Induction of labour with a viable infant: a randomised clinical trial comparing intravaginal misoprostol and intravaginal dinoprostone

Abstract

Objective To compare the efficacy and safety of vaginal misoprostol (50mg) with vaginal dinoprostone.Design Double-blind randomised trial.Participants 370 patients with medical indications for induction of labour.Outcome measures Vaginal deliveries within 24 hours, as well as time to vaginal deliveries, caesarean rates, costs, and fetal, neonatal and maternal condition. Results Compared with vaginal dinoprostone, vaginal misoprostol resulted in greater efficacy in several areas:vaginal delivery within 24 hours; time to vaginal delivery; and vaginal delivery within 12 hours. There was a non-significant increase in the caesarean section rate for fetal distress in the misoprostol group, but fewer caesarean sections for failed induction. Fetal tolerance was similar in the two groups, although significantly more neonates had a cord pH ,7.20 and (non-significantly) none had meconium stained amniotic fluid in the misoprostol group. The incidence of poor neonatal outcome was similar in both groups. Subgroup analysis by indication for induction showed that the higher rates of arterial cord pH ,7.20 and of meconium-stained amniotic fluid with misoprostol persisted only in possible fetal compromise. Poor neonatal outcome was less frequent in the misoprostol group in cases of induction for non-fetal indications. Conclusions Vaginal misoprostol resulted in successful and earlier induction of labour more often than dinoprostone, but the safety of misoprostol raises some concern in potentially compromised infants. Misoprostol should be preferred to dinoprostone in cases of induction for non-fetal indications.

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

“…No significant differences between the groups with respect to maternal and neonatal outcomes was noted. Thus, in agreement with other studies, 3,7,8,10,11,24,27,29,30 all measures of fetal tolerance of the treatment, umbilical cord pH, the Apgar score and frequency of admission to the neonatal intensive care unit, were the same. The incidence of uterine hyperstimulation, which is commonly thought to be elevated by administration of misoprostol, was low and similar in all three groups.…”

“…These findings are in disagreement with most, 3,6,8 but not all, 4 studies that have demonstrated a higher incidence of hyperstimulation associated with fetal distress in women treated with misoprostol group. In our study, 100 microgram tablets of misoprostol were cut into four pieces of equal size, which might not always have been placed in the posterior fornix, due to difficulties in handling such small pieces, which could explain the unexpected reductions in efficacy and hyperstimulation.…”

Induction of Labour by Intravaginal Misosprostol and Intracervical Dinoprostone: A Comparative Study

“…[7][8][9] In the present study, the main indication was PROM (38.6%) followed by PDP (28.6%). The reason may be that after reaching term, the efficiency of placenta starts to diminish and the foetus suffers increasingly from anoxia.…”

Induction of labour with titrated oral Misoprostol suspension. A comparative study with vaginal Misoprostol

“…12 Other minor side effects in the mother were nausea; vomiting; diarrhea; rashes; dizziness; abdominal pains and flatulence.1,1 1 Passage of meconium, low Apgar scores and increased Caesarean section for foetal heart rate abnormalities have been observed in the foetus. 7 The optimal route and safe dosage o f misoprostol is still being studied. Misoprostol tablets can be given intra-vaginally, sublingually, rectally and orally as a suspension.2,13 Most studies in the literature have used the intravaginal route.3,5,6 The side effects of vaginal misoprostol are dose related.12 The current drug formulation of two hundred microgram 200pg tablet available in our country is difficult to break into a measurable dose.…”