Evaluation of vaginal and sublingual routes of misoprostol in induction of labor

Background: Labor induction is used to initiate uterine contractions. Various misoprostol administration routes demonstrate differing pharmacokinetics and efficacy. Optimal route is selected considering factors like onset of action, side effects, patient comfort, and neonatal outcomes. Objectives were to study the response of sublingual and vaginal routes of misoprostol for induction of labor and compare both the routes for induction of labor. Methods: A randomized prospective study was conducted from May 2023 to October 2024 at Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, UP. Participants were assigned to either sublingual or vaginal misoprostol (25 mcg every 4 hours, up to five doses), stopped at 4 cm dilation or if adverse effects occurred. Oxytocin was given if needed. Labor progress, induction-to-delivery time, doses, patient preference, and side effects were recorded. Results: The present study on labor induction with sublingual and vaginal misoprostol showed no significant differences in demographic factors, gravidity, parity, or gestational period between the groups. Bishop scores improved significantly after three doses of misoprostol. The sublingual group had a shorter labor duration and required fewer doses, supporting its quicker induction efficiency. No significant differences were found in adverse effects, mode of delivery, failure rates, or neonatal outcomes but individualized care is essential. Conclusions: This study highlighted that both sublingual and vaginal misoprostol are effective for labor induction, with sublingual route offering faster results but higher risks, suggesting that the choice of route should be based on patient-specific factors.