Intravaginal Dinoprostone Research Articles

Induction of labour: A comparison between controlled‐release dinoprostone vaginal pessary (Cervidil®) and dinoprostone intravaginal gel (Prostin E2®)

There are various prostaglandin preparations available for inducing labour. Controlled-release dinoprostone vaginal pessary is used in a number of centres in Australia and New Zealand. To compare the efficacy and safety of controlled-release dinoprostone vaginal pessary (Cervidil) with dinoprostone intravaginal gel (Prostin E2) for induction of labour. Retrospective cohort study of 969 women who were induced using either 10-mg controlled-released dinoprostone vaginal pessary (n=507) or intravaginal dinoprostone gel (n=462) at National Women's Health, Auckland City Hospital. Study outcomes included induction to delivery interval, mode of delivery, rate of oxytocin augmentation and incidence of uterine hyperstimulation. Induction to vaginal birth interval was longer among nullipara receiving the pessary compared to those receiving intravaginal gel (21.5 vs 17.8 h, P=0.004). There was no difference in rates of oxytocin augmentation or in mode of birth between pessary and gel groups. There was a trend to more uterine hyperstimulation among women induced with the pessary compared with those induced with intravaginal gel (22 (4.5%) vs 11 (2.4%) relative risk (RR) 1.9 (0.9-3.9)). Hyperstimulation associated with an abnormal fetal heart pattern (14 (2.9%) vs 2 (0.4%), RR 6.5 (1.5-28.9)) or treated with tocolytics (9 (1.8%) vs 1 (0.2%), RR 8.4 (1.1-66)) was more common in women who received the pessary. Use of dinoprostone vaginal pessaries did not shorten time to delivery or improve any other birth outcome measured compared to dinoprostone intravaginal gel. Clinically significant hyperstimulation appeared more common following use of the pessary. Large randomised controlled trials are needed to confirm or refute these findings.

A randomised controlled trial of intravaginal dinoprostone, intravaginal misoprostol and transcervical balloon catheter for labour induction

To compare the efficacy and safety of induction of labour by vaginal application of dinoprostone or misoprostol or transcervical insertion of a balloon (Bard) catheter. A non-blinded, randomised, controlled trial. A tertiary level Swedish hospital. A total of 592 women who had undergone full-term pregnancies, not previously been subjected to a caesarean section, and required induction of labour for common, routine indications. Women were randomly assigned to induction of labour using intravaginal dinoprostone (2 mg once every 6 hours) or misoprostol (25 micrograms once every 4 hours) or a transcervical balloon catheter. The time interval between induction to delivery in general and vaginal delivery in particular, the mode of delivery, maternal and neonatal parameters of outcome. Of the 588 subjects included in the final intention-to-treat analysis, 191 were assigned to treatment with dinoprostone, 199 with misoprostol and 198 with the balloon catheter. The shortest mean induction-to-delivery interval was obtained with the catheter (12.9 hours versus 16.8 and 17.3 hours for dinoprostone and misoprostol, respectively). The efficacies of the two prostaglandins were similar. The maternal and neonatal outcomes associated with each of the three procedures were similar. Induction of labour with a transcervical balloon catheter is effective and safe and can be recommended as the first choice. The two prostaglandins, dinoprostone and misoprostol, were shown to be equally effective and safe, while misoprostol costs significantly less and is easier to store.

Intravaginal glyceryl trinitrate and dinoprostone for cervical ripening and induction of labor

Intravaginal glyceryl trinitrate and dinoprostone for cervical ripening and induction of labor

Randomized controlled trial of vaginal misoprostol versus dinoprostone vaginal insert for labor induction

Objective: To compare the safety and efficacy of vaginal misoprostol versus dinoprostone vaginal inserts for cervical ripening and labor induction.Methods: Two hundred singleton gestationswith an indication for cervical ripening and induction of labor were randomized to receive either 50 μg of misoprostol intravaginally every 3 h or a 10-mg dinoprostone vaginal insert every 12 h for amaximum of 24 h. Statistical analysis included Student's t test, the Mann-Whitney U test, χ2 analysis and Fisher's exact test.Results: Ninety-seven women received vaginalmisoprostol while 89 women received the dinoprostone vaginal insert. Fourteen women were removed from the study after randomization. The interval from start of induction to vaginal delivery (794.5 ±408 min vs. 1005.3 ± 523 min; p < 0.02) was significantly shorter in the misoprostol group. Women receiving misoprostol were more likely to deliver vaginally both in < 12 h (44% vs.12%; p < 0.0001) and < 24 h (68% vs. 38%; p < 0.001). A non-reassuring fetal heart rate tracing was the indication for 71.4% (20/28) of Cesarean deliveries in the misoprostol groupcompared to 40% (14/35) in the dinoprostone group (p = 0.03). There were no significant differences in neonatal outcomes.Conclusion: Intravaginal misoprostol and dinoprostone are safeand effective medications for use in cervical ripening before labor induction. Misoprostol results in a shorter interval from induction to delivery. However, Cesarean delivery for a non-reassuring fetalheart rate tracing was more common with misoprostol.

