{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T20:33:48Z","timestamp":1769546028670,"version":"3.49.0"},"reference-count":26,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2019,5,15]],"date-time":"2019-05-15T00:00:00Z","timestamp":1557878400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2019,8]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To compare the World Health Organization (<jats:styled-content style=\"fixed-case\">WHO<\/jats:styled-content>) recommended orally administrated dosage of misoprostol (25\u00a0\u03bcg) with a vaginal slow\u2010release (7\u00a0\u03bcg\/hour) insert of misoprostol regarding time from induction to delivery and safety of the method.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Open label, <jats:styled-content style=\"fixed-case\">Randomised controlled trial (RCT)<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Delivery ward at a secondary referral hospital in Stockholm, Sweden, from 1 October 2016 to 21 February 2018.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>One hundred and ninety\u2010six primiparous women with singletons in cephalic presentation at \u226537\u00a0weeks of gestation and with a Bishop score of \u22644.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Women were randomised to an oral solution of misoprostol (Cytotec<jats:sup>\u00ae<\/jats:sup> <jats:italic>n<\/jats:italic>\u00a0=\u00a099) or vaginal slow\u2010release misoprostol (Misodel<jats:sup>\u00ae<\/jats:sup> [<jats:styled-content style=\"fixed-case\">MVI<\/jats:styled-content>] <jats:italic>n<\/jats:italic>\u00a0=\u00a097).<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Primary outcome: time from induction to vaginal delivery. Secondary outcomes: mode of delivery; proportion of vaginal deliveries within 24\u00a0hours (<jats:styled-content style=\"fixed-case\">VD<\/jats:styled-content>24); neonates with an Apgar score of &lt;7 at 5\u00a0minutes; <jats:styled-content style=\"fixed-case\">pH<\/jats:styled-content>\u00a0&lt;\u00a07.10; postpartum haemorrhage (<jats:styled-content style=\"fixed-case\">PPH<\/jats:styled-content>) of &gt;1000\u00a0ml; hyperstimulation; and women's delivery experience (<jats:styled-content style=\"fixed-case\">VAS<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There was no difference in the time to vaginal delivery (median 21.1\u00a0hours in the <jats:styled-content style=\"fixed-case\">MVI<\/jats:styled-content> group and 23.2\u00a0hours in the oral group; Kaplan\u2013Mayer log rank <jats:italic>P<\/jats:italic>\u00a0=\u00a00.31). There was no difference regarding the proportion of <jats:styled-content style=\"fixed-case\">VD<\/jats:styled-content>24 (50.5 versus 55.7%, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.16). Hyperstimulation with non\u2010reassuring cardiotocography (<jats:styled-content style=\"fixed-case\">CTG<\/jats:styled-content>) was more common in the <jats:styled-content style=\"fixed-case\">MVI<\/jats:styled-content> group (14.4 versus 3.0%, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.01). Terbutaline (Bricanyl<jats:sup>\u00ae<\/jats:sup>) was used more often for hyperstimulation in the <jats:styled-content style=\"fixed-case\">MVI<\/jats:styled-content> group (22.7 versus 4.0%, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.01). There was no difference in the numbers of children admitted to the neonatal intensive care unit (<jats:styled-content style=\"fixed-case\">NICU<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Vaginal delivery after induction of labour (<jats:styled-content style=\"fixed-case\">IOL<\/jats:styled-content>) with slow\u2010release misoprostol did not result in a shorter time from induction to vaginal delivery, compared with oral misoprostol solution, but was associated with a higher risk for hyperstimulation and fetal distress. There were no differences in mode of delivery or neonatal outcome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Tweetable abstract<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">IOL<\/jats:styled-content> with <jats:styled-content style=\"fixed-case\">MVI<\/jats:styled-content> was similar to oral solution of misoprostol but hyperstimulation and fetal distress were more common.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.15796","type":"journal-article","created":{"date-parts":[[2019,4,16]],"date-time":"2019-04-16T03:46:46Z","timestamp":1555386406000},"page":"1148-1155","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Slow\u2010release vaginal insert of misoprostol versus orally administrated solution of misoprostol for the induction of labour in primiparous term pregnant women: a randomised controlled 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