Effectiveness, safety and costs of labor induction with intravaginal misoprostol versus dinoprostone vaginal insert

Abstract

Background: Over the last decade, a lot of clinical reviews have been published, but they are heterogeneous and present disparity of outcomes. The best choice for inducing labor is not clear today. The objective of the study is to compare misoprostol with dinoprostone for labor induction including obstetrical and neonatal outcomes, side effects and costs. Methods and findings:From September 2012 to December 2013 a retrospective observational study was performed, including all pregnant women with medical indication of induction of labor. Three-hundred ten patients were included: 180 received 25μg of vaginal misoprostol and 130 received 10mg of vaginal dinoprostone. The study groups were similar with regard to age, parity, initial Bishop score and birth weight. Misoprostol group had higher percentage of entering active phase of labor within 24 hours (61.1% versus 45.4%; ORa=2.0 [1.3-3.3]). The cesarean section rate was lower with misoprostol (17.2% versus 24.6%; ORa=0.6 [0.3-1.1]). The Bishop score obtained with misoprostol was more favorable after ripening. The use of epidural analgesia was statistically higher in misoprostol group (81.7% versus 68.5%; ORa=2.4 [1.4-4.2]). The difference in time from the start of induction to delivery and adverse neonatal outcomes were similar in both groups. The hospital stay and the costs of hospital stay were significantly lower with misoprostol (€2690 versus €3152; pa=0.006). Conclusions:Misoprostol at doses of 25μg is more effective and more cost effective than vaginal dinoprostone, with the same safety in labor induction in women with unfavorable cervix.

Vaginal dinoprostone and misoprostol are equally safe in labour induction at term whereas dinoprostone is less efficacious for cervical ripening and shortening the time of labour

“…The mean percentage of induced labour is in the range of about 20-25 percent, which signifies that every fifth pregnant woman is qualified to pregnancy termination before the onset of spontaneous uterine contractions [9]. In our material, this percentage was similar and did not differ from the data of other authors.…”

“…On the other hand, in the studies by Yehia et al [20], no statistical differences were observed in the occurrence of uterine hyperstimulation in the groups of women undergoing induction with misoprostol and dinoprostone, which may be due to differences in the form and dose of drugs used: titrated oral misoprostol (20 mcg every 2 hours) and vaginal dinoprostone (3 mg). Other studies compared oral misoprostol (50mcg every 4 hours), vaginal misoprostol (25-50mcg every 6 hours) with vaginal gel dinoprostone [23] or vaginal insert dinoprostone (10 mg) [9]. In all the studied groups, the authors did not find statistically significant differences in the occurrence of tachysystole and uterine hyperstimulation.…”

“…The most used are propstaglandin [12]. Both drugs, apart from inducing uterine contractions, play a critical role in cervical ripening and softening [3,9,11]. Studies by Melamed et al [13] proved that after prostaglandin E2 administration in a dose of 3 mg, an effective cervical ripening with favourable cervix to delivery was not achieved in 25% of pregnant women.…”

Comparison of Efficacy of Pervaginal Misoprostol, Intracervical Foley Catheter, Intracervical Dinoprostone on Induction of Labor

“…In group I, mean preinduction Bishop score was 2.18 whereas 2.5 in Chia et al 4 and Cazorla et al 16 study, 3.1 in Ghanaie et al 17 study. In group II, mean preinduction Bishop score was 2.95 whereas it was 2.9 in the study by Henry et al 18 and it was 4.2 in the study by Young et al 14 study.…”