Induction of Labor: A Comparative Study of Intravaginal Misoprostol and Dinoprostone (original) (raw)
Related papers
Reproductive biology and endocrinology : RB&E, 2004
The objective of this randomized prospective study was to compare the efficacy of 50 mcg vaginal misoprostol and 3 mg dinoprostone, administered every nine hours for a maximum of three doses, for elective induction of labor in a specific cohort of nulliparous women with an unfavorable cervix and more than 40 weeks of gestation. One hundred and sixty-three pregnant women with more than 285 days of gestation were recruited and analyzed. The main outcome measures were time from induction to delivery and incidence of vaginal delivery within 12 and 24 hours. Admission rate to the neonatal intensive care unit within 24 hours post delivery was a secondary outcome. The induction-delivery interval was significantly lower in the misoprostol group than in the dinoprostone group (11.9 h vs. 15.5 h, p < 0.001). With misoprostol, more women delivered within 12 hours (57.5% vs. 32.5%, p < 0.01) and 24 hours (98.7% vs. 91.4%, p < 0.05), spontaneous rupture of the membranes occurred more fr...
Archives of Gynecology and Obstetrics, 2009
Objective To compare efficacy and safety of vaginal misoprostol (PGE1 analog) with dinoprostone (PGE2 analog) vaginal insert for labor induction in term pregnancies. Study design A total of 112 women with singleton pregnancies of ≥37 weeks of gestation, and low Bishop scores underwent labor induction. The subjects were randomized to receive either 50 μg misoprostol intravaginally every 4 h to a maximum of five doses or a 10 mg dinoprostone vaginal insert for a maximum of 12 h. Time interval from induction to vaginal delivery, vaginal delivery rates within 12 and 24 h, requirement of oxytocin augmentation, incidence of tachysystole and uterine hyperstimulation, mode of delivery, rate of cesarean section due to fetal distress and neonatal outcome were outcome measures. Student’s t test, Chi square test, Fischer’s exact test were used for statistical analysis. Results Time interval from induction to vaginal delivery was found to be significantly shorter in misoprostol group when compared to dinoprostone subjects (680 ± 329 min vs. 1070 ± 435 min, P < 0.001). Vaginal delivery rates within 12 h were found to be significantly higher with misoprostol induction [n = 37 (66%) vs. n = 25 (44.6%); P = 0.02], whereas vaginal delivery rates in 24 h did not differ significantly between groups [n = 41 (73.2%) vs. n = 36 (64.2%); P = 0.3]. More subjects required oxytocin augmentation in dinoprostone group [n = 35 (62.5%) vs. n = 20 (35.7%), P = 0.005] and cardiotocography tracings revealed early decelerations occurring more frequently with misoprostol induction (10.7 vs. 0%, P = 0.03). Tachysystole and uterine hyperstimulation, mode of delivery, rate of cesarean sections due to fetal distress and adverse neonatal outcome were not demonstrated to be significantly different between groups (P = 1, P = 0.5, P = 0.4, P = 0.22, P = 0.5). Conclusion Using vaginal misoprostol is an effective way of labor induction in term pregnant women with unfavorable cervices, since it is associated with a shorter duration of labor induction and higher rates of vaginal delivery within 12 h. Misoprostol and dinoprostone are equally safe, since misoprostol did not result in a rise in maternal and neonatal morbidity, namely, tachysystole, uterine hyperstimulation, cesarean section rates and admission to neonatal intensive care units as reported previously in literature.
2011
Objectives: To compare the safety and efficacy of low dose misoprostol and dinoprostone for cervical ripening and labor induction Methods: It was an open label randomized controlled trial conducted at department of Obstetrics & Gynecology, Dr TMA Pai Rotary Hospital, Karkala. The main outcome measure was induction-to-vaginal delivery interval. Secondary outcome measures were the labor characteristics, maternal complications and neonatal outcomes. Results: Out of 320 eligible women included for final analysis, 159 received misoprostol and 161 dinoprostone. There was no significant difference between the two groups in induction-to-vaginal delivery interval, mode of delivery, number of women delivering within 24 hours and neonatal outcomes. The efficacies of the two prostaglandins were similar. Conclusion: Low dose misoprostol is as efficient as dinoprostone in achieving active labor and delivering with in 24 hours. The maternal and neonatal outcomes associated with each group were similar. It is a cheaper alternative for labor induction.
