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Background <p>Most patients with pre-labor rupture of membranes (PROM) enter labor spontaneously at term. However, maternal and neonatal complications increase with prolonged PROM. Induction of labor (IOL) is therefore often recommended, but the optimal agent is still debated. Low-dose oral misoprostol (OM) is safe, effective, cheap, and easy to administer. However, there is little data regarding its role in PROM at term.</p> Objective <p>To determine the safety and efficacy of OM compared to Intravenous Oxytocin for IOL for PROM at term.</p> Study design <p>A cohort study compared the perinatal outcomes of patients with unfavorable Bishop scores who underwent IOL for PROM at term with OM compared to IV Oxytocin. Patients were allocated to OM or Oxytocin based on : patient preference, physician discretion, and bed availability in the antenatal or labor ward. The primary outcome was the rate of vaginal delivery within 24&#xa0;h of membrane rupture. Other outcomes included duration from PROM and induction until delivery, duration of labor ward admission, mode of delivery, indications for cesarean delivery, postpartum hemorrhage (PPH), suspected chorioamnionitis, placental abruption, blood transfusion, shoulder dystocia, postpartum readmission, APGAR score &lt; 7 at 5&#xa0;min, umbilical artery pH &lt; 7.1, neonatal intensive care unit admission, GBS disease, infectious or respiratory morbidity, hypoglycemia, jaundice and necrotizing enterocolitis. Outcomes were analyzed individually and as composite adverse maternal and neonatal outcomes.</p> Results <p>493 patients (62.4%) patients underwent IOL with OM. Outcomes were compared to 296 (37.6%) patients undergoing induction with IV Oxytocin. Patients receiving OM had a reduced chance of vaginal delivery within 24&#xa0;h (76.3% vs. 87.5% OR 0.6 (0.4–0.9, <i>p</i> &lt; 0.001 but not within 48&#xa0;h (93.7% vs. 95.2% OR 0.7 (0.4–1.4), <i>p</i> = 0.2). They had a longer interval from PROM (1190 ± 26.7&#xa0;min vs. 856.9 ± 33.6&#xa0;min, <i>p</i> &lt; 0.001) (95% CI 40–60%) and induction to delivery (671.6 ± 26.1&#xa0;min vs. 453 ± 27.5&#xa0;min, <i>p</i> &lt; 0.001) but a shorter labor ward admission (233.7 ± 10.5&#xa0;min vs. 471 ± 13.8&#xa0;min, <i>p</i> &lt; 0.001), with no increased risk of maternal and neonatal complications. Restricting the analysis to nuliparas, there was a significant reduction in the rate of vaginal delivery within 24&#xa0;h with OM(59.4% vs. x85.8% OR 0.2 [0.1–0.5], <i>p</i> &lt; 0.001).</p> Conclusion <p>IOL with OM for term PROM is effective, leading to a high rate of vaginal delivery without associated increased risks. It may prolong delivery duration but reduces labor ward time, making it a valuable option to discuss during patient counseling.</p>

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Is there a role for oral misoprostol in labor induction for prelabor rupture of membranes at term?

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  • 发表日期：

    2025年4月23日

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  • Adi Ashkenazi Katz,
  • Ella Segal,
  • Lior Kashani-Ligumsky,
  • Ariel Many,
  • Miriam Lopian

摘要

Background

Most patients with pre-labor rupture of membranes (PROM) enter labor spontaneously at term. However, maternal and neonatal complications increase with prolonged PROM. Induction of labor (IOL) is therefore often recommended, but the optimal agent is still debated. Low-dose oral misoprostol (OM) is safe, effective, cheap, and easy to administer. However, there is little data regarding its role in PROM at term.

Objective

To determine the safety and efficacy of OM compared to Intravenous Oxytocin for IOL for PROM at term.

Study design

A cohort study compared the perinatal outcomes of patients with unfavorable Bishop scores who underwent IOL for PROM at term with OM compared to IV Oxytocin. Patients were allocated to OM or Oxytocin based on : patient preference, physician discretion, and bed availability in the antenatal or labor ward. The primary outcome was the rate of vaginal delivery within 24 h of membrane rupture. Other outcomes included duration from PROM and induction until delivery, duration of labor ward admission, mode of delivery, indications for cesarean delivery, postpartum hemorrhage (PPH), suspected chorioamnionitis, placental abruption, blood transfusion, shoulder dystocia, postpartum readmission, APGAR score < 7 at 5 min, umbilical artery pH < 7.1, neonatal intensive care unit admission, GBS disease, infectious or respiratory morbidity, hypoglycemia, jaundice and necrotizing enterocolitis. Outcomes were analyzed individually and as composite adverse maternal and neonatal outcomes.

Results

493 patients (62.4%) patients underwent IOL with OM. Outcomes were compared to 296 (37.6%) patients undergoing induction with IV Oxytocin. Patients receiving OM had a reduced chance of vaginal delivery within 24 h (76.3% vs. 87.5% OR 0.6 (0.4–0.9, p < 0.001 but not within 48 h (93.7% vs. 95.2% OR 0.7 (0.4–1.4), p = 0.2). They had a longer interval from PROM (1190 ± 26.7 min vs. 856.9 ± 33.6 min, p < 0.001) (95% CI 40–60%) and induction to delivery (671.6 ± 26.1 min vs. 453 ± 27.5 min, p < 0.001) but a shorter labor ward admission (233.7 ± 10.5 min vs. 471 ± 13.8 min, p < 0.001), with no increased risk of maternal and neonatal complications. Restricting the analysis to nuliparas, there was a significant reduction in the rate of vaginal delivery within 24 h with OM(59.4% vs. x85.8% OR 0.2 [0.1–0.5], p < 0.001).

Conclusion

IOL with OM for term PROM is effective, leading to a high rate of vaginal delivery without associated increased risks. It may prolong delivery duration but reduces labor ward time, making it a valuable option to discuss during patient counseling.