The Effect of Buccal versus Vaginal Misoprostol on Time to Favorable Simplified Bishop Score

Abstract

OBJECTIVE: To evaluate whether buccal or vaginal Misoprostol provides a statistically significant shorter time interval to a favorable simplified Bishop score, and to determine if there is a significant difference in time to delivery between these two modes of administration. DESIGN: Retrospective cohort study via chart review SETTING: Augusta University, Augusta, Georgia PATIENTS: Mothers who delivered full term singleton gestations after being admitted for induction of labor at Augusta University from January 1, 2015 to July 31, 2018 with an initially unfavorable simplified Bishop score on cervical exam. Exclusion criteria: (1) Favorable initial simplified Bishop score (>5) at the time of onset of induction of labor, (2) multiple gestation, (3), pre-term gestation and (4) use of multiple different modalities for cervical ripening. INTERVENTION: Medical records were reviewed to determine if mothers meeting the criteria above had a statistically significant difference in time to favorable simplified Bishop score using vaginal versus buccal Misoprostol and/or a statistically significant difference in time to delivery. MAIN OUTCOME MEASURE: The primary outcome was time to favorable simplified Bishop score (>5). The secondary outcome was time to delivery. RESULTS: • Primary outcome- no significant difference between the buccal and vaginal groups in median time from initial Misoprostol dose to time of favorable simplified Bishop score (p=0.371). • Secondary outcome- no significant difference between the buccal and vaginal groups in median time from initial Misoprostol dose to time of delivery (p=0.371). • No significant difference in complication rate between the buccal and vaginal groups (p=0.199).