Enliven Archive, 2018
Background Prospective cohort observational study to compare the efficacy low doses (25 micrograms misoprostol) tablet With dinoprostone gel (1mg) introduced vaginally in term pregnancy for induction of labour as regard maternal and fetal outcome. Methods Three hundred pregnant women in full term (40- 41 weeks) pregnancy were randomly assigned for induction of labor either intra vaginal misoprostol tablet or dinoprostone gel. They were divided into 2 groups (A, B). Group A (150 ladies) obtained tablet misoprostol 25 micrograms vaginally 4 hourly and Group B (150 ladies) received dinoprostone gel 1mg vaginally every 6 hourly, the both medications would not be repeated more than 3 doses. Outcomes were; expression of time interval of induction of labour, augmentation requirement, operative and instrumental rate, expenditure efficiency and neonatal outcome. Results The demographic criteria as regard the age. body mass index, Gestational age , initial Bishop score and final Bishop score were analogous in both group (the misoprostol and dinoprostone groups), respectively with no significant differences but about parity ; there was significant difference between them with p value 0.4 .No significant differences between both group as regard occurrence of no reassuring FHR , Uterine hyper stimulation and meconiumstained amniotic fluid but there was significant differences in spontaneous rupture of the membranes and uterine tachysystole with p value 0.02 and 0.01 respectively . Time of labour induction was shorter in the misoprostol group with p < 0.001. The need of more doses was fewer in G1 than G2 with p value 0.03. Also the need to oxytocin for augmentation was lesser in G1than G2 with p value 0.02. In misoprostol group more deliverers within 24 h p < 0.04. The vaginal deliveries, was more in misoprostol group with lesser percentage of CS but with no significant difference .The Fetal outcome in both group was similar according to birth weight, Apgar score and at 5, The requirement for neonatal resuscitation and Neonatal Intensive Care Unit admission. Conclusions The time interval for induction of labour by misoprostol tablet vaginally was shorter than dinoprostone gel, associated with less requirement to augmentation of labor with oxytocin and more deliveries in the first 24 hrs of induction
"An Assessment of Induction of Labour with Misoprostol Per- vaginaly in Postdated Pregnancies"
Introduction: Induction of labour is the artificial initiation of labour before its spontaneous onset for the purpose of delivery of the foetoplacental unit using mechanical or pharmacologic methods. Considering maternal complications, it is preferred to induce labour after 40 weeks. In Bangladesh very few studies have been conducted on this issue. Aim of the study: The aim of this study was to assess the effectiveness of 25 micrograms of vaginal misoprostol for induction of labour in postdated pregnancies and to reduce the rate of Caesarean section in postdated pregnancies Methods: This was a prospective observational study which was conducted in the Chowgasa Upazilla Health Complex of Jashore district of Bangladesh during the period from May 2019 to December 2019. In total 150 women with uncomplicated postdated pregnancy who were admitted to labour ward of the mentioned health complex were selected as the study population. For each of the participants 25 μg of vaginal misoprostol was used for inducing labour. Gestational age, parity, Induction starting time with misoprostol, initiation of uterine contractions, induction delivery interval, caesarean section and vaginal delivery rate and other variables including tachysystole, improvement in Bishop score, foetal outcome were recorded on the checklist. Result: In this study, we found in the highest 94(62.67%) cases the gestational age was 40-41 weeks and in 56(37.33%) cases gestational age was 41-42 weeks. In analyzing the gravidity of the participants we found 22(14.67%) participants were with primi-gravida whereas 128(85.33%) participants were with multi-gravida. In this study, for the highest 100(66.67%) % cases single induction dosage were required whereas 2 dosage were required for 50(33.33%) participants. In this study the induction had been failed on 31(20.67%) and had been successful on 119(79.33%) cases. On 119(79.33%) cases normal delivery were performed whereas on 31(20.67%) cases LSCS were performed.Although we had the arrangements of Forceps/Vacuum procedure also but that wasn't in needed for any participants in this study. In this study among all the participants in only 2.67% cases (n=4) uterine tachysystole was found as the complication whereas no complication 146(97.33%). In Apgar score analysis of this study population we found the Apgar score at 1 min < 7 in 17(11.33%) cases and ≥7 in 133(88.67%) we also found of this study population we found the Apgar score at min < 7 in 7(4.67%) cases and ≥7 in 143(95.33%). Conclusion: In this study the induction had been failed on 31(20.67%) and had been successful on 119(79.33%) cases. So the success rate of induction of labour with misoprostol per-vaginaly was satisfactory. These findings may be helpful for further studies and in the treatment arena.
