Comparative study of the efficacy and safety of dinoprostone vaginal insert versus low dose intravaginal misoprostol for induction of labour at term: a retrospective cohort study

Abstract

Background: Induction of labour is one of the most commonly performed obstetric procedures worldwide. Prostaglandins are among the most effective agents used for cervical ripening and labour induction. Various prostaglandin formulations are available, and their comparative efficacy and safety continue to be evaluated. This study aimed to compare the efficacy, safety, and patient acceptability of dinoprostone vaginal insert and intravaginal misoprostol for induction of labour.

Methods: This retrospective cohort study was conducted at a tertiary care centre over a six-month period. Medical records of 40 pregnant women who underwent induction of labour were reviewed. Participants were randomly allocated into two groups: 20 women received a single 10 mg dinoprostone vaginal insert for a maximum duration of 24 hours, while 20 women received 25 µg intravaginal misoprostol placed in the posterior fornix every 4 hours for a maximum of 24 hours. Maternal and fetal outcomes, induction-to-delivery interval, oxytocin requirement, mode of delivery, adverse effects, and patient acceptability were compared between the two groups.

Results: The induction-to-delivery interval was significantly shorter in the dinoprostone vaginal insert group compared with the misoprostol group. The requirement for oxytocin augmentation was lower in the dinoprostone group. Caesarean section rates were comparable between the groups. Uterine hyperstimulation was more frequent in the dinoprostone group, whereas there were no significant differences in the incidence of meconium-stained liquor or postpartum haemorrhage. Patient acceptability was higher with dinoprostone, attributed to reduced first-stage labour pain and fewer per-vaginal examinations. Neonatal outcomes, assessed using Apgar scores at 1 and 5 minutes, were comparable between the two groups.

Conclusions: Both intravaginal misoprostol and dinoprostone vaginal insert are safe and effective methods for induction of labour. Dinoprostone vaginal insert was associated with a shorter induction-to-delivery interval, reduced oxytocin requirement, and better patient acceptability. The choice of induction agent should be individualised based on clinical indication, patient preference, and cost considerations.