaluated profile of the studied women (gravidity, weight, height, maternal age, gestational age), effectiveness and safety of the misoprostol and need for oxytocin administration in group M, start of induction-to-active labour interval (contractions), start of induction-to-vaginal delivery interval, hyperstimulation syndrome, delivery within 24 hours of drug application and caesarean section rate. Before starting labour induction a Bishop score was obtained. Statistical analysis was performed. Baseline and outcome variables were tested with student's t-test and c2 analysis. We needed p < 0.05 for statistical significance. RESULTS: There were no differences in the patient profiles (gravidity, weight, height, maternal age, gestational age) between groups except the score of cervical ripening. The Bishop score before induction was lower in group M. The interval between the initiation of induction to active labour was shorter in the misoprostol group (334.23 +/- 126.35 versus 610.00 +/- 352.14 minutes). The mean time between the initiation of induction to delivery was shorter in group M (707.69 +/- 341.15 +/- versus 1025.77 +/- 369.16 minutes). These differences were statistically significant. 28 (93.33%) patients in the misoprostol group delivered within 24 hours compared with 24 (70.59%) women in the oxytocin group. 8 patients in the misoprostol group and 8 patient in the oxytocin group had caesarean section. Labor induction was successful in 30 (100%) women in the misoprostol group compared with 24 (70.59%) patients in the group Ox. CONCLUSIONS: Intravaginal misoprostol is an effective, easy to use and cheap drug for the induction of labour, especially for cervical ripening in women with unfavourable cervix (Bishop score < = 4).     

Labor induction post-term with 25 micrograms vs. 50 micrograms of intravaginal misoprostol.

OBJECTIVES: To compare the effectiveness of 25 microg vs. 50 microg of intravaginal misoprostol for cervical ripening and labor induction beyond 41 weeks' gestation. METHODS: The study population consisted of 120 women not in active labor with a gestational age >41 weeks, singleton pregnancy with vertex presentation, reactive fetal heart rate tracing, amniotic fluid index >/=5, and Bishop score <5. Women were randomized to receive either 25 microg (n=60) or 50 microg (n=60) of intravaginal misoprostol. The dose was repeated every 4 h (maximum number of doses limited to six) until the patient exhibited three contractions in 10 min. The main outcome measure was the induction-vaginal delivery interval. RESULTS: There was no significant difference between the two groups with regard to the induction-vaginal delivery interval (685+/-201 min in the 25 microg group vs. 627+/-177 min in the 50 microg group, P=0.09). The proportion of women delivering vaginally with one dose of vaginal misoprostol was significantly greater in the 50 microg group (0/49 vs. 41/47, P<0.001). There were no differences in the rates of cesarean and operative vaginal delivery rates, or in the incidences of tachysystole and hyperstimulation syndrome in the two treatment groups. Neonatal outcomes were also similar. CONCLUSIONS: Intravaginal administration of 25 microg of misoprostol appears to be as effective as 50 microg for cervical ripening and labor induction beyond 41 weeks' gestation.     

Comparative Evaluation of 50 Microgram Oral Misoprostol and 25 Microgram Intravaginal Misoprostol for Induction of Labour at Term: A Randomized Trial

ObjectivesTo assess and compare the efficacy and safety of 50 μg oral misoprostol and 25 μg intravaginal misoprostol for induction of labour at term.MethodsThis non-blinded, randomized clinical trial included 228 pregnant women at term with obstetric or medical indications for induction of labour. Women either took 50 μg misoprostol orally (two 25 μg tablets) or had one 25 μg tablet of misoprostol inserted in the posterior vaginal fornix. In each group, misoprostol administration was repeated every four hours in the same dose until regular uterine contractions were established or to a maximum of five doses. Time to delivery and outcome data for each group were compared.ResultsOf the 228 women, eight (3.5%) were excluded from the analysis as they withdrew their consent after randomization. Mean induction-to-delivery interval was similar in both groups (21.22 hours in the oral group vs. 20.15 hours in the vaginal group; P = 0.58). There was no significant difference between the groups with respect to the number of women who delivered within 24 hours or who required oxytocin augmentation of labour, the mode of delivery, and neonatal outcomes (P > 0.05). Uterine hyperstimulation occurred in two women who received misoprostol vaginally, but not in any of the women in the oral misoprostol group.ConclusionOral misoprostol in a dose of 50 μg every four hours, to a maximum of five doses, has the potential to induce labour as safely and effectively as 25 μg misoprostol administered vaginally every four hours.     