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2018
Induction of labour is defined as the process of artificially initiating uterine contractions, prior to their spontaneous onset, with progressive effacement and dilatation of the cervix and ultimately, the delivery of the baby. 1 There are many indications for term labour induction, including post dated pregnancy, preeclampsia, diabetes mellitus, oligohydramnios, intrauterine fetal growth retardation and abnormal ante partum fetal surveillance results. 2 With more than 15% of all gravid women requiring aid in cervical ripening and labour induction, there is widespread interest in, and demand for, an effective and safe method of assistance. The immature cervix is the greatest barrier to labour induction. As oxytocin affects mostly uterine contractions and minimally cervical ripening, prostaglandin agents are the first choice for labour inductions as they exert a local effect on the ABSTRACT Background: With more than 15% of all gravid women requiring prostaglandins in cervical ripening and labour induction. However, evidence is not clear about the preferred route or dose of the drug. So this study was designed with objectives to compare the induction delivery interval and safety of titrated oral misoprostol solution with vaginal misoprostol for labour induction in term primigravida women. Methods: In this randomised controlled trial out of 576 eligible women, 220 women as per inclusion criteria between 37 and 42 weeks of gestation with an unfavourable cervix (Bishop score <6) with indication for labour induction were randomly assigned (110each) to receive titrated oral solution of 20 mL misoprostol solution (1 mcg/mL) every 1 hour for four doses and then were titrated against individual uterine response or vaginal misoprostol 25 mcg every 4 hours. Vaginal delivery within 12 hours was the primary outcome. The data were analyzed by intention-to-treat. Results: Vaginal delivery occurred within 12 hours in 56 (50.9%) women in the titrated oral group and 24 (21.8%) women in the vaginal group with significant p-value (<0.001). The incidence of caesarean, hyper stimulation, low apgar score was less in the titrated oral group. More women experienced nausea in the titrated oral group. Conclusions: Titrated oral misoprostol is safe and effective for labour induction in primigravida patients with unfavourable cervix.
Tropical journal of obstetrics and gynaecology, 2013
Context: Induction of labour is an old procedure performed to artificially terminate pregnancy for various indications in the interest of the mother, the fetus or both. The aim is to achieve vaginal delivery. Various methods have been in use which include the use of Misoprostol, Dinoprostone, oxytocin infusion and others. In an effort to determine which agent gives better outcome studies were carried out comparing the agents with one another. Objectives: To compare the outcomes of labour induced with Misoprostol and Dinoprostone and to determine the incidence of induction of labour at Aminu Kano Teaching Hospital Kano Nigeria. Materials and Methods:The study was restrospective involving a total of 364 patients admitted for labour induction between January 2005 to December 2009. Out of this 274 were induced with Misoprostol and 90 were induced with Dinoprostone. Results: The incidence of labour induction is 2.35%. The indications include postdatism, Hypertensive disorders of pregnancy, PROM, IUFD and others such as Sickle cell disease, and Diabetes Mellitus. The most common indication was postdatism 45.9%. The success rate was 83.9% for Misoprostol and 82.2% for Dinoprostone. There is a statistically significant difference in terms of shorter induction delivery interval in favour of Misoprostol. There were less number of babies with APGAR score less than 6 in the Misoprostol group. There is no statistically significant difference in terms of the spontaneous vaginal deliveries and caesarean section rates between the two groups. Conclusion: The rate of induction of labour in the centre is 2.35%. Misoprostol was found to be a more efficient and safer agent for induction of labour if the procedure is well managed. It was associated with shorter induction delivery interval without compromising the fetomaternal outcome compared to Dinoprostone.
