The misoprostol vaginal insert compared with oral misoprostol for labor induction in term pregnancies: a pair-matched case-control study

Döbert, Moritz; Brandstetter, Aleke; Henrich, Wolfgang; Hasselbeck, Hendrik; Döbert, Timm F.; Hinkson, Larry; Schwaerzler, Peter

doi:10.1515/jpm-2017-0049

Cited by 19 publications

(41 citation statements)

References 14 publications

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“…Uterine hyperstimulation is a drawback of a too efficient induction method. The incidence of uterine hyperstimulation has been found to be more common with MVI than dinoprostone, vaginal misoprostol tablets or OM . Supporting these findings, we found the use of tocolysis to be more common in the MVI group.…”

Section: Discussionsupporting

confidence: 81%

“…In previous studies, MVI has been shown to shorten the time interval to vaginal delivery by 6‐14 hours when compared with vaginal dinoprostone, vaginal misoprostol and OM . In our study the time interval difference was even larger.…”

Section: Discussionsupporting

confidence: 47%

“…However, we found no difference in the incidences of pathological CTG patterns or adverse neonatal outcomes; however, our study was not powered to investigate neonatal safety. Previously, no differences in neonatal outcomes have been found between MVI and dinoprostone and vaginal misoprostol tablets, whereas one study questioned the safety of MVI in comparison with OM . More studies are needed to address the safety aspects of MVI compared with OM.…”

Section: Discussionmentioning

confidence: 99%

“…Since then, a few publications showed superior efficacy of MVI with respect to the time interval to vaginal delivery compared with dinoprostone and vaginal misoprostol tablets . So far, only one study has compared MVI with OM; the study showed superior efficacy of MVI but questioned its effects on neonatal safety …”

Section: Introductionmentioning

confidence: 99%

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The efficacy of misoprostol vaginal insert compared with oral misoprostol in the induction of labor of nulliparous women: A randomized national multicenter trial

Hokkila

Kruit

Rahkonen

et al. 2019

Acta Obstet Gynecol Scand

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Introduction Our objective was to compare the efficacy of a 200‐μg misoprostol vaginal insert vs oral misoprostol regarding the cesarean section rate and the time interval to vaginal delivery in nulliparous women with unfavorable cervix. Material and methods In this prospective multicenter trial, 283 nulliparous women at term with Bishop score <6 were randomized to induction of labor with either a misoprostol vaginal insert (n = 140) or oral misoprostol (n = 143). In the oral misoprostol group, a 50‐μg dose of oral misoprostol was administered every 4 hours up to three times during the first day; during the second day, the dose was increased to 100‐μg every 4 hours up to three times during the first day, if necessary. Primary outcome was the cesarean section rate. Secondary outcomes were the time from induction of labor to vaginal delivery, the rate of other induction methods needed, labor augmentation with oxytocin and/or amniotomy, use of tocolytics and adverse neonatal and maternal events. Results In the misoprostol vaginal insert group, median time to vaginal delivery was shorter (24.5 hours vs 44.2 hours, P < 0.001), whereas no difference was found in the cesarean section rate (33.8% vs 29.6%, odds ratio [OR] 1.21, 95% confidence interval [CI] 0.66‐1.91, P = 0.67). Other induction methods and labor augmentation with oxytocin and/or amniotomy were less frequent in the misoprostol vaginal insert group (OR 0.32, 95% CI 0.18‐0.59 and OR 0.56, 95% CI 0.32‐0.99, respectively). Need for tocolysis and meconium‐stained amniotic fluid were more common in the misoprostol vaginal insert group (OR 3.63, 95% CI 1.12‐11.79 and OR 2.38, 95% CI 1.32‐4.29, respectively). Maternal and neonatal adverse events did not differ between groups. Conclusions Misoprostol vaginal insert proved to shorten the time to vaginal delivery and to reduce the use of other methods of labor induction and augmentation, but it did not reduce the cesarean section rate compared with oral misoprostol. The benefit of more rapid delivery associated with misoprostol vaginal insert should be weighed against the greater risks for uterine hyperstimulation and meconium‐stained amniotic fluid.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionsupporting

confidence: 47%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The efficacy of misoprostol vaginal insert compared with oral misoprostol in the induction of labor of nulliparous women: A randomized national multicenter trial

Hokkila

Kruit

Rahkonen

et al. 2019

Acta Obstet Gynecol Scand

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“…In many countries MVI is the only misoprostol product approved for induction of labor in women, using evidence from a large randomized controlled trial conducted in the United States [6, 7]. Compared with dinoprostone (prostaglandin E2, PGE2), misoprostol has shown enhanced uterine contractility effects [7–9], which offer advantages in terms of shorter time interval to delivery but also increases the risk for uterine tachysystole [7, 10, 11].…”

Section: Introductionmentioning

confidence: 99%

Clinical experience with misoprostol vaginal insert for induction of labor: a prospective clinical observational study

Neophytou

Hars²,

Freudenberg

et al. 2018

Arch Gynecol Obstet

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PurposeTo provide real-world evidence using misoprostol vaginal insert (MVI) for induction of labor in nulliparous and parous women at two German Level I Centers in a prospective observational study.MethodsBetween 1 August 2014 and 1 October 2015, eligible pregnant women (≥ 36 + 0 weeks of gestation) requiring labor induction were treated with MVI. Endpoints included time to and mode of delivery rates of tocolysis use, tachysystole, uterine hypertonus or uterine hyperstimulation syndrome and newborn outcomes.ResultsOf the 354 women enrolled, 68.9% (244/354) achieved vaginal delivery (nulliparous, 139/232 [59.9%]; parous 105/122 [86.1%]; p < 0.001). Median time from MVI administration to vaginal delivery was 14.0 h (nulliparous, 14.5 h; parous, 11.9 h; p < 0.001). A total of 205/244 (84.0%) and 228/244 (93.4%) women achieved a vaginal delivery within 24 h and 30 h, respectively. The most common indications for cesarean delivery were pathologic cardiotocography (nulliparous, 41/232 [17.4%]; parous, 13/122 [10.7%]; p = 0.081) and arrested labor (dilation or descent; nulliparous, 45/232 [19.4%], parous, 3/122 [2.5%]; p ≤ 0.001). A total of 24.3% of women experienced uterine tachysystole and 9.6% experienced uterine tachysystole with fetal heart rate involvement, neither of which were significantly different for nulliparous and parous women. In total, 42/345 (12.2%) of the neonates had an arterial pH < 7.15 and 12/345 3.5% had a 5-min Apgar score ≤ 7.ConclusionWhen clinically indicated, MVI was efficient and safe for induction of labor in women with an unfavorable cervix. Women, however, should be counseled regarding the risk of uterine tachysystole prior to labor induction with MVI.

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

Beyer

Jäger

Balci

et al. 2022

Geburtshilfe Frauenheilkd

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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.

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The misoprostol vaginal insert compared with oral misoprostol for labor induction in term pregnancies: a pair-matched case-control study

Abstract: The MVI compared with OM significantly shortened the time from application to delivery at the expense of a higher cesarean section rate and negative effects on neonatal outcomes.

Cited by 19 publications

References 14 publications

The efficacy of misoprostol vaginal insert compared with oral misoprostol in the induction of labor of nulliparous women: A randomized national multicenter trial

The efficacy of misoprostol vaginal insert compared with oral misoprostol in the induction of labor of nulliparous women: A randomized national multicenter trial

Clinical experience with misoprostol vaginal insert for induction of labor: a prospective clinical observational study

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

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