Titrated Misoprostol Versus Dinoprostone for Labor Induction

Abstract

Background: Misoprostol is as effective as dinoprostone for labor induction with low cost and temperature stability.

Aim: This study designed to compare titrated misoprostol regarding its safety and efficacy with dinoprostone for induction of labor.

Subjects and Methods: Women with a single pregnancy, above 37 weeks’ gestation, cephalic presentation, modified Bishop’s score <8, and not in labor with reassuring fetal heart rate, admitted for labor induction enrolled in this randomized controlled study. Studied women were randomized into; Group I: received oral misoprostol titrated in sterile water (200 μg tablet was dissolved in 200 ml sterile water [1 μg/ml]), starting dose of 20 μg misoprostol required, given every 2 h, and stopped if adequate contractions obtained and Group II: received vaginal dinoprostone tablet maximum two doses followed by augmentation of labor by oxytocin ± amniotomy if there is no uterine contractions after two doses of dinoprostone. In Group I, if the contractions were inadequate after two doses of oral titrated misoprostol (20 μg [20 ml]), the starting dose increased to 40 μg (40 ml), escalating the dose from 5 to 10 ml (45–50 μg), and 20 ml (60 μg) maximum ± amniotomy. If the uterine contractions were adequate, the next dose of misoprostol or dinoprostone was omitted. Statistical analysis done using Student’s t‑test for quantitative data and Chi‑square test for qualitative data.

Results: Induction‑to‑delivery time was significantly longer in misoprostol than dinoprostone group (975 vs. 670 min, respectively), (P = 0.01). About 20.2% (21/104) of women in misoprostol group did not deliver vaginally within 24 h compared to 7.4% (8/108) in dinoprostone group (significant difference, P = 0.01). Augmentation of labor was significantly high in dinoprostone (37.96% [41/108]) compared to misoprostol group (10.6% [11/104]) (P < 0.01).

Conclusion: Titrated misoprostol for induction of labor seems to be associated with significantly longer induction‑to‑delivery time, low incidence of vaginal birth within 24 h, and less need for augmentation of labor compared to vaginal dinoprostone.

KEY WORDS: Dinoprostone, labor induction, titrated misoprostol