A Randomized Comparison Between Intravaginal Misoprostol and Intracervical Dinoprostone for Cervical Ripening and Labour Induction in Participants with Unfavourable Cervices

The goal of obstetrics is a pregnancy that culminates in a healthy infant and a minimally traumatized mother. Ideally all pregnancies should go to term and labour should begin spontaneously. More often than not, the need for delivery is clear but the timing is not emergent and the route is not dictated by foetal demands. A method to initiate the normal process of labour at a time before labour begins naturally is needed. Cervical ripening is of fundamental importance for the successful induction of labour as measured by Bishop score (1). Dinoprostone, a prostaglandin E2 analogue (either vaginally or intracervically) is widely used for cervical ripening and labour induction (2,3). However, dinoprostone gel preparations are expensive and need refrigeration for storage. Recently misoprostol, a methyl ester of prostaglandin E1, marketed for the prevention of peptic ulcer, has received increased attention as a highly effective cervical ripening agent. This medication has advantages of being inexpensive, easy to store and stable at room temperature. Many clinical trials have confirmed the safety and efficacy of misoprostol as an inducing agent (4,5). The purpose of our study was to determine whether the evidence from large number of clinical trials that support the use of misoprostol as a safe and effective ripening and inducing agent would be applicable to our population. Abstract To compare efficacy, safety and tolerance of intravaginal misoprostol with intracervical dinoprostone for cervical ripening and labour induction in women with unfavorable cervices.Two hundred women requiring induction of labour at or beyond term were randomized to receive one of the two methods: intravaginal misoprostol 25 ug every 4 hours up to a maximum of eight doses and intracervical diniprostone gel 0.5 mg every 6 hours up to a maximum of three doses. Induction delivery interval was significantly shorter (p< 0.01) in the study group 10.86 hours (651.470 minutes) versus 13.31 hours (798.625 minutes). The proportion of women delivering vaginally within 24 hours was 84% in misoprostol group and 69% in dinoprostone group. The rates of women who needed oxytocin (28% versus 48%) were higher in dinoprostone group. Cesarean section rate in the study group was lower than in control group but not significantly so (15% versus 24%; p=0.09). Foetal distress was more common in the study group than in the control group but not significantly so (23% versus 18%; p=0.38). Neonatal outcome was comparable in the two groups. There were no significant maternal complications in both the groups. Intravaginal misoprostol 25 ug every four hours was more effective for cervical ripening and labour induction than intracervical dinoprostone 0.5 mg every six hours.