Cervical ripening and induction of labor with misoprostol, dinoprostone gel, and a foley catheter: A randomized trial of 3 techniques

Objective: The purpose of this study was to compare the efficacy of 3 different techniques of cervical ripening and induction. Study Design: Patients who required cervical ripening and induction were randomized to one of 3 groups: (1) supracervical Foley catheter and intravaginal dinoprostone gel, (2) supracervical Foley catheter and 100 μg oral doses of misoprostol, or (3) serial 100-μg oral doses of misoprostol. Intravenous oxytocin was administered when a protraction disorder of labor was identified. Results: There were 339 women randomized. There was no significant difference in the time from first intervention to delivery in the 3 groups (P =.546). In each group, a similar percentage of women required oxytocin (P =.103). The rates of cesarean delivery were equivalent among the groups (P =.722). Rates of tachysystole were high but statistically equivalent among the 3 groups. There were no significant differences in Apgar scores or umbilical artery pH. Conclusion: Oral 100 μg serial doses of misoprostol, with or without the use of a supracervical Foley catheter, were equivalent to the use of a supracervical Foley catheter and serial 4-mg doses of dinoprostone gel for cervical ripening and the induction of labor. (Am J Obstet Gynecol 2002;186:1124-9.)

Induction of labour with a viable infant: a randomised clinical trial comparing intravaginal misoprostol and intravaginal dinoprostone

Objective To compare the efficacy and safety of vaginal misoprostol (50μg) with vaginal dinoprostone. Design Double-blind randomised trial. Setting Obstetrics Department, Poissy Hospital, France. Participants 370 patients with medical indications for induction of labour. Outcome measures Vaginal deliveries within 24 hours, as well as time to vaginal deliveries, caesarean rates, costs, and fetal, neonatal and maternal condition. Results Compared with vaginal dinoprostone, vaginal misoprostol resulted in greater efficacy in several areas: vaginal delivery within 24 hours; time to vaginal delivery; and vaginal delivery within 12 hours. There was a non-significant increase in the caesarean section rate for fetal distress in the misoprostol group, but fewer caesarean sections for failed induction. Fetal tolerance was similar in the two groups, although significantly more neonates had a cord pH <7.20 and (non-significantly) none had meconium stained amniotic fluid in the misoprostol group. The incidence of poor neonatal outcome was similar in both groups. Subgroup analysis by indication for induction showed that the higher rates of arterial cord pH <7.20 and of meconium-stained amniotic fluid with misoprostol persisted only in possible fetal compromise. Poor neonatal outcome was less frequent in the misoprostol group in cases of induction for non-fetal indications. Conclusions Vaginal misoprostol resulted in successful and earlier induction of labour more often than dinoprostone, but the safety of misoprostol raises some concern in potentially compromised infants. Misoprostol should be preferred to dinoprostone in cases of induction for non-fetal indications.

Randomised controlled trial of intravaginal misoprostol versus intravaginal dinoprostone for the induction of labour

Randomised controlled trial of intravaginal misoprostol versus intravaginal dinoprostone for the induction of labour

Randomized comparison between intravaginal misoprostol and dinoprostone for cervical ripening and induction of labor

Objective: We sought to evaluate the efficacy and safety of intravaginal misoprostol and dinoprostone for labor induction. Study Design: One hundred eighty-nine women with singleton term pregnancies and unfavorable cervices were randomly assigned to receive intravaginal misoprostol or dinoprostone. The outcome variables were change in Bishop score, time from application to active phase of labor and delivery, fetal and maternal morbidity, and the incidence of cesarean deliveries. Results: The interval from application of the initial dose to the beginning of the active phase of labor was 9.8 ± 5.8 and 14.2 ± 10.2 hours ( P < .01), and the interval from initial dose to delivery was 15.3 ± 9.8 and 19.1 ± 13.2 hours ( P = .027) for the misoprostol and dinoprostone groups, respectively. There were no significant differences in Bishop score change, cesarean delivery rate, and the incidence of tachysystole, hypersystole, and hyperstimulation. No maternal and neonatal adverse effects were noted. Conclusion: Intravaginal misoprostol is more effective than intravaginal dinoprostone for labor induction in low-risk patients at term with unfavorable cervices. (Am J Obstet Gynecol 1999;181:626-9.)

