Safety and efficacy of titrated oral misoprostol solution versus vaginal dinoprostone for induction of labor: A single‐center randomized control trial

Xiu, Wang; Zhang, Chao; Xia, Li; Qi, Hongyan; Qing, Liu; Lei, Jing

doi:10.1002/ijgo.13546

Cited by 14 publications

(7 citation statements)

References 28 publications

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“…In addition, vaginal dinoprostone insert (Propess) appeared to function safely, with a low incidence of complications. The rate of oxytocin augmentation was low at 25%, similar to the rates reported in some previous studies ( 13 ,14). Only 4 women (3.92%) experienced uterine tachysystole.…”

Section: Discussionsupporting

confidence: 89%

“…Only 4 women (3.92%) experienced uterine tachysystole. Other studies have reported that vaginal dinoprostone produced uterine hyperstimulation in approximately 10% of pregnant women but with no serious adverse maternal or fetal outcomes ( 13 ,15). This once again confirms that prostaglandin E2 is effective at stimulating uterine contractions.…”

Section: Discussionmentioning

confidence: 99%

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Dinoprostone Vaginal Insert for Induction of Labor in Women with Low-Risk Pregnancies: A Prospective Study

Anh¹,

Tran²,

Ha³

et al. 2022

Med Arch

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Background: Induction of labor (IOL) is a technique to establish vaginal delivery when the risks for continuing the pregnancy for mother or baby are higher than the risks of delivery. It is usually performed in high-risk pregnancies, but can also be beneficial in low-risk populations, as shown in the ARRIVE trial. Objective: To evaluate the effectiveness and safety of slow-release vaginal dinoprostone (prostaglandin E2 10 mg) for labor induction in women with low-risk pregnancies. Methods: A prospective study was performed at Hanoi Obstetrics and Gynecology Hospital, Vietnam. We recruited women with low-risk pregnancies from 39 weeks + 0 days to 40 weeks + 6 days of gestation and an unfavorable cervix. Women who participated received 10 mg intravaginal slow-release dinoprostone (Propess) for induction of labor. Labor, deliveries, and post-partum management were performed according to the local protocol. Results: From September 2020 to March 2021, 102 low-risk women were eligible to participate in the study. Among these women, 67.6% had vaginal deliveries, 6.9% had postpartum bleeding, and 3.9% experienced tachysystole. All newborns were healthy, with good APGAR scores. None of the women needed respiratory support or intensive care unit admission. All other maternal or fetal complications were explored. The rate of cesarean section was 3.8 higher in nulliparous than multiparous women and 2.2 times higher in women who did not receive epidural analgesia than in those who did. The risk of cesarean section increased if the time between labor induction and active labor was greater than 12.5 hours. Conclusion: Slow-release dinoprostone insert is safe and effective for the induction of labor in low-risk pregnant women. The risk of cesarean section was elevated in nulliparous patients and those who did not receive epidural analgesia during labor. As the time from labor induction to active labor increased, the risk of cesarean section increased.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Dinoprostone Vaginal Insert for Induction of Labor in Women with Low-Risk Pregnancies: A Prospective Study

Anh¹,

Tran²,

Ha³

et al. 2022

Med Arch

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“…Meta‐analysis of direct randomised comparisons 11 suggests low‐dose oral misoprostol reduces the need for birth by caesarean and rate of hyperstimulation, but is otherwise of similar efficacy and safety to the standard dinoprostone regimens, and there may be potential logistical advantages of the oral regimen (oral administration, low cost, and heat stability). The largest study to date 12 randomly allocated 4395 women to titrated oral misoprostol solution 20–50 micrograms 1–2 hourly or vaginal insert dinoprostone 10 mg. Those given oral misoprostol had a significantly lower caesarean birth rate (21.7% vs. 27.0%) and significantly less hyperstimulation (3.6% vs. 8.6%).…”

