Induction of labour with intravaginal misoprostol and prostaglandin E₂ gel: a comparative study

Abstract

A prospective study was carried out at a tertiary care hospital on 100 pregnant women admitted for induction of labour to compare the effect of misoprostol and dinoprostone on the induction of labour. The patients were divided randomly into two groups of 50 each. Group I received 25 microg misoprostol intravaginally every 3 h (maximum dose 200 microg), and Group II received 0.5 mg PGE(2) gel (dinoprostonev) intracervically every 6 h (maximum three doses in 24 h) until good uterine contractions started. The primary outcome measure was vaginal delivery occurring within 24 h of administration of the first dose of either study drug (successful induction). Statistical analysis were conducted using chi(2) test, Fisher exact test, Student's t-test and relative risk (RR) with 95% confidence interval (CI). In the misoprostol group, more patients achieved successful inductions as compared with the dinoprostone group, 80% vs. 62% (P = 0.0473, RR 1.63, 95% CI 0.95-2.81). The mean induction to delivery interval (IDI) was shorter in the misoprostol group, 13.30+/-8.74 (3-40.15) hours, as compared with the dinoprostone group, 18.53+/-11.33 (2-48.07) hours (P = 0.011). Misoprostol was associated with significantly less oxytocin use (18% vs. 50%) as compared with dinoprostone (P = 0.001 RR 0.36, 95% CI 0.19-0.69). In conclusion, although both misoprostol and dinoprostone appear to be effective agents for labour induction, misoprostol is cheaper, stable at room temperature, has shorter IDI and requires less oxytocin. These results make misoprostol superior to dinoprostone for induction of labour especially in developing and tropical countries.

A Comparative Study of the Safety and Efficacy of Intra Vaginal Misoprostol Tablet Versus Intra Cervical Dinoprostone Gel for Cervical Ripening and Induction of Labour

“…It was statistically significant and was in accordance with the study by Nanda et al [7] The no of vaginal deliveries are 92% in misoprostol and 84% in dinopostone group. Gupta N et al [8] have also reported that vaginal deliveries were 86% in misoprostol, 68% in dinoprostone group.…”

Comparison of vaginal misoprostol tablets and prostaglandin E2 gel for the induction of labor in premature rupture of membranes at term: A randomized comparative trial

“…Several studies have been conducted that have compared 25 µg vaginal misoprostol with PGE 2 preparations (0.5 mg, 16 2 mg, 17 3 mg 18 ) for induction of labor in women without PROM and have found misoprostol to be equally effective 17,18 or more effective than PGE 2 with similar maternal and neonatal outcomes 16 …”

“…Several studies have been conducted that have compared 25 mg vaginal misoprostol with PGE2 preparations (0.5 mg, 16 2 mg, 17 3 mg 18 ) for induction of labor in women without PROM and have found misoprostol to be equally effective 17,18 or more effective than PGE2 with similar maternal and neonatal outcomes. 16 Our trial is the first study that has compared immediate induction with vaginal misoprostol to PGE2 gel for induction of labor in women with PROM at term. The findings do not support the study hypothesis that vaginal misoprostol results in a shorter time interval from induction to delivery than PGE2 gel, but vaginal misoprostol may offer similar efficacy to PGE2 gel for induction of labor after PROM at term.…”

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

“…In an additional report, 37 this same dose of misoprostol was found to be less effective than 1 mg of dinoprostone applied vaginally, but the former was associated with a reduced incidence of instrumental delivery. Moreover, Nanda et al 38 have reported that this dose of misoprostol is more effective than 0.5 mg intracervical dinoprostone, without increasing the frequency of adverse maternal or fetal outcomes. A Cochrane review published in 2003 12 documented no change in the failure to deliver in less than 24 hours when 25 microgram misoprostol was administered vaginally instead of dinoprostone.…”