Efficacy of Intra Vaginal Misoprostol as Various Doses versus Intra cervical Dinoprostone in Cervical Ripening and Induction of Labor

Abstract

Objective: To compare the efficacy of intra vaginal misoprostol as various doses versus intra cervical dinoprostone in cervical ripening and induction of labor.Study Design: A Prospective Randomized Controlled Trial.Place and Duration of Study: Obstetrics and Gynecology Department of Nishtar Medical University and Hospital, Multan from May 2016 to July 2018.Methodology: We divided 168 patients into three groups; Group M1 and M2 were given 25µg and 50µg misoprostol, respectively; Group D was given 0.5mg dinoprostone. Complete history was followed by complete examination. Outcome variables, age, parity, gestational age, indications for the induction of labor and initial Bishop Score were compared. Data was put in SPSS 23 and analyzed by applying one way ANOVA and Chi-square tests, as appropriate considering p≤0.05 statistically significant.Results: Induction to vaginal delivery interval was 15.51±6.18min in Group-M1, 12.14±4.65min in Group-M2 and 13.43±6.96min in Group-D (p=0.008). The women who need oxytocin supplementation were 30.6%, 17.7% and 41.9% from Group M1, M2 and D, respectively (p=0.013). Bishop Score after 6 hours of delivery was 3.45±1.2, 4.41±1.5 and 4.21±1.3 in group M1, M2 and D, respectively, and the difference was highly statistically significant (p<0.001). All other variables were comparable among the groups (p>0.05).Conclusion: Higher dose of misoprostol i.e. 50µg misoprostol is higher in efficacy than 0.5mg dinoprostone which is in turn better than 25µg misoprostol. But 50µg misoprostol can cause hyper-stimulation and dinoprostone needs oxytocin augmentation. Misoprostol is a good and cheap agent for the induction of vaginal delivery.

Keywords: misoprostol, dinoprostone, cervical ripening, induction of labor.