Fauzia Nausheen, Javed Iqbal, Shahida Sheikh.
Induction of labor Misoprostol vs Dinoprostone.
Ann King Edward Med Uni Jan ;10(4):394-6.

Objective: To compare the safety and efficacy of misoprostol with PGE2 for induction of labor by intra vaginal administration Study Design: It was a comparative and interventional study Study Venue: The study was carried out in the Department of obstetrics & Gynaecology, Jinnah Hospital, Lahore. Subjects and Methods: 46 women with indications for labor induction at term and post-term were randomly assigned to two groups. Each woman received either 200µg of misoprostol or 3mg of prostaglandin E2 intravaginally. If labor was not initiated after 4 h, the same dose was repeated every 4 h to a maximum of 400µg of misoprostol or 6mg of PGE2, until adequate labor and vaginal delivery was achieved or patients delivered by abdominal route. Main Outcome Measures: The main parameters measured were: latent period, time from induction to vaginal delivery, delivery route, and occurrence of uterine tonus alterations, hypoxia and neonatal morbidity. The statistical analysis of the data was carried out in SPSS software. Results: 23 women were allocated to the misoprostol group and 23 to the prostaglandin E2 group. Misoprostol was more effective than PGE2 in producing cervical changes. Delivery within 10-12 h, after the first administration occurred more often in the misoprostol group than in the PGE2 [16 (69.56%) vs 2 (8.69%)]. Less patients in the misoprostol group required oxytocin augmentation than in the PGE2 [3 (13.04%) vs. 5 (21.73%)]. Uterine tachysystole and hyperstimulation occurred more frequently in the misoprostol group [3 (13.04%)] than in the PGE2 group [ 1 (4.34%)]. No statistically significant differences were noted between the two groups including mode of delivery and neonatal or maternal adverse outcome. The interval from induction to vaginal delivery was significantly shorter in the misoprostol group (6-8 hrs vs 11-12hrs). Abdominal delivery rate was more frequent in misoprostol group because of fetal tachycardia and hyper-stimulation than prostaglandin group [2 (8.69%) vs 1 (4.34%)]. Repeat dose was required mainly prostaglandin group [6 (26.08%)] as compared with misoprostol [4 (17.39%)]. Conclusions: Compared with prostaglandin E2, intracervical misoprostol is more effective in cervical ripening and labor induction at term. The higher frequency of uterine hyper-contractility associated with the use of misoprostol did not increase the risk of adverse intrapartum and neonatal outcomes, but the vigilant fetomaternal monitoring is considered to be essential in every case of induction.

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