Sublingual Misoprostol (PGE1) Versus Intracervical Dinoprostone (PGE2) Gel for Induction of Labour: A Randomized Control Trail.

Abstract

Prostaglandins are popular agents for induction of labour, owing to their dual action of cervical ripening and inducing uterine contractions. Sublingual misoprostol offers high efficacy as it bypasses first-pass metabolism. Researchers have proved that intracervical PGE1 is as effective as PGE2 except for increased caesarean rate and hyperstimulation. Limited knowledge is available on the efficacy of sublingual PGE1 and intracervical PGE2. This study was designed to compare the effectiveness of sublingual PGE1 with intracervical PGE2. A randomized control trial was conducted in Bangalore Baptist Hospital, Bangalore. One hundred and ninety women with singleton, term pregnancy were equally divided into PGE1 and PGE2 groups, and primary outcome was measured. Post-induction mean Bishop's score in PGE1 group was statistically significant (t=6.57, p<0.05). Failed induction rate (1 vs 13.6%) and need for augmentation (46.3 vs 62.1%) were lower with PGE1 than those with PGE2 (p<0.05). Significant (p<0.05) maternal and foetal outcomes like higher rate of NVD (35.8 vs 26%), lower LSCS rate (15.8 vs 32.6%), lower incidence of foetal complications (7.3 vs 21%) were noted with PGE1. APGAR scores at 1 and 5min were not significant. Mean cost of induction with PGE1 was 12.55+/4.15 INR and with PGE2 470.65+/126.5. Sublingual PGE1 is a better cervical ripening agent, faster and more effective, with a shorter induction-to-delivery interval as compared to intracervical PGE2. We also noted lower incidence of caesarean section and foetal distress with sublingual PGE1 compared to oral or vaginally administered PGE1.