Download PDF
CC BY-NC-ND 4.0 · AJP Rep 2017; 07(03): e158-e162
DOI: 10.1055/s-0037-1603954
Case Report
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Survey of Provider Preferences Regarding the Route of Misoprostol for Induction of Labor at Term

Rachel Towns
1   Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana
,
Sara K. Quinney
1   Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana
,
Rebecca C. Pierson
1   Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana
2   Department of Obstetrics, Gynecology and Women's Health, University of Louisville, Louisville, Kentucky
,
David M. Haas
1   Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana
› Author Affiliations
Further Information

Publication History

30 January 2017

31 March 2017

Publication Date:
25 July 2017 (online)

Also available at
   Permissions and Reprints

Abstract

Objective To survey obstetrical provider preferences regarding use of misoprostol for induction of labor (IOL).

Methods An anonymous 25-question survey was distributed at an American College of Obstetricians and Gynecologists (ACOG) joint District V and VII Meeting in 2014 to obstetrics providers. The same survey was sent electronically to local providers. A separate survey was emailed to the labor and delivery nurses at two of the teaching hospitals in Indianapolis. The surveys queried provider demographics, dosing practice for misoprostol, opinions regarding different dosing strategies, and instructions on buccal administration.

Results A total of 113 (46.5%) providers responded. Of these, 92.9% used misoprostol for IOL, 73% preferred the vaginal route, 20% preferred buccal administration, and 7% oral administration. Only resident physician and midwife providers endorsed buccal route preference. Being a midwife independently predicted a preference for using buccal misoprostol (odds ratio [OR]: 125.8, 95% confidence interval [CI]: 7.9–1992.3). Additionally, 44 nurses completed the survey regarding administration techniques of buccal misoprostol. Also, 54.5% of nurses correctly instructed their patients on buccal administration techniques.

Conclusion Although not extensively studied, one-fifth of providers, particularly nurse midwives, prefer buccal administration of misoprostol for IOL. The majority of nurses correctly administered buccal misoprostol. There may be a need for further study and education about buccal administration of misoprostol for IOL.

Keywords

misoprostol - labor induction - provider preference - buccal - vaginal

Note

This research was presented at the Annual District V Meeting of ACOG, from September 18 to 20, 2015, Denver, CO.


Supplementary Material

 

  • References

  • 1 Osterman MJ, Martin JA. Recent declines in induction of labor by gestational age. NCHS Data Brief 2014; (155) 1-8
    PubMedSearch in Google Scholar
  • 2 Hofmeyr GJ, Gülmezoglu AM, Pileggi C. Vaginal misoprostol for cervical ripening and induction of labour. Cochrane Database Syst Rev 2010; (10) CD000941
    PubMedSearch in Google Scholar
  • 3 ACOG Committee on Practice Bulletins–Obstetrics. ACOG Practice Bulletin No. 107: Induction of labor. Obstet Gynecol 2009; 114 (2, Pt 1): 386-397
    CrossrefPubMedSearch in Google Scholar
  • 4 Alfirevic Z, Aflaifel N, Weeks A. Oral misoprostol for induction of labour. Cochrane Database Syst Rev 2014; 6 (06) CD001338
    PubMedSearch in Google Scholar
  • 5 Elati A, Weeks AD. The use of misoprostol in obstetrics and gynaecology. BJOG 2009; 116 (Suppl. 01) 61-69
    CrossrefPubMedSearch in Google Scholar
  • 6 Tang OS, Gemzell-Danielsson K, Ho PC. Misoprostol: pharmacokinetic profiles, effects on the uterus and side-effects. Int J Gynaecol Obstet 2007; 99 (Suppl. 02) S160-S167
    CrossrefPubMedSearch in Google Scholar
  • 7 Zieman M, Fong SK, Benowitz NL, Banskter D, Darney PD. Absorption kinetics of misoprostol with oral or vaginal administration. Obstet Gynecol 1997; 90 (01) 88-92
    CrossrefPubMedSearch in Google Scholar
  • 8 Muzonzini G, Hofmeyr GJ. Buccal or sublingual misoprostol for cervical ripening and induction of labour. Cochrane Database Syst Rev 2004; (04) CD004221
    PubMedSearch in Google Scholar
  • 9 Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42 (02) 377-381
    CrossrefPubMedSearch in Google Scholar
  • 10 Krause E, Malorgio S, Kuhn A, Schmid C, Baumann M, Surbek D. Off-label use of misoprostol for labor induction: a nation-wide survey in Switzerland. Eur J Obstet Gynecol Reprod Biol 2011; 159 (02) 324-328
    CrossrefPubMedSearch in Google Scholar
  • 11 Carlan SJ, Blust D, O'Brien WF. Buccal versus intravaginal misoprostol administration for cervical ripening. Am J Obstet Gynecol 2002; 186 (02) 229-233
    CrossrefPubMedSearch in Google Scholar
  • 12 Shetty A, Mackie L, Danielian P, Rice P, Templeton A. Sublingual compared with oral misoprostol in term labour induction: a randomised controlled trial. BJOG 2002; 109 (06) 645-650
    CrossrefPubMedSearch in Google Scholar
  • 13 Shetty A, Danielian P, Templeton A. Sublingual misoprostol for the induction of labor at term. Am J Obstet Gynecol 2002; 186 (01) 72-76
    CrossrefPubMedSearch in Google Scholar
  • 14 Wolf SB, Sanchez-Ramos L, Kaunitz AM. Sublingual misoprostol for labor induction: a randomized clinical trial. Obstet Gynecol 2005; 105 (02) 365-371
    CrossrefPubMedSearch in Google Scholar
  • 15 Zahran KM, Shahin AY, Abdellah MS, Elsayh KI. Sublingual versus vaginal misoprostol for induction of labor at term: a randomized prospective placebo-controlled study. J Obstet Gynaecol Res 2009; 35 (06) 1054-1060
    CrossrefPubMedSearch in Google Scholar
  • 16 Souza AS, Amorim MM, Feitosa FE. Comparison of sublingual versus vaginal misoprostol for the induction of labour: a systematic review. BJOG 2008; 115 (11) 1340-1349
    CrossrefPubMedSearch in Google Scholar