A COMPARATIVE EVALUATION OF INTRAVAGINAL MISOPROSTOL (PGE1) WITH INTRACERVICAL DINOPROSTONE (PGE2) GEL FOR CERVICAL RIPENING AND LABOUR INDUCTION

Abstract

Objectives: (1) To compare the efficacy of low dose PGE1 with PGE2 for induction of labour at term. (2) To compare the safety of PGE1 with PGE2 in terms of labour and neonatal outcome. METHODOLOGY: It was an open label randomized controlled trial conducted in the Department of Obstetrics & Gynaecology, J.L.N.M.C.H Bhagalpur. Total 200 patients satisfying the inclusion criteria were included in the study. One hundred of them received PGE1 (25 µg repeated 4th hourly to a maximum of six doses) and remaining one hundred received PGE2 (0.5 mg gel repeated 6th hourly to a maximum of three doses). Analysis was done with respect to age, parity, gestational age, indication for induction, number of doses required, oxytocin requirement, mode of delivery, indication if LSCS done, induction delivery interval, complications and neonatal outcome with respect to 5 minutes APGAR score, meconium stained liquor and NICU admission. RESULTS: Both groups were comparable to age, parity and gestational age. Oxytocin requirement was more for PGE2 group (63%) than PGE1 group (35%). LSCS rate was 26% for PGE1 group compared to 23% in PGE2 group. The major indication for LSCS was fetal distress , more in PGE1 (80%) group than PGE2(73%) group, whereas the incidence of failed induction and failure to progress was more in PGE2 group. Incidence of traumatic PPH was 11% in PGE1 group compared to 6% in PGE2 group. Incidence of atonic PPH was 3% in PGE2 group which was 2% in PGE1 group. Other complications and induction to delivery interval were comparable in both groups. Neonatal outcome in terms of 5 minutes APGAR < 7, NICU admission rates and meconium staining of liquor were all less with PGE2 group. CONCLUSION: Dinoprostone (PGE2) appears to be a safer inducing agent in view of fewer complications with respect to labour and neonatal outcome with induction delivery interval almost equal in both drugs. Misoprostol is efficacious and low cost agent for cervical ripening and labour induction. But even with low dose regimens (25 µg repeated 4th hourly to a maximum of 6 doses), it is associated with increased uterine contraction abnormalities, Fetal HR irregularities; NICU admission rates and low APGAR scores. Although it is efficacious, it requires extensive trials to determine the appropriate dose and route of administration. Keywords: Cervical Ripening; Dinoprostone; Labour Induction; Misoprostol