Section: Misoprostolmentioning

confidence: 99%

Evaluating misoprostol and mechanical methods for induction of labour

Weeks¹,

Lightly²,

Mol³

et al. 2022

BJOG

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Plain language summaryIncreasingly, births around the world are started artificially using medications or other methods. This process is known as induction of labour. As it becomes more common, methods are needed to meet the different clinical needs and birth preferences of women.Induction of labour typically includes a combination of the medication dinoprostone inserted into the vagina, artificial rupture of membranes (‘releasing the waters’), and synthetic oxytocin (hormone given via a drip). This paper reviews some of the methods less commonly used for induction in the UK, namely a drug called misoprostol, which can be given orally or vaginally, and ‘mechanical’ methods, where labour is started by stretching the cervix (neck of the womb), most commonly with a soft silicone tube with a balloon near the tip, filled with water. Low‐dose oral misoprostol tablets are now commercially available in the UK. Other methods for labour induction are not reviewed in detail in this paper.The evidence suggests mechanical induction of labour (using a balloon catheter) and misoprostol are both at least as safe and effective as using the standard drug, dinoprostone. There is evidence to suggest a balloon catheter may reduce the chance of serious negative outcomes for babies when compared with dinoprostone, and that giving low‐dose oral misoprostol results in fewer caesarean births.Where possible and after informed consent, the method of induction of labour should be personalised to suit the individual woman, her clinical condition, and the setting in which she is giving birth. Local contexts and resources also need to be taken into account. To date, research into women's perspectives and experiences of induction of labour have been significantly lacking.

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“…In KBTH, the protocol for induction of labour using misoprostol has evolved over the past decades with specific revisions aimed at improving both the perinatal and maternal outcomes. 19 The use of OMS has been found to be equally effective compared with vaginal route in systematic review by Hofmyer et al 20 Similarly, OMS was found to be associated with lower induction to delivery interval and less side effect compared to vaginal misoprostol in a recent RCT in Egypt. In Ghana, the use of OMS is not well integrated.…”

Section: Resultsmentioning

confidence: 97%

“…In a recent randomized trial in China, titrated OMS for IOL resulted in a lower CS rate (21.7% versus 27%) and tachysystole with fetal heart rate abnormalities (3.6% versus 8.6%) compared to vaginal dinoprostone. 19 The use of OMS has been found to be equally effective compared with vaginal route in systematic review by Hofmyer et al 20 Similarly, OMS was found to be associated with lower induction to delivery interval and less side effect compared to vaginal misoprostol in a recent RCT in Egypt. In Ghana, the use of OMS is not well integrated.…”

Section: Discussionmentioning

confidence: 97%

Factors associated with adverse obstetric events following induction of labour: a retrospective study in a tertiary hospital in Ghana

Adu‐Bonsaffoh¹,

Seffah²

2022

Afr H. Sci.

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Background: Induction of labour (IOL) remains an indispensable intervention in obstetric practice; however, it may be associated with significant untoward perinatal outcomes. This study determined the major adverse outcomes of IOL and the associated factors at a tertiary hospital in Ghana Methods: Retrospective study involving women with singleton gestations, conducted at the Korle Teaching Hospital in Ghana. Multivariable logistic regression was used to explore the factors associated with adverse outcomes of IOL. Findings: A total of 195 women who had IOL were analysed with 161 (82.6%) and 34 (17.4%) undergoing vaginal and caesarean deliveries respectively. The main IOL methods used included Misoprostol (91.3%), Oxytocin (5.1%) and Foley’s catheter (3.6%). Composite adverse perinatal outcomes occurred in 46 neonates (23.6%) comprising perinatal deaths (7.2%) and or NICU admission (21.0%). Caesarean delivery following IOL was significantly associated with nulliparity, gestational age <41 weeks, hypertensive disorders in pregnancy and birth weight ≥3.5kg. Gestational age <41 weeks and birth weight <2.5kg weresignificantly associated with adverse perinatal outcome. Five women (2.6%) had uterine rupture all of which occurred in the misoprostol group. Conclusion: Induction of labour may result in significant perinatal complications which are related to both maternal (nulliparity and hypertension) and fetal (gestational age and birth weight) factors. Strict selection criteria and continuous fetal-maternal monitoring are strongly recommended to improve the birth outcomes of IOL. Keywords: Induction of labour; adverse outcomes; Ghana.

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Safety and efficacy of titrated oral misoprostol solution versus vaginal dinoprostone for induction of labor: A single‐center randomized control trial

Abstract: This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Cited by 14 publications

References 28 publications

Dinoprostone Vaginal Insert for Induction of Labor in Women with Low-Risk Pregnancies: A Prospective Study

Dinoprostone Vaginal Insert for Induction of Labor in Women with Low-Risk Pregnancies: A Prospective Study

Evaluating misoprostol and mechanical methods for induction of labour

Factors associated with adverse obstetric events following induction of labour: a retrospective study in a tertiary hospital in Ghana

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