Comparative study of intravaginal misoprostol versus dinoprostone gel for induction of labour in primigravida


  • Shirish S. Dulewad Department of Obstetrics and Gynecology, Dr. Shankarrao Chavan Government Medical College, Nanded, Maharashtra, India
  • Chitikala Haritha Department of Obstetrics and Gynecology, Dr. Shankarrao Chavan Government Medical College, Nanded, Maharashtra, India



Dinoprostone, Induction of labour, Misoprostol


Background: Labour is an inevitable consequence of pregnancy. The aim of the present research was to study the safety, efficacy and effect of intravaginal misoprostol and dinoprostone gel for induction of labour.

Methods: 300 patients who required induction of labour in a tertiary care centre were included in this prospective randomized controlled study from August 2019 to August 2021 with a study duration of 12 months. 50% of cases received 25 µg of intravaginal misoprostol and repeated for a maximum of 6 doses every 4 hours as needed. 50% cases received 0.5 mg dinoprostone gel and repeated for maximum of 2 doses every 6 hours as needed. The patients selected were evaluated initially by modified Bishop’s score and admission test for fetal wellbeing. After drug insertion, patients were monitored for fetal heart rate, vital signs, progress of labour. A partogram was strictly maintained in all patients.

Results: The highest number in both groups being below 40 weeks which were 74% and 76% in dinoprostone and misoprostol groups respectively. Rest were between 40.1-41.6 weeks. The mean induction delivery interval in dinoprostone was more (16.15±3.1) than in misoprostol (12.26±2.21). Requirement of oxytocin augmentation was less in misoprostol group than dinoprostone group. Caesarean section rate was less in misoprostol group. Maternal side effects were minimal in either groups and neonatal outcome was good in both the groups.

Conclusions: Both misoprostol and dinoprostone gel are safe, effective for cervical ripening and induction but misoprostol is more cost effective and stable at room temperature.



Shi L, Yao W, Gan Y, Zhao LY, Eugene McKee W, Vink J, et al. Anisotropic material characterization of human cervix tissue based on indentation and inverse finite element analysis. J Biomech Eng. 2019;141(9):0910171-3.

Pierce S, Bakker R, Myers DA, Edwards RK. Clinical insights for cervical ripening and labor induction using prostaglandins. Am J Perinatol Rep. 2018;8(04):e307-14.

Bakker R, Pierce S, Myers D. The role of prostaglandins E1 and E2, dinoprostone, and misoprostol in cervical ripening and the induction of labor: a mechanistic approach. Arch Gynecol Obstet. 2017;296(2):167-79.

Shepherd JH, Knuppel RA. The role of prostaglandins in ripening the cervix and inducing labor. Clin Perinatol. 1981;8(1):49-62.

Trofatter KF Jr, Bowers D, Gall SA, Killam AP. Preinduction cervical ripening with prostaglandin E2 (Prepidil) gel. Am J Obstet Gynecol. 1985;153(3):268-71.

Nager CW, Key TC, Moore TR. Cervical ripening and labor outcome with preinduction intracervical prostaglandin E2 (Prepidil) gel. J Perinatol. 1986;7(3):189-93.

Sanchez-Ramos L. Induction of labor. Obstet Gynecol Clin. 2005;32(2):181-200.

Fletcher HA, Mitchell S, Frederick J, Simeon D, Brown D. Intravaginal misoprostol versus dinoprostone as cervical ripening and labor-inducing agents. Obstet Gynecol. 1994;83(2):244-7.

Bugalho A, Bique C, Machungo F, Faundes A. Low-dose vaginal misoprostol for induction of labor with a live fetus. Int J Gynecol Obstet. 1995;49(2):149-55.

Varakalis K, Gumina R. Randomised controlled trial of vaginal misoprostol and intracervical PGE2 gel for induction of labour at term. Obstet Gynaecol. 1995;86:541-4.

Herabutya Y, Prasertsawet P, Pokpirom J. A comparison of intravaginal misoprostol and intracervical PGE2 gel for ripening of unfavourable cervix and labour induction. J Obstet Gynaecol. 1997;23(4):369-74.

Baños N, Migliorelli F, Posadas E, Ferreri J, Palacio M. Definition of failed induction of labor and its predictive factors: two unsolved issues of an everyday clinical situation. Fet Diagnos Therap. 2015;38(3):161-9.

Wing DA, Rahall A, Jones MM, Goodwin TM, Paul RH. Misoprostol: an effective agent for cervical ripening and labor induction. Am J Obstet Gynecol. 1995;172(6):1811-6.

Young D, Bennett K, Butt K, Mundle W, Windrim R. Induction of labour with misoprostol- a review. J SOGC. 1996;18(11):1153-7.

Sanchez Ramos L, Kaunitz AM, Dei Valle GO, Delke I, Schroeder PA, Briones DK. Labor induction with the prostagiandin E1 methyl analog misoprostol versus oxytocin: a randomized trial. Obstet Gynecol. 1993;81:332-6.






Original Research Articles