Induction of Labor at Term with Oral Misoprostol or as a Vaginal Insert and Dinoprostone Vaginal Insert – A Multicenter Prospective Cohort Study

Abstract

Introduction The efficacy, safety, and perinatal outcome of oral misoprostol (OM), a misoprostol vaginal insert (MVI), and a dinoprostone vaginal insert (DVI) for induction of labor at term was examined in a prospective multicenter cohort study (ethics committee vote 4154–07/14). The primary aims of the study were the induction-birth interval (IBI), the cumulative delivery rates after 12 h, 24 h, and 48 h as well as the mode of delivery. Method 322 pregnant women were included in four German tertiary perinatal centers (MVI 110, DVI 64, OM 148). They did not vary in age or BMI. Statistical analysis was carried out using a multivariate linear regression analysis and binary logistic regression analysis. Results With regards to the median IBI, MVI and OM were equally effective and superior to the DVI (MVI 823 min [202, 5587]; DVI 1226 min [209, 4909]; OM 847 min [105, 5201]; p = 0.006). Within 24 hours, 64% were able to deliver with DVI, 85.5% with MVI and 87.5% with OM (p < 0.01). The rates of secondary Caesarean sections (MVI 24.5%; DVI 26.6%; OM 18.9%) did not differ significantly. Uterine tachysystole was found in 20% with MVI, 4.7% with DVI and 1.4% with OM (p < 0.001). A uterine rupture did not occur in any of the cases. Perinatal acidosis occurred (umbilical cord arterial pH < 7.10) in 8.3% with MVI, 4.7 with DVI and 1% with OM (p = 0.32). Neonatal condition was only impaired in three cases (5-minute Apgar score < 5). Summary Induction of labor at term using the prostaglandins misoprostol and dinoprostone is an effective intervention that is safe for the mother and child. Oral application of misoprostol demonstrated the highest efficacy while maintaining a favorable safety profile.

Is oral misoprostol more effective than vaginal dinoprostone for cervical ripening in women with preeclampsia or gestational hypertension: a retrospective cohort study

“…Dinoprostone, a form of prostaglandin E2, is known for its effectiveness in labor induction and improvement of the cervical score [8]. However, its use may be associated with unwanted side effects such as uterine tachysystole, fetal distress, and an increased risk of cesarean delivery [9][10].…”

“…In light of these considerations, the use of vaginal misoprostol or vaginal dinoprostone for cervical ripening and labor induction in patients with preeclampsia or gestational hypertension may not be entirely safe and could potentially lead to adverse pregnancy outcomes. Consequently, researchers have been investigating the use of low-dose oral misoprostol, which has demonstrated e cacy in achieving delivery while minimizing hyperstimulation [9,[14][15]. The 2023 SOGC Guidelines recommend the use of oral misoprostol as the preferred method for cervical maturation and induction of labor [3].…”

Induction of Labour with a Double Balloon Catheter – Comparison of Effectiveness of Six Versus Twelve Hours Insertion Time: a Prospective Case Control Study

“…Oxytocin and prostaglandins are available as drugs for induction 7 8 . Prostaglandin E2 (PGE2 – dinoprostone) and prostaglandin E1 (PGE1 – misoprostol) have a cervical ripening and labour-inducing effect, which is why, unlike oxytocin, they are also used in cases of immature cervical findings.…”