Oral compared with vaginal administration of misoprostol 400 ^g has a shorter time to peak serum level (34 versus 80 min) and produces a higher peak, but has far briefer activity. This is reflected in more rapid and pronounced initial increase but less persistence in uterine tonus with the oral route. Because of the short duration of action with the oral route, we have studied oral misoprostol 2-hourly for labour induction, commencing with a dose of 20 ^g, increased if necessary to 40 ^g after 2-3 doses. To administer such small doses, we dissolved 200 ^g misoprostol in 200 m water, and shook well before each administration. The solution was discarded after 12 h. In a multicentre randomized trial in 695 women, we found this method to be similar to vaginal dinoprostone 2 mg, repeated after 6 h, with respect to effectiveness, uterine hyperstimulation, Caesarean section rates and perinatal outcome. For consistency with commonly used dosages we have modified the dosage to 25 ^g 2-hourly, increased, if necessary, in nulliparous women only to 50 ^g 2-hourly.
Systematic review of randomized trials comparing oral with vaginal routes of administration has found the oral route to be associated with slower labours but fewer Caesarean sections.
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The first trimester is very important for the mother and the baby. For most women it is common to find out about their pregnancy after they have missed their menstrual cycle. Since, not all women note their menstrual cycle and dates of intercourse, it may cause slight confusion about the exact date of conception. That is why most women find out that they are pregnant only after one month of pregnancy.