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.