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Oral misoprostol alone compared to oral misoprostol followed by oxytocin in India: a multicentre randomised trial in women induced for hypertension of pregnancy.
  • +11
  • Andrew D Weeks,
  • Mundle S,
  • Lightly K,
  • Jill Durocher,
  • Hillary Bracken,
  • Moushmi Parpillewar,
  • Seema Parvekar,
  • Poonam Verma Shivkumar,
  • Brian Faragher,
  • Thomas Easterling,
  • Simon Leigh,
  • Mark Turner,
  • Zarko Alfirevic,
  • Beverly Winikoff
Andrew D Weeks
University of Liverpool

Corresponding Author:[email protected]

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Mundle S
All India Institute of Medical Sciences - Nagpur
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Lightly K
University of Liverpool
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Jill Durocher
Gynuity Health Projects
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Hillary Bracken
Patient-Centered Outcomes Research Institute
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Moushmi Parpillewar
Government Medical College and Hospital Nagpur
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Seema Parvekar
Daga Memorial Women's Government Hospital
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Poonam Verma Shivkumar
Mahatma Gandhi Institute of Medical Sciences
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Brian Faragher
Liverpool School of Tropical Medicine
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Thomas Easterling
University of Washington
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Simon Leigh
Nexus Clinical Analytics
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Mark Turner
University of Liverpool
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Zarko Alfirevic
University of Liverpool
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Beverly Winikoff
Gynuity Health Projects
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Objective: To assess whether, in those requiring ongoing uterine stimulation after cervical ripening with oral misoprostol and membrane rupture, augmentation with low dose oral misoprostol is superior to intravenous oxytocin. Design: Open-label, superiority randomised trial Setting: Government hospitals in India Population: Women induced with oral misoprostol for hypertensive disease in pregnancy and requiring ongoing induction after membrane rupture Methods: Participants received misoprostol (25mcg orally two hourly) or titrated oxytocin through an infusion pump. Main Outcome Measure: Caesarean birth Results: 520 women were randomised and the baseline characteristics were comparable between the groups. The caesarean section rate was not reduced by the use of misoprostol (misoprostol 32.3% vs oxytocin 27.3%; adjusted odds ratio 1.226 (95% CI 0.81-1.85, p=0.33)). There were no differences in rates of hyperstimulation, fetal heart rate abnormalities, or maternal side effects, although the geometric mean time from randomisation to birth was 31 minutes longer with misoprostol. Fewer babies in the misoprostol arm were admitted to the special care unit (10 vs 21 in the oxytocin group) and there were no neonatal deaths in the misoprostol group, compared to 3 in the oxytocin arm. Women’s acceptability ratings were high in both study groups. Conclusion: Following cervical preparation with oral misoprostol and membrane rupture, the use of ongoing oral misoprostol for augmentation did not significantly reduce caesarean rates compared to oxytocin. The method, however, was safe for both mother and baby.
12 Feb 2024Submitted to BJOG: An International Journal of Obstetrics and Gynaecology
13 Feb 2024Reviewer(s) Assigned
04 Mar 2024Editorial Decision: Revise Major
28 Mar 20241st Revision Received
02 Apr 2024Submission Checks Completed
02 Apr 2024Assigned to Editor
02 Apr 2024Review(s) Completed, Editorial Evaluation Pending