Sublingual compared with vaginal misoprostol for labour induction at term: a randomised controlled trial

OBJECTIVE: To compare the efficacy and safety of 50 microg of sublingual misoprostol with 25 microg of vaginal misoprostol administered for labour induction at term.Design Double-blinded, randomised controlled trial.Setting University Hospital, Kaunas, Lithuania.Sample A total of 140 women at term with indications for labour induction.Methods Women were randomised to receive either 50 microg of sublingual misoprostol with vaginal placebo (n = 70) or sublingual placebo with 25 microg of vaginal misoprostol (n = 70) every 4 hours (maximum six doses).Main outcome measures The number of women delivering vaginally within 24 hours of labour induction.Results Fifty-eight women (83%) in the sublingual misoprostol group and 53 (76%) in the vaginal misoprostol group delivered vaginally within 24 hours [relative risk (RR) 1.1, 95% confidential interval (CI) 0.9-1.3]. However, the induction to vaginal delivery time was significantly shorter in the sublingual group (15.0 +/- 3.7 hours) compared with the vaginal group (16.7 +/- 4.1 hours, P = 0.03). The incidence of tachysystole was more than three-fold higher in the sublingual than in the vaginal group (14 versus 4.3%; RR 3.3, 95% CI 0.9-11.6), but this was not statistically significant. There were no significant differences in the incidence of hypertonus or hyperstimulation syndrome, mode of delivery, interventions for fetal distress or neonatal outcomes between the two groups.Conclusion A 50 microg of sublingual misoprostol 4 hourly for labour induction at term seems to have similar efficacy as 25 microg of vaginal misoprostol. Further studies on safety with larger numbers of women need to be conducted before routine sublingual misoprostol use in this setting.     

Vaginally administered misoprostol for outpatient cervical ripening in pregnancies complicated by diabetes mellitus

OBJECTIVE: To compare the use of vaginally administered misoprostol to placebo for outpatient labor induction in patients with diabetes. STUDY DESIGN: In this double-masked, controlled clinical trial, pregnant women with diabetes and gestational age of >38(1/2) weeks were randomized to receive 25 microg misoprostol or placebo vaginally on days 1 and 4 of a 7-day outpatient cervical ripening period. If necessary, inpatient labor induction was managed by using a standard protocol. RESULTS: Of 120 women included in the study, 57 received misoprostol and 63 received placebo. Most of the women had been diagnosed with gestational (Class A) diabetes. Similar numbers of misoprostol and placebo-treated women delivered within 7 days of the first dose (31/57 [54%] vs 36/63 [57%], P =.63). The mean (+/-SEM) interval from induction to delivery was similar (8530.5 minutes +/-1439.7 minutes vs 6712.5 minutes +/-606.4 minutes, P =.23). CONCLUSION: Vaginally administered misoprostol was no more effective than placebo in reducing the need for inpatient labor induction or the induction-delivery interval. Outpatient cervical ripening with use of vaginally administered misoprostol was well tolerated.     

The use of misoprostol in termination of second-trimester pregnancy

Misoprostol, a synthetic prostaglandin E1 analog, is initially used to prevent peptic ulcer. The initial US Food and Drug Administration-approved indication in the product labeling is the treatment and prevention of intestinal ulcer disease resulting from nonsteroidal anti-inflammatory drugs use. In recent two decades, misoprostol has approved to be an effective agent for termination of pregnancy in various gestation, cervical ripening, labor induction in term pregnancy, and possible management of postpartum hemorrhage. For the termination of second-trimester pregnancy using the combination of mifepristone and misoprostol seems to have the highest efficacy and the shortest time interval of abortion. When mifepristone is not available, misoprostol alone is a good alternative. Misoprostol, 400 μg given vaginally every 3-6 hours, is probably the optimal regimen for second-trimester abortion. More than 800 μg of misoprostol is likely to have more side effects, especially diarrhea. Although misoprostol can be used in women with scarred uterus for termination of second-trimester pregnancy, it is recommended that women with a scarred uterus should receive lower doses and do not double the dose if there is no initial response. It is also important for us to recognize the associated teratogenic effects of misoprostol and thorough consultation before prescribing this medication to patients regarding these risks, especially when failure of abortion occurs, is needed.     

