A study of vaginal misoprostol tablet versus intra cervical dinoprostone gel for the induction of labour

Chandni N. Badlani; Shraddha S. Shastri; Neelesh S. Risbud

doi:10.18203/2320-1770.ijrcog20171399

Authors

Chandni N. Badlani Department of Obstetrics and Gynecology, Smt. Kashibai Navale Medical College and General Hospital Pune, Maharastra, India
Shraddha S. Shastri Department of Obstetrics and Gynecology, Smt. Kashibai Navale Medical College and General Hospital Pune, Maharastra, India
Neelesh S. Risbud Department of Obstetrics and Gynecology, Smt. Kashibai Navale Medical College and General Hospital Pune, Maharastra, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20171399

Keywords:

Dinoprostone gel, Induction of labour, Vaginal misoprostol

Abstract

Background: This was a comparative study conducted to compare the effectiveness of 25 microgram of intravaginal misoprostol with intracervical dinoprostone gel in terms of efficacy of drug, feto-maternal outcome, side effects and complications of drugs.

Methods: 400 nulliparas at term, admitted for induction of labor were included in this study. They were randomly selected to receive either intravaginal misoprostol or intracervical dinoprostone gel. Group A (200 women) recieved tablet misoprostol 25 micrograms vaginally 4 hrly to a maximum of 3 doses and Group B (200 women) received dinoprostone gel 0.5mg intracervically 6 hrly to a maximum of 3 doses. Comparison was done in terms of Induction to delivery interval, need for augmentation, LSCS and instrumentation rate, need for NICU admissions and cost effectiveness.

Results: The mean induction to delivery interval was less in the misoprostol group than dinoprostone group (12.5 hrs vs. 20 hrs). 78% patients delivered in the first 24 hrs in misoprostol group compared to 52 % patients in dinoprostone group. Group A had a higher success rate (81% vs.76%) and also required less augmentation of labor ( 30% vs. 60%) compared to group B. Need for LSCS was also lower in misoprostol group (11% vs. 16%). Need for instrumentation and incidence of NICU admission was similar in both groups. Misoprostol was more cost effective compared to dinoprostone.

Conclusions: The misoprostol group had a shorter induction to delivery interval, more number of deliveries in the first 24 hrs of induction and a reduced need of augmentation of labor with oxytocin. There was no significant difference in the rate of caesarean section, hyper-stimulation syndrome, neonatal and maternal morbidity between the two groups. Thus, misoprosol appears to be safer, cheaper and more efficacious alternative for induction of labor especially for non-fetal indications as compared to dinoprostone gel.

Metrics

Metrics Loading ...

References

Houghton Mifflin Company. Induction of labor. In: American Heritage Dictionary, eds. The American Heritage Dictionary, 4th ed. Boston, MA. Houghton Mifflin Harcourt; 2006:1074.

Beischer NA. Maternal well-being during pregnancy. In: Beischer NA, Mackay EV, Colditz PB, eds. Obstetrics and the Newborn. An Illustrated Textbook. 3rd ed. Plhiladelphia: Saunders;1997:449.

Kurup A, Chua S, Arulkumaran S, Tham KF, Tay D, Ratnam SS. induction of labor in nulliparas with poor cervical scores; Oxytocin or prostaglandin vaginal pessaries?: Aust NZJ Obste Gynecol. 1991;31:223-6.

Pollnow DM, Broekhuizen FF. Randomized double-blind trial of PGE2 intravaginal gel versus low dose oxytocin for cervical ripening before induction of labor. Am J Obstet gynecol. 1996;174:1910-3.

Witter FR. Prostaglandin E2 preparations for pre-induction cervical ripening. Clin Obstet Gynecol. 2000;43:469-74.

Arias F. Pharmacology of oxytocin and prostaglandins. Clin Obstet Gynecol. 2000;43:455-68.

American College of Obstetricians and Gynecologist. New U.S. food and drug administration labeling on cytotec (misoprostol) use and pregnancy. In: ACOG, eds. Committee Opinion. Washington, DC: American College of Obstetricians and Gynecolgists;1999:283.

Li XM, Wan J, Xu CF, Zhang Y, Fang L, Shi ZJ, Li K. Misoprostol in labor induction in term pregnancy: a meta-analysis. Chin Med J (Engl). 2004;117:449-52.

Schroder AK, Taulhert S, Diedrich K. induction of labor at term with misoprostol: an effective, safe and inexpensive alternative. Zenrealbl Gynecol. 2004;126:54-8.

Bartusevicus A, Barcaite E, Nadisauskiene R. Oral, vaginal and sublingual misoprostol for induction of labor. Int. J Gynecol Obstet. 2005;91:2-9.

Garry D, Figueroa R, Kalish RB, Catalano CJ, Maulik D. Randomized controlled trial of vaginal misoprostol versus dinoprostone vaginal insert for labor induction. J Matern Fetal Neonatal Med. 2003;13:254-9.

Papanikolaou EG, Plachouras N, Drougia A Andronikou S, Vlachou C, Stefos T et al. Comparison of misoprostol and dinoprostone for elective induction of labor in nulliparous women at full term: a randomized prospective study. Reprod Biol Endocrinol. 2004;2:70.

Murthy BK, Arkalgud MS. Misoprostol alone versus a combination of cerviprime gel and oxytocin for induction of labor. J Obstet Gynecol India. 2006;56(5):413-6.

Latika S, Biswajit C. Comparison of prostaglandin E1 (misoprostol) with prostaglandin E2 (cerviprime) for labor induction. J Obstet Gynecol India. 2004;54(2):139-42.

Patil KP, Swamy MK, Rao RK. Oral misoprostol vs intracervical cerviprime for cervical ripening and labor induction. J Obstet Gynecol India. 2005;55(2):128-31.

Chuck FJ, Huffaker JB. Labor induction with intravaginal misoprostol versus intracervical prostaglandin E2 gel (Prepidil gel): randomized comparison. Am. J Obstet Gynecol. 1995;17:1137-42.

Agarwal N, Gupta A, Kriplani A, Bhatla N, Parul. Six hourly vaginal misoprostol versus intracervical dinoprostone gel for cervical ripening and labor induction. J Obstet Gynecol Res. 2003;29:147-51.

Le Roux PA, Olarogun JO, Penny J, Anthony J. Oral and vaginal misoprostol compared with dinoprostone for induction of labor: a randomized control trial. Obstet Gynecol. 2002;99:201-5.

Van Gemund N, Scherjon S, LeCessie S, Schagen van Leeuwen JH, van Roosmalen J, Kanhai HHH. A randomized trial comparing low dose vaginal misoprostol and dinoprostone for labor induction. BJOG. 2004;111:42-9.

Meydanli MM, Caliskan E, Burak F, Narin MA, Atmaca R. Labor induction post term with 25 microgram vs. 50 micrograms of intravaginal misoprostol. Int J Gynecol Obstet. 2003;81:249.