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Labor

Poster Session 3

(912) Oxytocin versus oral misoprostol for PROM induction in nulliparas with unfavorable cervix: A randomized trial

Wednesday, February 14, 2024
8:30 AM – 10:00 AM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective:

To determine if oxytocin or oral misoprostol (miso) results in a shorter time to delivery after induction of labor (IOL) for premature rupture of membranes (PROM) in nulliparas with an unfavorable cervical exam.

Study Design:

This randomized trial was conducted at an urban tertiary care center from 2019-2023. For nulliparas with a singleton gestation undergoing PROM IOL, we compared time from IOL to delivery (hours, h) between oxytocin vs oral miso (50 mcg q4h). Subjects were > 36 wks with an unfavorable starting cervical exam (< 2 cm and Bishop < 8). Secondary outcomes included intraamniotic infection, cesarean, composite maternal and neonatal morbidity, and patient satisfaction. Sub-group analyses for those with BMI ≥ 30kg/m2 and cervical dilation ≥ 1cm were performed. We needed 148 subjects to have 80% power to detect a 2-hour difference in time to delivery. The study was stopped early by the DSMB due to feasibility concerns in recruiting desired sample size.

Results: 108 subjects were randomized: 56 oxytocin; 52 oral miso. There were no differences in demographic or baseline characteristics (Table 1). For time to delivery, there was no statistical difference between groups (14.9h oxytocin vs. 18.1h miso, p =0.06). In sub-group analyses with oxytocin compared to miso, there was a 5h shorter time to delivery for those with a BMI ≥ 30kg/m2 and 4.5h shorter time to delivery for those with cervix ≥ 1cm. There was no difference in intraamniotic infection, cesarean, maternal or neonatal morbidity (Table 1).  Satisfaction was higher for those receiving oxytocin compared to miso (29.0 vs. 26.3, p=0.03).

Conclusion:

There was no overall difference in time to delivery between oxytocin and oral miso in this group of nulliparas with PROM and an unfavorable cervix. There was, however, a shorter time to delivery with oxytocin in obese patients and those with cervical dilation of at least 1 cm. Additionally, patient satisfaction was increased with oxytocin with no difference in cesarean or morbidity.