Prospective randomized clinical trial of inpatient cervical ripening with stepwise oral misoprostol vs vaginal misoprostol

OBJECTIVE: The purpose of this study was to compare the efficacy and safety of stepwise oral misoprostol vs vaginal misoprostol for cervical ripening before induction of labor. STUDY DESIGN: Two hundred and four women between 32 to 42 weeks of gestation with an unfavorable cervix (Bishop score < or = 6) and an indication for labor induction were randomized to receive oral or vaginal misoprostol every 4 hours up to 4 doses. The oral misoprostol group received 50 microg initially followed by 100 microg in each subsequent dose. The vaginal group received 25 microg in each dose. The primary outcome was the interval from first misoprostol dose to delivery. Patient satisfaction and side effects were assessed by surveys completed after delivery. RESULTS: Ninety-three (45.6%) women received oral misoprostol; 111 (54.4%) received vaginal misoprostol. There was no difference in the average interval from the first dose of misoprostol to delivery in the oral (21.1 + 7.9 hrs) and vaginal (21.5 + 11.0 hrs, P = NS) misoprostol groups. The incidence of hyperstimulation in the oral group was 2.2% vs 5.4% in the vaginal group, P = NS. Eighteen patients in the oral group (19.4%) and 36 (32.4%) in the vaginal group underwent cesarean section (P < .05). This difference was attributed to better tolerance of more doses of misoprostol by the women in the oral group. There was no difference in side effects (nausea, vomiting, diarrhea, shivering) between groups. Fourteen percent of women in the vaginal group versus 7.5% in the oral group were dissatisfied with the use of misoprostol (P = NS). CONCLUSION: Stepwise oral misoprostol (50 microg followed by 100 microg) appears to be as effective as vaginal misoprostol (25 microg) for cervical ripening with a low incidence of hyperstimulation, no increase in side effects, a high rate of patient satisfaction, and is associated with a lower cesarean section rate.     

Oral misoprostol (100 microg) versus vaginal misoprostol (25 microg) in term labor induction: a randomized comparison

OBJECTIVE: To compare the efficacy of vaginal misoprostol (25 microg) to oral misoprostol (100 microg) in labor induction at term. METHODS: One hundred and one women at term, with indications for labor induction and cervical Bishop's scores of less than 8, were randomly assigned to receive 100 microg of oral misoprostol or 25 microg vaginal misoprostol after random allocation. This could be repeated every 4 h to a maximum of five doses. The number delivering vaginally within 24 h of the induction was the main outcome measure. RESULTS: Of those who delivered vaginally (74.5% in the oral group vs. 72% in the vaginal group), significantly fewer women delivered within 24 h of induction in the oral group (42.1% vs. 72.2%, RR 0.6, 95% CI 0.4-0.9), with more women receiving more than one dose (45.7% vs. 16.7%, RR 2.7, 95% CI 1.2-6.0). More women in the oral group received oxytocin (68.6% vs. 44%, RR 1.6, 95% CI 1.1-2.2), and the induction to delivery interval was shorter in the vaginal group, although this was not statistically significant [28.9 h (SD 20.2) vs. 20.6 h (SD 16.1), mean difference - 8.3 h, 95% CI - 16.8 to 0.2]. There were no differences in the modes of delivery, uterine hyperstimulation rates or in the neonatal outcomes. CONCLUSION: Vaginal misoprostol in its currently recommended dose of 25 microg seems to be more efficacious than the 100 microg oral dose.     