2023
Objective: To compare the effectiveness and safety of 50μg of sublingual misoprostol administered six (6) hourly to that of 50μg of vaginal misoprostol administered four (4) hourly. Methodology: A non-blinded, randomized controlled trial conducted from Sept 1, 2014, to Nov 31, 2014, at a tertiary hospital in Ghana. Hundred and sixty women with medical or obstetric indications for labour induction were randomized into two groups. Results: The rate of vaginal delivery, caesarean section, uterine tachysystole and uterine hyperstimulation were similar in both groups. Sixty-three (78.8%) and 66 (82.5%) mothers in the vaginal and sublingual groups delivered vaginally. More (10.0%) mothers in the vagina group required emergency caesarean for foetal distress. Six (vaginal group) and 8 (sublingual group) of the mothers required emergency caesarean for cephalopelvic disproportion. Three mothers from each group had an emergency caesarean section due to failed labour induction. Almost the same number of mothers had uterine tachysystole in both groups. More (3.8%) mothers in the vaginal group had uterine hyperstimulation. Differences in the mean induction delivery interval and the need for oxytocin augmentation were not significant. No differences were found in the intrapartum passage of meconium, blood loss in the third stage of labour, 5-minute Apgar score <7, and neonatal intensive care unit admissions. Conclusion: The sublingual regimen was as effective and safe as the vaginal regimen in achieving vaginal delivery.
A comparison of vaginal misoprostol and prostaglandin E2 for induction of labour at term
Our objective was to compare the efficacy of vaginal misoprostol and tablet PGE2 for induction of labor at term.Methods: In this RCT a total of 140 women at term gestation were given either misoprostol (50 mcg) or prostaglandin E2 (3 mg) for induction of labour. The study was conducted at the Gynae/Obstetrics department, PAEC Hospital Islamabad, in a period of six months. All women requiring induction, having gestational age > 37 weeks, singleton pregnancy with cephalic presentation, bishop score < 6 and reassuring fetal heart rate tracing were included in the study. The study outcome was measurement of efficacy in terms of induction delivery interval, number of vaginal deliveries achieved within 24 hours, mode of delivery, total doses, need for oxytocin and number of successful inductions. Results: The mean age and average gestational age was similar in the two groups of patients. In group A (51.4%) patients required two doses while in group B (32.9%) took two doses. Similarly, (60%) patients required oxytocin in group A compared to (50%) in group B. The mean delivery induction interval was 10.8 hours (650 minutes) in group A compared to 9.01 hours (541 minutes) in group B; and this difference in two means is statistically significant. In group A (18.5%) patients required emergency cesarean section while in group B (27.1%) needed cesarean section. The major indication for emergency cesarean section in group B was fetal distress. Therefore misoprostol can play a very important role in the practice of obstetrics and gynecology in resource depleted countries where other prostaglandins are expensive and storage at low temperature is a problem.
A randomised trial comparing low dose vaginal misoprostol and dinoprostone for labour induction
BJOG: An International Journal of Obstetrics and Gynaecology, 2004
Objective To compare vaginal misoprostol with dinoprostone for induction of labour. Design Randomised multicentre trial. Setting Labour wards of one university hospital and two teaching hospitals. Population Six hundred and eighty-one women with indication for labour induction at 36 weeks of gestation, singleton pregnancy and no previous ceasarean section. Methods Misoprostol (25 mcg, hospital-prepared capsule) in the posterior vaginal fornix, every four hours, maximum three times daily or dinoprostone gel (1 mg) every four hours. Oxytocin was administered if necessary. Main outcome measures Primary: 'adverse neonatal outcome' (5-minute Apgar score <7 and/or umbilical cord pH <7.15). Secondary: labour duration, mode of delivery and patient satisfaction. Results Three hundred and forty-one women received misoprostol and 340 dinoprostone. The median induction-delivery interval was longer in the misoprostol group compared with the dinoprostone group (25 versus 19 hours, P ¼ 0.008). The caesarean section rate was lower in the misoprostol group: 16.1% versus 21%, but this difference was not statistically significant RR ¼ 0.8 (95% CI 0.6-1.04). 'Adverse neonatal outcome' was found to be similar in both groups: 21% in the misoprostol and 23% in the dinoprostone groups. Significantly fewer neonates were admitted to NICU in the misoprostol group compared with dinoprostone 19% versus 26% (RR ¼ 0.7, 95% CI 0.5-0.98). Conclusions Misoprostol in this dosing regimen is a safe method of labour induction. NICU admission rates were lower in the misoprostol group. No difference could be detected in patient satisfaction between groups.