Randomized prospective trial to compare the efficacy and safety of intra-vaginal misoprostol with intra-cervical dinoprostone gel in induction of labor

Abstract

Induction of labor is the intentional or artificial initiation of labor before spontaneous onset of labor. At present dinoprostone is the agent of choice but misoprostol is a potential alternative. Objectives: To compare the efficacy and safety of intravaginal misoprostol with intracervical dinoprostone in induction of labor. Materials and Methods: Two groups of 135 subjects received 0.5 mg of dinoprostone gel intracervically and tab misoprostol 25 μg digitally placed at the posterior fornix. Results: In group-one (Dinoprostone gel), 116 (85.9%) had vaginal delivery, 13 (9.6%) had ventouse delivery and six (4.4%) underwent cesarean section, whereas in group-two (Misoprostol), 118 (87.0%) and 12 (8.9%) had vaginal and ventouse delivery respectively, whereas 5 (3.7%) underwent cesarean section. Induction to delivery interval was less than 12 hours in 50% when induced with misoprostol and 33.3% with dinoprostone. Median Bishop score at the time of instillation was found to be 3 (Range 2-4) while equivalent median Bishop score for the latter group is 2 (Range 2-4) in group-one and two respectively. The difference observed was significant (P = 0.026) indicating that misoprostol improves the Bishop score more significantly than dinoprostone. No significant variation in Apgar score and maternal complications was noted in both groups. Conclusion: Both dinoprostone and misoprostol are effective agents for induction. Misoprostol with its shorter induction delivery interval, cheaper cost and less stringent storage conditions may be preferred in developing countries.