Comparative evaluation of low dose-vaginal misoprostol and intra-cervical dinoprostone for cervical ripening and induction of labour in term pregnancy

Abstract

Background: Induction of labour is one of the most common obstetric interventions worldwide. The study was conducted to compare the efficacy and safety of 25µg (low dose) vaginal Misoprostol with intracervical Dinoprostone for cervical ripening and induction of labour in term pregnancy.

Methods: The study was conducted on 200 eligible term gravidas admitted for the purpose of labour induction. Subjects were randomly allotted to two groups. Group A (100 patients) received 25µg vaginal Misoprostol 6 hourly, while Group B (100 patients) received intracervical Dinoprostone 6 hourly for a maximum of 3 doses each, for cervical ripening and induction of labour. The main outcomes analysed were the induction-to-vaginal delivery interval, number of vaginal deliveries within 24 hours, dose of prostaglandin required, need for oxytocin augmentation and incidence of operative or caesarean delivery and rates of hyper stimulation, maternal complications and neonatal outcome.

Results: Misoprostol use was associated with shorter induction-to-vaginal delivery interval (1165.60+306.28 minutes v/s 1369.80+286.96 minutes, p= <0.001), a greater proportion of patients delivering vaginally within 24 hours (67% v/s 46%, p=0.001) and lesser need for oxytocin augmentation to achieve vaginal delivery (25.3% v/s 54.7%, p<0.001).The mean change in Bishop’s score was greater with Misoprostol, although the difference was not statistically significant. The rates of operative and caesarean deliveries, and indications for caesarean were similar in both groups. The rates of uterine hyper stimulation, maternal and neonatal outcomes were similar.

Conclusions: Vaginal Misoprostol is more efficacious than intracervical Dinoprostone for induction of labour in term gravidas.