A randomised comparison of oral misoprostol and vaginal prostaglandin E2 tablets in labour induction at term

OBJECTIVE: To compare the efficacy of 100 microg of oral misoprostol with 3 mg prostaglandin E2 vaginal tablets in term labour induction. DESIGN: A non-blinded, randomised, controlled trial. SETTING: A tertiary level, teaching Scottish Hospital. POPULATION: Two hundred women at term with indications for labour induction and modified Bishop's cervical score of less than 8. METHODS: The women were randomly allocated to receive either 100 microg of misoprostol orally (which could be repeated 4 hourly to a maximum of five doses if indicated), or a 3 mg tablet of prostaglandin E2 vaginally (which could be repeated in 6 hours, according to routine departmental protocol). MAIN OUTCOME MEASURE: The number delivering vaginally within 24 hours of the induction. RESULTS: Seventy-five women delivered vaginally in the misoprostol group and 73 in the PGE2 group. Of these, 50.7% in the misoprostol group and 54.8% in the PGE2 group delivered within 24 hours of the induction (RR 0.92, 95% CI 0.7 to 1.3). More women in the misoprostol group were given oxytocin, but this was not statistically significant (60%vs 47%, RR 1.3, 95% CI 0.98 to 1.7). Two women in the misoprostol group had uterine hyperstimulation. The neonatal outcomes were not significantly different in the two groups. There was a pound 1100 saving on direct drug costs in the misoprostol group. CONCLUSIONS: Oral misoprostol (100 microg) has similar efficacy to vaginal PGE2 tablets, and may be an option to consider for term labour induction.     

A comparison of orally administered misoprostol with vaginally administered misoprostol for cervical ripening and labor induction.

OBJECTIVE: Our purpose was to compare orally administered with vaginally administered misoprostol for cervical ripening and labor induction. MATERIAL AND METHODS: Two hundred twenty subjects with medical or obstetric indications for labor induction and undilated, uneffaced cervices were randomly assigned to receive orally administered or vaginally administered misoprostol. Fifty micrograms of oral misoprostol or 25 microgram of vaginal misoprostol was given every 4 hours. If cervical ripening (Bishop score of >/=8 or cervical dilatation of >/=3) or active labor did not occur, repeated doses were given to a maximum of 6 doses or 24 hours. Thereafter, oxytocin was administered intravenously by a standardized incremental infusion protocol to a maximum of 22 mU/min. RESULTS: Of the 220 subjects evaluated, 110 received orally administered misoprostol and 110 received vaginally administered misoprostol. Fewer subjects who received the oral preparation (34/110, 30.9%) were delivered vaginally within 24 hours of initiation of induction, in comparison with those who received the vaginal preparation (52/110, 47.3%) (P =.01). The average interval from start of induction to vaginal delivery was nearly 6 hours longer in the oral treatment group (mean and SD 1737.9 +/- 845.7 minutes) than in the vaginal treatment group (mean and SD 1393.2 +/- 767.9) (P =.005, log-transformed data). Orally treated patients required significantly more doses than vaginally treated patients (orally administered doses: mean and SD 3.3 +/- 1.7; vaginally administered doses: mean and SD 2.3 +/- 1.2) (P <.0001). Oxytocin administration was necessary in 83 (75.4%) of 110 orally treated subjects and in 65 (59.1%) of 110 vaginally treated subjects (P =.01, relative risk 1. 28, 95% confidence interval 1.06-1.54). Vaginal delivery occurred in 95 (86.4%) orally treated subjects and in 85 (77.3%) vaginally treated subjects (P =.08, relative risk 1.12, 95% confidence interval 0.99-1.27), with the remainder undergoing cesarean delivery. There was no difference in the incidence of uterine contractile abnormalities (tachysystole, hypertonus, or hyperstimulation), intrapartum complications, or neonatal outcomes between the 2 groups. CONCLUSIONS: Oral administration of 50-microgram doses of misoprostol appears less effective than vaginal administration of 25-microgram doses of misoprostol for cervical ripening and labor induction. Further investigation is needed to determine whether orally administered misoprostol should be used for cervical ripening and labor induction.