Cervical ripening: A randomized comparison between intravaginal misoprostol and an intracervical balloon catheter combined with intravaginal dinoprostone

OBJECTIVES: Our purpose was to compare the efficacy of intravaginal misoprostol and intracervical Foley catheter/intravaginal dinoprostone for cervical ripening. STUDY DESIGN: Patients admitted for induction of labor were randomized to receive intravaginal misoprostol 25 μg every 4 hours or intracervical Foley catheter/intravaginal dinoprostone 4 mg every 4 hours. Patients not entering active labor and having ruptured membranes or arrest of dilatation received intravenous oxytocin. RESULTS: Sixty-five patients received Foley catheter/dinoprostone gel and 62 patients received misoprostol. The mean time until cervical ripening was less in the catheter/gel group (7.5 ± 3.4 vs 12.0 ± 5.9 hours, p < 0.01). The mean time until vaginal delivery was less in the catheter/gel group (17.4 ± 6.9 vs 21.2 ± 7.5 hours, p = 0.004). Among vaginal deliveries, more patients in the catheter/gel group delivered within 24 hours (90% vs 69%, p = 0.013). CONCLUSIONS: Intracervical Foley catheter/intravaginal dinoprostone was associated with more rapid cervical ripening, shorter induction to vaginal delivery interval, and greater number of vaginal deliveries within 24 hours. (Am J Obstet Gynecol 1998;178:1333-40.)

Induction of labour with intravaginal misoprostol versus dinoprostone in intrauterine death: A retrospective study

SummarySummaryBetween March 1992 and November 1994, 48 patients with intrauterine death had labour induced, 36 with the prostaglandin analogue misoprostol and 12 with the prostaglandin dinoprostone. Both were used as a single dose in 24 hours intravaginally. The patients were all of low parity and all but one were in the third trimester. Of those getting misoprostol, 92 per cent, and of those getting dinoprostone, 67 per cent, went into spontaneous labour. Eighty-one per cent of those getting misoprostol and 67 per cent of those getting dinoprostone delivered within 24 hours without the need for further prostaglandin or oxytocin, a difference that was not significant. No differences were found in other outcome variables such as diagnosis or induction to delivery time or need for oxytocin, between the two groups. Only one maternal medical complication occurred, chorioamnionitis in a patient who had misoprostol, and in whom labour was delayed 6 days.

Drug therapy during labor and delivery

Situations related to labor and delivery that may require drug therapy are discussed, and treatment options are reviewed. The goal of labor induction and augmentation at term is to facilitate vaginal delivery of a healthy infant. The primary uterine stimulant used for this purpose is oxytocin. Low-, intermediate-, and high-dose protocols have been reported; augmentation requires approximately half as much oxytocin as induction does. Mifepristone has also been used for labor induction. Prostaglandins are the primary agents used for cervical ripening, but oxytocin, relaxin, and mifepristone have also been used. Mechanical dilators are available for cervical dilation, which may be necessary when prostaglandins are contraindicated. Oxytocin is the drug of choice for preventing postpartum hemorrhage; if it is not effective, methylergonovine or carboprost may be used to control the hemorrhage. Labor induction during the midtrimester may be necessary because of obstetrical or medical complications or fetal death. These situations call for aggressive dosing of uterine stimulants (e.g., high-dose oxytocin, intravaginal dinoprostone suppositories, carboprost, mifepristone). Drug therapy may be required for labor induction or augmentation, cervical ripening or dilation, and prevention or control of postpartum hemorrhage. Oxytocin is the most commonly used agent for labor induction or augmentation and for prevention of postpartum hemorrhage; prostaglandins are frequently used for cervical ripening. Aggressive dosing of uterine stimulants is required when labor must be induced during the midtrimester.