Limits on misoprostol use in second-trimester induction of labor not needed

  • Contraception

  • von Elisabeth Aron, MD, MPH, FACOG
  • Clinical Essentials
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Takeaway

  • Current limitations on doses of misoprostol in second-trimester induction of labor may be unwarranted.

Why this matters

  • In 2019, the American College of Obstetricians and Gynecologists (ACOG) cautioned against using more than 5 doses of misoprostol for second-trimester induction of labor.
  • However, some professional organizations have questioned this number; the WHO and the International Federation of Gynecology and Obstetrics recently updated their guidelines to no longer suggest a maximum number of doses.

Key results

  • No differences in rates of chorioamnionitis (P=.79), dilation and curettage for the retained placenta (P=.91), hemorrhage (P=.33), or transfusion (P=1.00) between the ≥6 and ≤5 doses groups.

Study design

  • Retrospective study.
  • Women undergoing induction of labor between 14 weeks 0 days and 23 weeks 6 days of gestation during 2003-2016 were identified from a delivery database.
  • Women receiving ≥6 doses of misoprostol (n=78) were compared with those receiving ≤5 doses of misoprostol (n=390).
  • Funding: None disclosed.

Limitations

  • Small numbers in the study.
  • Broad range in gestational age.
  • Dosage of misoprostol varied.