1. Alfirezic Z. Oral misoprostol for induction of labour (Cochrane Review). In: The Cochrane Library Issue 2, 2001. Oxford: Update Software, US. 2. Bennett KA, Butt K, Crane JMG, Hutchens D, Young DC. A masked randomized comparison of oral and vaginal administration of misoprostol for labour induction. Obstet Gynecol 1998;92:481–6. 3. Wing DA, Park MR, Paul RH. A randomized comparison of oral and intravaginal misoprostol for labour induction. Obstet Gynecol 2000;95:905–8. 4. Wing DA, Ham D, Paul RH. A comparison of orally administered misoprostol with vaginally administered misoprostol for cervical ripening and labour induction. Am J Obstet Gynecol 1999;180:1155–60. 5. Crane JMG, Young DC, Butt KD, Bennett KA, Hutchens D. Excessive uterine activity accompanying induced labour. Obstet Gynecol 2001;97:926–31.

Objective: To test the null hypothesis that administering misoprostol orally or vaginally will result in no difference in time to vaginal birth, and to determine whether different frequencies of tachysystole and hyperstimulation are associated with route of administration.Methods: Two hundred six women after 37 completed weeks' gestation who presented with an indication for induction were randomly assigned to receive misoprostol (50 mu g) either orally or vaginally every 4 hours as needed to induce labor. placebo use and allocation concealment accomplished blinding until data analysis was completed. Sample size was calculated to allow a two-tailed alpha of .05 and power (1 - beta) of 80%. All fetal heart rate and uterine activity graphs were classified according to Curtis' criteria before induction groups were unmasked.Results: Analysis involved 104 women in the oral group and 102 in the vaginal group. The mean time (+/- standard deviation) to vaginal birth with oral misoprostol was 1072 (+/-593) minutes compared with 846 (+/-385) minutes with the vaginal protocol (P = .004). There were no significant differences in cesarean rate, epidural use, or neonatal outcomes. More frequent tachysystole for 20 minutes (P < .01) and hyperstimulation (P < .04) were observed with vaginal misoprostol. No neonatal asphyxia occurred in either group.Conclusion: Misoprostol effectively induces labor, given orally or vaginally. There is a shorter interval to vaginal birth with vaginal application; however, the more frequent occurrence of fetal heart rate graph abnormalities in this group suggests that, until the optimal dosing interval for vaginal use is determined, the preferred route of misoprostol administration might be oral. (Obstet Gynecol 1998;92: 481-6. (C) 1998 by The American College of Obstetricians and Gynecologists.).

Lower genital cytopathology was evaluated in 105 immunosuppressed renal transplant recipients. Evidence of human papillomavirus infection was found in 17.5% and of lower genital neoplasia in 9.5%. The rate of the virus infection in the immunosuppressed was nine times greater than in a general population and 17 times greater than in a matched immunocompetent population. The rate of cervical neoplasia was 16 times greater than in a general population and nine times greater than in a matched immunocompetent population. In one-third of patients with human papillomavirus lesions and one-half of patients with neoplastic lesions, multiple lower genital sites were also involved. Of risk factors evaluated, only the number of sexual partners was associated with the development of human papillomavirus/lower genital neoplasia.