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

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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.