Analysis of intravaginal misoprostol 0.2 mg versus intracervical dinoprostone 0.5 mg doses for labor induction at term pregnancies

Abstract

Objectives: Labor-induction methods are used in about 23% of labors. Most commonly, pharmacological methods are used to pre-induct the labor with dinoprostone -a PGE2 analog, and misoprostol -a PGE1 analog. The aim of this study was to evaluate two pharmacological methods of labor induction with the use of prostaglandins applied via an intravaginal insert containing misoprostol at a dose of 0.2 mg and intracervical gel containing dinoprostone at a dose of 0.5 mg. Material and methods:This retrospective study was conducted on a group of 50 adult patients qualified for the pre-induction of labor. Following data were recorded: the time from the drug administration to the beginning of regular contractile function, the time from administration to amniotic fluid rupture, the time from medicament administration to the vaginal labor or caesarean section, the duration of I, II and III stages of labor, the delivery method and in the event of caesarean section -the indications for surgery. Results:In comparison to dinoprostone, the misoprostol application was found to shorten the time from drug administration to amniotic fluid rupture by 14.1 hours, the time to the beginning of the first stage of labor by 11.7 hours and from the drug administration to the delivery by 17.3 hours (p-value < 0.05). The duration of the first stage of labor in the misoprostol group was shorter by 1.2 hours than in dinoprostone group (p-value < 0.05). Conclusions:Application of intravaginal insert with misoprostol at a dose of 0.2 mg appears to be a more effective method of labor induction in comparison to intracervical gel with dinoprostone at a dose of 0.5mg. Thorough analysis of these methods requires further studies.

Obstetric outcomes of pre-induction of labor with a 200 μg misoprostol vaginal insert

“…The results of this study concerning average age, parity and duration of pregnancy are comparable to the results reported in literature [4,6,21,22]. Yet, similarly to studies of Wing et al, Tsicouras et al or that of Kosińska-Kaczyńska et al, in our study the primigravidas prevail (65-82%), which is associated with the cervix being more immature in that subgroup, hence more often selected for pre-induction [2,3,7,23]. To support this, we show that the Bishop score in our study was significantly higher compared to the multiparas subgroup.…”

“…Other authors report comparable results [7,16,18,21]. In our clinic the study yields a vaginal delivery rate within 12 hours equal to 43.28% and within 24 hours equal to 83.58%.…”

“…The literature is rich is articles that compare and assess the effectiveness and safety of pre-induction methods involving prostaglandins such as dinoprostone gel and vaginal insert or misoprostol in form of tablets or inserts [7,[15][16][17][18][19]. Misoprostol tablets are registered in Europe for the prevention and treatment of gastric ulcers only.…”

“…Moreover, our vaginal delivery rate within 12 hours was higher in multiparas (p < 0.05), while the rate within 24 hours converged between the groups. Also, in our study group over half of patients were observed to have PROM before the onset of second stage of labor, usually after 15 [7].…”

“…Induction of labor is an obstetric procedure that is used increasingly more often (20-40% of pregnancies) [1][2][3][4][5][6][7]. The reason for that may be the increased proportion of pregnant patients with a chronic condition (for instance obesity, hypertension, diabetes mellitus) and the advancements in diagnostic methods during prenatal care that allow early detection of threats to fetal well-being [1,4].…”