The effect of a pill inserter on vaginal misoprostol dosing

Objective: To determine whether the method of placing a 25- &#119 g misoprostol chip into the posterior fornix to achieve cervical ripening affects the drug's efficacy. Methods: A pill inserter was used to place a misoprostol chip into the posterior fornix for the purpose of cervical ripening prior to induction of labor. Data from a control group were obtained by retrospective chart review. Results: The control and study groups contained 49 patients each. Compared to placing the misoprostol chip with a lubricated finger, the use of the pill inserter resulted in statistically significantly more patients receiving only one dose. This occurred either because a Bishop score of 8 or greater was achieved or because repeat dosing was disallowed secondary to the onset of uterine contractions. Although the total number of patients subsequently requiring oxytocin was significantly increased, there was no difference in the use of oxytocin for either induction or augmentation of labor. The lengths of the latent and active phases of labor did not differ between the two groups. Conclusion: The number of doses of a 25- &#119 g misoprostol chip for cervical ripening that result in uterine contractions, with or without a change in the Bishop score, is affected by the method used to place it in the vagina.