Sublingual Misoprostol (PGE1) Versus Intracervical Dinoprostone (PGE2) Gel for Induction of Labour: A Randomized Control Trail

Abstract

Background Prostaglandins are popular agents for induction of labour, owing to their dual action of cervical ripening and inducing uterine contractions. Sublingual misoprostol offers high efficacy as it bypasses first-pass metabolism. Researchers have proved that intracervical PGE1 is as effective as PGE2 except for increased caesarean rate and hyperstimulation. Limited knowledge is available on the efficacy of sublingual PGE1 and intracervical PGE2. This study was designed to compare the effectiveness of sublingual PGE1 with intracervical PGE2. Methods A randomized control trial was conducted in Bangalore Baptist Hospital, Bangalore. One hundred and ninety women with singleton, term pregnancy were equally divided into PGE1 and PGE2 groups, and primary outcome was measured. Results Post-induction mean Bishop's score in PGE1 group was statistically significant (t = 6.57, p \ 0.05).This study was conducted at Bangalore Baptist Hospital, Bellary Road, Hebbal, Bangalore, 560024 (Phone: 080-22024700). Sr. Dr. Veena Braganza is a missionary nun belonging to the Sisters of Charity which runs health centres in Goa and rural Karnataka. She did her DGO in Goa Medical College and served in various mission hospitals before she obtained DNB from Bangalore Baptist Hospital, Bangalore. She is passionate in reaching out to the poor with low-cost affordable yet safe and effective care. This PG thesis on PGE1 as promising agent was her special interest due to its low cost, and she herself used in limited resource settings. Hence, she conceptualized this trail to prove its efficacy scientifically. Her keen interest is VBAC to bring down cost of surgeries and obstetric care. She is currently involved in making health care accessible to migrant population in Goa and Karnataka. Braganza Veena is Medical Director and Consultant in Obstertics andThe Journal of Obstetrics and Gynecology of India (September-October 2016) 66(S1):S122-S128 DOI 10.1007/s13224-015-0820-8123 Conclusion Sublingual PGE1 is a better cervical ripening agent, faster and more effective, with a shorter inductionto-delivery interval as compared to intracervical PGE2. We also noted lower incidence of caesarean section and foetal distress with sublingual PGE1 compared to oral or vaginally administered PGE1.

A Comparative Study between Sublingual Misoprostol (PGE1) versus Intracervical Dinoprostone Gel (PGE2) in the Induction of Labor:- A Prospective Observational Study

“…In our study, majority of pregnant women belonged to the age group of 21-30 years, which were comparable to the study done by Swaran et al [16] Gestational age corresponded from 37 to 42 weeks of gestation, similar to a study done by Sophia et al [17] In our study, there was shorter IDI in the misoprostol group compared to the dinoprostone group, which was similar to the studies done by Chitrakar, [10] Veena et al, [13] and Girija and Manjunath. [18] Saxena et al's study showed, that induction to vaginal delivery interval with misoprostol 25 µg was 16.44 ± 7.37 h, and in dinoprostone group (0.5 mg), it was 16.38 ± 7.49 h, whereas in our study, IDI was 14.16 ± 3.62 h and 13.93 ± 5.69 h, respectively.…”

“…to achieve vaginal delivery and with no increase in perinatal morbidity. [13] A pregnant woman is in labor, when three or more uterine contractions occur in 10 min and dilatation of the cervix is more than 4 cm. [14] The comparative studies of sublingual, oral, and vaginal misoprostol showed that the sublingual route of administration is better than oral and vaginal routes for cervical ripening.…”

Cervical Versus Vaginal, and Sublingual Misoprostol for Labor Induction at Term Parturient: a Randomized Double-blind Clinical Trial

“…In this study, the majority of 189 (63%) of our patients required a single induction dose of 50 µg, which is similar to other investigations (19,20). In the cervical groups, the time from initial administration to regular contractions was 3.01 ± 0.86 hours, a gure better than the intravaginal and sublingual results of the same dose of misoprostol (21,22). Approximately 92.7% of women achieved vaginal delivery below 10 h and 7.3% achieved vaginal induction up to 10 h, of which the cervical community reported the least time to delivery with a mean of 6.1 ± 1.3 h. In the cervical group the rate of spontaneous vaginal delivery (93%) appeared to be better than to that reported by Souizi et al (64.5%) (23), Veena (76.8%) ( 22), Girija (60%) (24), Jahromi (25) using routes of administration sublingual or vaginal.…”

Factors associated with delayed onset of active labor following vaginal misoprostol administration among women at Mbarara Regional Referral Hospital, Uganda

“…The proportion of mothers with delayed onset of labor in our study is higher than that found in studies carried out in similar settings in resource‐limited countries. In a study by Veena et al, 6 at a multispecialty teaching hospital in Bangalore, the proportion of mothers who failed to attain active labor within 12 hours of initiating labor induction was 11.5%. The study however used sublingual misoprostol at an interval of 4 hours, which might explain the difference.…”