Efficacy and safety of oral and vaginal administration of misoprostol for induction of labor in high-risk obese pregnant women with hypertension or diabetes mellitus

Abstract

Objective

This study aims to compare the safety and efficacy of misoprostol administered orally and vaginally in obese pregnant women at term with either gestational hypertension or diabetes.

Methods

A total of 264 pregnant women were enrolled and categorized into two groups based on their primary condition: hypertension (134 cases) or diabetes mellitus (130 cases) and were further divided into subgroups for misoprostol administration: orally (Oral group) or vaginally (Vaginal group). The primary outcomes measured were changes in the Bishop score following treatment, induction of labor (IOL) success rates, requirement for oxytocin augmentation, duration of labor, mode of delivery, and cesarean section rates.

Results

Significant enhancements in Bishop scores, decreased cesarean section rates and increased success rates of IOL were noted in both administration groups. The incidence of vaginal delivery within 24 h was significantly higher in the Vaginal group compared to the Oral group. Adverse effects, including nausea, uterine overcontraction, hyperfrequency of uterine contraction and uterine hyperstimulation without fetal heart rate deceleration, were significantly more prevalent in the Vaginal group than in the Oral group.

Conclusion

Misoprostol administration, both orally and vaginally, proves effective for labor induction in obese pregnant women with hypertension or diabetes. However, the oral route presents a lower risk of adverse maternal and neonatal outcomes, suggesting its preference for safer labor induction in this demographic.

Keywords:

• Misoprostol
• vaginal administration
• oral administration
• induction of labor
• high-risk obese pregnant women

Ethics approval and consent to participate

The study was reviewed and approved by the Ethics Committee of Haidian District Maternal and Child Health Hospital (ZS2023001) and strictly followed the principles of the Declaration of Helsinki. All pregnant women signed an informed consent form before IOL.

Authors’ contributions

ST and LW conceived and designed the study. ST and LW conducted the study. YWH and YNL contributed to data acquisition. FQL and XHJ analyzed the data. ST and FQL interpreted the data. ST and LW edited the manuscript draft. ST and LW reviewed and edited the manuscript. All authors have read and approved the manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Availability of data and materials

The datasets used and/or analyzed during the current study can be made available from the corresponding author upon reasonable request.

Additional information

Funding

This study was supported by High-level Talent Development Program of Health System of Haidian District (project number: 2022HDXD006).