Abstract
BackgroundProstaglandins are commonly used for labour induction in obstetric practice. Given the harsh effects of occupation and siege on provision of health care and on economic conditions, this study was conducted to compare the efficacy and safety of oral misoprostol and vaginal dinoprostone, to find the more appropriate and economic drug for labour induction in the Gaza Strip, occupied Palestinian territory. MethodsIn this case-control study, we screened medical files of 155 women undergoing labour induction at Al-Helal Al-Emirati Hospital, Rafah, in the Gaza Strip. Inclusion criteria were singleton, cephalic presentation, and full-term pregnancies (40 weeks) needing labour induction. Patient files were divided into two groups according to the drug regimen. 76 women received 50 μg oral misoprostol for parity 0–4 or 25 μg for parity 4 or greater, every 6 hours. 79 women received dinoprostone vaginal tablets, with a dose of 3 mg then 1·5 mg for nulliparous women and 1·5 mg for parity 1 or greater, every 8 hours. There were no significant differences between the misoprostol and dinoprostone groups in terms of mean age (25·07 [SD 5·66] vs 27·86 [6·56] years, p=0·34), mean gestational age (279·43 [SD 11·41] vs 285·57 [SD 15·50] days, p=0·81), and mean parity (2·10 [SD 1·97] vs 2·73 [SD 2·64], p=0·05). Outcome measures were induction success, induction–delivery interval, number of used drugs and doses, caesarean section rate, and maternal complications. Data were analysed with SPSS software. We compared outcomes using the Mann–Whitney U-test, student's t-test, or chi squared test. A p value of less than 0·05 was considered significant. The study was approved by the Helsinki Committee, Gaza Strip. FindingsInduction of labour succeeded in 80% (61 of 76) and 78% (62 of 79) cases (p=0·492) in the misoprostol and dinoprostone groups, respectively. There was no significant difference between the misoprostol and dinoprostone groups in the induction–delivery interval (15·2 h vs 16·4 h, p=0·625). The number of doses required was 2·2 and 1·8 in the misoprostol and dinoprostone groups, respectively (p=0·070). The caesarean section rate did not differ significantly between the misoprostol and dinoprostone groups (7·9% [six of 76] vs 10·1% [eight of 79], p=0·369). In addition, complications (mild vaginal bleeding, post-partum haemorrhage, and puerperal fever) also did not differ significantly between the misoprostol and dinoprostone groups (37·7% [23 of 76] vs 33·9% [21 of 79], p=0·430), and all were mild. InterpretationOral misoprostol and dinoprostone vaginal tablets have the same safety and efficacy. Misoprostol is a good alternative for induction of labour. FundingNone.
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