Labor induction with vaginal misoprostol and extra-amniotic prostaglandin F 2α gel

Abstract

Objective: To compare the effectiveness of vaginally administered misoprostol with extra-amniotic prostaglandin F 2α (PGF 2α) gel for induction of labor. Method: A randomized controlled trial, with women allocated to receive either misoprostol 50 μg intra-vaginally or extra-amniotic PGF 2α gel 5 mg, was conducted in Harare Maternity Hospital. A total of 152 women were admitted for induction of labor with a term singleton, pregnancy and cephalic presentation were recruited. The main outcome was duration of induction. Results: There were no differences in the characteristics of women in the two groups at recruitment. In the misoprostol group there was a significantly reduced need for augmentation of labor with oxytocin (OR=0.36; 95% C.I. 0.17–0.73) and delivery by cesarean section for failure to progress (OR=0.11; 95% C.I. 0.00–0.88). The risk for duration of induction to vaginal delivery exceeding 12, 18 or 24 h was reduced by 18%, 38% and 68%, respectively, but only the risk for duration >24 h was significantly reduced (OR=0.32; 95%C.I. 0.11–0.91). The mean duration of induction was shorter in the misoprostol group, 15.2 vs. 23.6 h ( P=0.02). There were no differences in fetal outcome. Conclusion: Misoprostol 50 μg was associated with less use of oxytocin in labor, a shorter induction to delivery interval and fewer cesarean sections for failure to progress when compared with extra-amniotic PGF 2α gel.