(198) Buccal Versus Vaginal Misoprostol Combined with a Foley Catheter Among Individuals with Obesity Undergoing Induction

This was a planned secondary analysis of a randomized controlled trial comparing identical dosages (25μg) of buccal and vaginal misoprostol in combination with a FC. Labor management was standardized among participants. Women undergoing IOL at ≥37 weeks with a singleton gestation and cervical dilation ≤2cm were included. Body mass index (BMI, kg/m2) was stratified. Our primary outcome was time to delivery. Kruskal-Wallis, Pearson chi-square and Cox survival analyses with intent-to-treat principles were performed.

Results:

215 participants were included with the following weight stratifications: 55 (25.6%) BMI < 30; 110 (51.2%) BMI 30-39.9; 50 (23.3%) BMI ≥40. Demographic characteristics were similar between the three groups. Vaginal drug administration achieved a faster median time to delivery than the buccal route among patients with a BMI range of 30-39.9, (vaginal miso–FC: 21.3hrs vs. buccal miso–FC: 23.6hrs, p=0.04). There was no difference in the cesarean delivery rate between the various groups. Furthermore, patients with a BMI range of 30-39.9 receiving vaginal misoprostol delivered 1.2 times faster than women who received buccal misoprostol after censoring for Cesarean delivery and adjusting for parity, (Hazard Ratio [HR] 1.2, 95% confidence interval [CI] 1.1-1.7). There were no significant differences in maternal and neonatal outcomes. 

Conclusion:

We found that vaginal misoprostol was superior to buccal misoprostol when combined with a FC among individuals with a BMI range of 30-39.9. Therefore, vaginal misoprostol should be the preferred route of drug administration for term IOL in this population.