A randomised trial comparing low dose vaginal misoprostol and dinoprostone for labour induction

Abstract

Objective To compare vaginal misoprostol with dinoprostone for induction of labour.Design Randomised multicentre trial.Setting Labour wards of one university hospital and two teaching hospitals.Population Six hundred and eighty-one women with indication for labour induction at 36 weeks of gestation, singleton pregnancy and no previous ceasarean section. Methods Misoprostol (25 mcg, hospital-prepared capsule) in the posterior vaginal fornix, every four hours, maximum three times daily or dinoprostone gel (1 mg) every four hours. Oxytocin was administered if necessary. Main outcome measures Primary: 'adverse neonatal outcome' (5-minute Apgar score <7 and/or umbilical cord pH <7.15). Secondary: labour duration, mode of delivery and patient satisfaction. Results Three hundred and forty-one women received misoprostol and 340 dinoprostone. The median induction-delivery interval was longer in the misoprostol group compared with the dinoprostone group (25 versus 19 hours, P ¼ 0.008). The caesarean section rate was lower in the misoprostol group: 16.1% versus 21%, but this difference was not statistically significant RR ¼ 0.8 (95% CI 0.6 -1.04). 'Adverse neonatal outcome' was found to be similar in both groups: 21% in the misoprostol and 23% in the dinoprostone groups. Significantly fewer neonates were admitted to NICU in the misoprostol group compared with dinoprostone 19% versus 26% (RR ¼ 0.7, 95% CI 0.5 -0.98). Conclusions Misoprostol in this dosing regimen is a safe method of labour induction. NICU admission rates were lower in the misoprostol group. No difference could be detected in patient satisfaction between groups.

A Comparative Study of the Safety and Efficacy of Intra Vaginal Misoprostol Tablet Versus Intra Cervical Dinoprostone Gel for Cervical Ripening and Induction of Labour

“…In this study there was no significant statistically difference apgar score at 1 min and min between both group similar to the study by Daniel et al [10] and Herabutya et al Van Gemund et al [11] . In this study with this lower dosage 25 g of misoprostol lesser neonatal complications and maternal complication were noted.…”

A randomised controlled trial of intravaginal dinoprostone, intravaginal misoprostol and transcervical balloon catheter for labour induction

“…In another recent study 36 similar to our own, no differences between 25 microgram misoprostol and 1-2 mg dinoprostone, both applied vaginally, was observed regarding efficacy of induction, the incidence of caesarean section or maternal and neonatal outcomes. In an additional report, 37 this same dose of misoprostol was found to be less effective than 1 mg of dinoprostone applied vaginally, but the former was associated with a reduced incidence of instrumental delivery. Moreover, Nanda et al 38 have reported that this dose of misoprostol is more effective than 0.5 mg intracervical dinoprostone, without increasing the frequency of adverse maternal or fetal outcomes.…”

A Comparison of Vaginal vs. Oral Misoprostol for Induction of Labor–Double Blind Randomized Trial

“…Out of all prostaglandins PGE 1 and PGE 2 have been tried for induction of labor. PGE 2 is being used as gel and tablet, has the advantage of being used intracervical or vaginally [1][2][3] but is expensive and needs refrigeration. PGE 1 's synthetic analogue, misoprostol, originally used as gastroprotective agent [4], its use as cervical ripener and labor inducer is upcoming [5] and is being tried enthusiastically by obstetricians worldwide.…”