Title: An Open Label, Prospective Study to Evaluate the Efficacy of Misoprostol Versus Dinoprostone Gel For Induction of Labour
Author: Dr Deepanjali Lomte*
DOI: http://dx.doi.org/10.18535/jmscr/v4i2.72
Objective:This prospective study was conducted to compare the effect, efficacy & safety of intra-vaginal misoprostol (PGE1) & intra-cervical dinoprostone gel (PGE 2) for induction of labour. Methods:60 women aged 18-35 years with single live fetus, cephalic presentation & term pregnancy, who were admitted for induction of labour were included in this study.30 women received intrvaginal 25 microgram Misoprostol (study group) & 30 women received 0.5mg of intracervical dinoprostone gel(control group). Comparison was done between the mean time taken for onset of labour, time taken for induction to delivery, mean duration of labour, requirement of Oxytocin augmentation, mode of delivery, side effects & the neonatal outcome in either of the groups. Results: The mean time taken for onset of labour was less in the misoprostol group than in the dinoprostone group (58.22 min and 1 hr 55 min). Similarly duration from induction to active phase (1hr 57 min and 4hrs 25 min) and active phase to delivery ( 3 hrs 21 min and 5 hrs 9min) was less for misoprostol group and thus the induction to delivery interval (5 hrs 18 min and 9 hrs 34 min). Cesarean section rate was less in misoprostol group (10% v/s 24%). Maternal side effects were minimal in either group & the neonatal outcome was good in both the groups. The induction cost was much less in the misoprostol group. Conclusion: Misoprostol is safe, efficacious, cheap and mother and fetus friendly drug for the induction of labour. Keywords:Induction of labour, Misoprostol, Dinoprostone gel. 1. Houghton Mifflin Company, The American Heritage Dictionary, 2006 2. Witter FR . Prostaglandin E2 preparations for preinduction cervical ripening. Clin Obstet Gynecol. 2000;43:469–74. 3. Arias F. Pharmacology of oxytocin and prostaglandins. Clin Obstet Gynecol 2000;43:455 68. 4. Hofmeyr GJ, Gulmezoglu AM. Vaginal misoprostol for cervical ripening and induction of labour. The Cochrane Database Syst Rev. 2003;CD000941. DOI:10.1002/14651858.CD000941. 5. Sanchez-Ramos L, Kaunitz AM. Misoprostol for cervical ripening and labor induction: a systematic review of the literature. Clin Obstet Gynecol. 2000; 43:475– 488. 6. ACOG committee opinion. New US Food and drug administration labeling of cytotec (misoprostol) use in pregnancy Int J Gynecol Obstet 2003;82:137-138. 7. American College of Obstetricians and Gynecologists. New U.S. Food and Drug Administration labeling on Cytotec (Misoprostol) use and pregnancy. Committee Opinion Washington, DC: American College of Obstetricians and Gynecologists; 1999;. 283 8. F.Gary Cunningham, Kenneth J.Leveno, Steven L.Bloom, John C., Rouse, Spong, Williams Obstetrics,2010;23:502 9. Sahu Latika,et al. Comparison of Prostaglandin E1(Misoprostol) with Prostaglandin E2(Dinoprostone) for Labor Induction. J Obstet Gynecology India 2004;54(2):139-142 10. Patil K P et al. Oral Misoprostol v/s intra-cervical dinoprostone for cervical ripening and labour induction. J Obstet Gynec India 2005; 55(2):128-131 11. Murthy BK et al. Misoprostol alone versus a combination of Dinoprostone and Oxytocin for induction of labour. J Obstet Gynec India 2006;56(5):413-416 12. Agarwal N, Gupta,A, Kriplani ,Bhatla NP. Six hourly vaginal misoprostol versus intracervical Dinoprostone for cervical ripening and labour induction.J Obstet and Gynecology Res 2003;29(3):147-51. 13. Garry D, Figueroa R, Kalish RB. Randomized Controlled Trial of Vaginal Misoprostol Versus Dinoprostone Vaginal Insert for labour induction Journal of Maternal-Fetal and Neonatal Medicine 2003; 13(4):254-259 14. Calder AA, Loughney AD,Weir CJ, Barber JW. Induction of labour in nulliparous and multiparous women: a UK, multicentre, open-label sudy of intrvaginal misoprostol in comparison with dinoprostone. BJOG 2008;115(10):1279-88. 15. Sebiha Ozkan, Eray Caliskan, Emek Doger, Izzet Yucesoy, Semih Ozeren, Birol Vural. Comparative safety and efficacy of vaginal Misoprostol versus Dinoprostone Vaginal insert in labour induction at term: a Randomized Trial. Archives of Gynecology and Obstetrics 2009;280(1):19-24 16. Neiger R. Greaves PC. Comparison between Vaginal Misoprostol and Cervical Dinoprostone for cervical ripening and labour induction. Tenn Med. 2001; 94(1): 25-7 15. F.Gary Cunningham, Kenneth J.Leveno, Steven L.Bloom, John C., Rouse, Spong. Williams Obstetrics, 2010;23:503 17. Cheng SY, Ming H, Lee JC. Titrated oral compared with vaginal misoprostol for labor induction: A randomized controlled trial. Obstet Gynecol.2008;111:119-125. 18. Muzonzini G, Hofmeyr GJ. Buccal or sublingual misoprostol for cervical ripening and induction of labour.Cochrane Database Syst Rev. 2004;4:CD004221. 19. Colon I, Clawson K, Hunter K, Druzin ML, Taslimi MM. Prospective randomized clinical trial of inpatient cervical ripening with stepwise oral misoprostol vs vaginal misoprostol. Am J Obstet Gynecol. 2005; 192:747-752.Abstract
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