A randomised comparison of patient satisfaction with vaginal and sublingual misoprostol for induction of labour at term*

Objective To compare patient satisfaction with two routes of misoprostol for term labour induction. Design Prospective randomised trial. Setting Tertiary care hospital. Population A total of 170 women admitted at ≥37 weeks of gestation for induction of labour. Methods Women were randomised to receive 50 micrograms of either sublingual or vaginal misoprostol. Main outcome measures Patient satisfaction with the route of administration. Results Despite a similar proportion reporting the labour induction as more painful than expected in both groups, a significantly lower proportion mentioned that the pelvic examinations were very painful in the sublingual group (19.7 versus 36.1%, relative risk [RR] 0.5, 95% CI 0.3–0.9). Request for analgesia was similar in both groups. More women in the sublingual group thought that the labour experience was better than expected (RR 2.0, 95% CI 1.2–3.3), had a positive attitude towards induction in subsequent pregnancies (RR 1.6, 95% CI 1.1–2.3) and preferred the same route in subsequent pregnancies (RR 3.1, 95% CI 2.2–4.5). Mean number of misoprostol doses, oxytocin augmentation, tachysystole and hyperstimulation, induction to vaginal delivery interval, vaginal delivery after a single dose, vaginal birth within 12 and 24 hours, and caesarean delivery rates were similar in both groups. Conclusion Sublingual misoprostol (50 micrograms) is associated with a significantly higher patient satisfaction rate compared with a similar dose of vaginal misoprostol. Sublingual administration offers additional choice to women, in particular those wishing to avoid vaginal administration.