A Study Comparing Vaginal Misoprostol and Intravenous Oxytocin for Induction of Labor

Randomized Comparison of Vaginal Misoprostol and Intravenous Oxytocin for Labor Induction in Multiparous Women

This study will compare the effectiveness of vaginal misoprostol (Cytotec) and intravenous oxytocin (Pitocin) in multiparous women who present at term for labor induction.

Both oxytocin and misoprostol have been demonstrated to be safe and effective methods for induction of labor. A direct comparison of efficacy and time to delivery in multiparas has not been specifically investigated. Additionally, the study will look at costs of the two drugs.Oxytocin is administered through an IV so requires more direct patient care time from the Registered Nurse, IV pump, and tubing, whereas misoprostol is a tablet, administered only once, per vagina or orally, every 4 hours. Misoprostol is also very inexpensive comparatively; if equally or more efficacious than oxytocin, this could demonstrate quite a cost and time savings to Vanderbilt University Medical Center and other institutions. Safety of either drug is not in question.

Inclusion Criteria:

• Clinical candidate for labor induction utilizing either misoprostol or oxytocin
• Greater than or equal to 18 years of age
• Multiparous
• Singleton gestation;
• Greater than 37 weeks gestation;
• Cephalic presentation

Exclusion Criteria:

• Any clinical contraindication to misoprostol as induction drug
• Age less than 18 years
• Contraindication to vaginal birth
• Nonreassuring fetal heart rate tracing
• Prior uterine surgery
• Active labor
• Active maternal bleeding
• Chorioamnionitis (infection)