Oral misoprostol and intracervical dinoprostone for cervical ripening and labor induction: a randomized comparison

Background: This randomized prospective study was conducted in the department of obstetrics and Gynaecology Batra Hospital and Medical Research centre from 1st March to 30th April 2008 to compare the safety and efficacy of intravaginal misoprostol and intracervical dinoprostone gel (cervigel) for cervical ripening and induction of labour.Methods: 80 women were recruited in the study. 40 women were administered misoprostol tablet 25ug vaginally while the other 40 were given intracervical cervigel.Results: A total of 85.1% (68 patients) delivered vaginally (33 in the misoprostol group and 35 in the cervigel group) i.e. spontaneous vaginal and assisted vaginal deliveries. The mean interval from start of induction to vaginal delivery was 707.63+146.511 minutes in the misoprostol group and 833.13 +144.36 minutes in the cervigel group with p=0.001 which was significant statistically. Though both the groups showed a favourable change in Bishop’s score after induction but this was not statistically significant. However, the number of doses required in both the groups to produce an effect on cervical ripening and dilation was statistically significant p=0.001, cervigel group requiring lesser dose (42.5% in cervigel vesus 7.5% in the misoprostol group after administration of 1st dose).Conclusions: Both 25ug misoprostol intravaginal and dinoprostone gel intracervical are equally effective and safe for cervical ripening and induction of labour.

“…The finding of our study was consistent with findings reported by Mundel and young and Bartha et al 7,8 No. of doses…”

Section: Discussionsupporting

confidence: 94%

“…The finding of our study was consistent with findings reported by Mundel and young and Bartha et al 7,8 Bishop's score at induction statistically not significant in both the groups. 92.5% (37) patients of misoprostol group had unfavourable cervix as compared to 100% (40) pts in cervigel group.…”

Section: This Comparativesupporting

confidence: 93%

To compare the efficacy and safety of intravaginal misoprostol and intracervica lcervigel for induction of labour

Malik

2017

“…6,7,8 In study done by Kulshreshtha S et al the mean preinduction Bishops score was 4.45±1.77 in PGE1 and 4.25±1.89 in PGE2 group and in our present study the mean pre-induction Bishops score was 3.46±1.23 in PGE1 and 3.36±1.1 in PGE2 group. 5 In studies done by Bartha et Incidence of caesarean sections was high in PGE2 group compared to PGE1 group in studies done by Bartha L et al, Patil Kamal P et al, Kulshreshtha S et al 3,4,9 Present study showed high caesarean section rate in PGE1 group compared to PGE2 group in accordance with study done by Parmar M et al, but it was not statistically significant. 6 Liquor colour at delivery was meconium stained in 12% in PGE1 group and 6% in PGE2 group in study done by Patil P et al10.In our study it was 16% in PGE1 and 8% in PGE2 group which was comparable.…”

Section: Resultssupporting

confidence: 75%

Randomized control trial of low dose oral misoprostol compared with intracervical dinoprostone gel for cervical ripening

Savithri

Chennupalli

Suvarna

et al. 2017

Background: Induction of labour is a therapeutic option when the benefits of delivery outweigh risks of continuing pregnancy. There are several agents for induction of labour to achieve better outcome of labour. Acceptable methods for induction are oxytocin infusion, dinoprostone gel, misoprostol and mechanical cervical dilators. Prostaglandins are the preferred choice in unripened cervix. Objective of this study was to compare efficacy, safety of low dose oral misoprostol compared with intracervical dinoprostone gel for cervical ripening.Methods: One hundred women with single live fetus, term gestation, cephalic presentation, reactive fetal heart pattern and Bishops score <6 were included in the study. They were randomized to receive either 6 doses of 25ug oral misoprostol every 3rd hourly or 0.5ug intracervical dinoprostone every 6th hourly for a maximum of 3 doses.Results: Bishops score improvement after 6,12,18 hours in both the groups was statistically insignificant. Induction delivery interval was11.96±5.88 for misoprostol and 10.95±4.58 in dinoprostone group with P value 0.341 which was statistically insignificant. Need for oxytocin augmentation was less (18%) in misoprostol group as compared to dinoprostone group (44%). Caesarean section rate was slightly higher in misoprostol group (26% vs 24%). Meconium stained amniotic fluid was high in misoprostol group (16%) compared to dinoprostone group (8%). Maternal complications were minimal and neonatal outcome was good in both the groups.Conclusions: Compared to dinoprostone; misoprostol is easy to store, cost effective, stable at room temperature, can be easily administered and had better patient compliance and acceptability. It was found to be a better cervical ripening agent with similar maternal and fetal safety profile.

“…Parmar M et al study showed 40% and 36% cases, Greagsons et al study 95% and 94%, Sheela CN et al study 36% and 32% cases induced for postdatism in Group I and Group II respectively. [6][7][8] Incidence of caesarean sections was high in PGE2 group compared to PGE1 group in studies done by Jose BL et al4, Kamal P et al, Kulshreshtha S et al [3][4][5] Present study showed high caesarean section rate in PGE1 group compared to PGE2 group in accordance with study done by Parmar M et al but it was not statistically significant. 6 Liquor colour at delivery was meconium stained in 12% in PGE1 group and 6% in PGE2 group in study done by Patil P et al 9 In present study it was 16% in PGE1 and 8% in PGE2 group which was comparable.…”

Section: Discussionsupporting

confidence: 79%

“…Similarly, in study done by Jose BL et al the mean age in both the groups is 28.31±5.09 and 28.12±4.66 and in Kulshreshtha S et al study the mean age is 20±3.75 and 25.35±3.31 in two groups respectively and the distribution in age in two groups was not statistically significant. 4,5 In present study postdatism was the most common indication for induction, 70% and 64%in Group I and Group II respectively. Parmar M et al study showed 40% and 36% cases, Greagsons et al study 95% and 94%, Sheela CN et al study 36% and 32% cases induced for postdatism in Group I and Group II respectively.…”

Section: Discussionmentioning

confidence: 46%

Neonatal outcome in randomized controlled trial of low dose oral misoprostol in comparison with intracervical Dinoprostone gel for labour induction

Savithri

Suvarna

Chennupalli

et al. 2017

Background: Induction of labour is a therapeutic option when the benefits of delivery outweigh risks of continuing pregnancy. There are several agents for induction of labour to achieve better outcome of labour. Acceptable methods for induction are oxytocin infusion, dinoprostone gel, misoprostol and mechanical cervical dilators. Prostaglandins are the preferred choice in unripened cervix. To study the neonatal outcome in induction of labour with low dose oral misoprostol compared with intracervical dinoprostone gel and also to assess occurrence of meconium staining liquor.Methods: One hundred women with single live fetus, term gestation, cephalic presentation, reactive fetal heart pattern and Bishops score <6 were included in the study. They were randomized to receive either 6 doses of 25ug oral misoprostol every 3rd hourly or 0.5ug intracervical dinoprostone every 6th hourly for a maximum of 3 doses. Oxytocin was administered. Fetal outcome was assessed in terms of APGAR score, meconium staining and need for NICU.Results: Meconium stained amniotic fluid was high in misoprostol group (16%) compared to dinoprostone group (8%). NICU admissions were seen in 7 neonates in both groups.Conclusions: Low dose oral misoprostol is a safe method of labour induction. APGAR and NICU admission rates were comparable in both groups. Meconium staining was more in misoprostol group compared to dinoprostone group.