Comparison of Misoprostol versus Dinoprostone for pre-induction cervical ripening at-term.

BACKGROUND

The purpose of this study was to compare the efficacy and safety of 25 μg Misoprostol vs. 0.5 mg Dinoprostone for pre-labour ripening of the cervix at-term.

METHODS

Nullipara or Para one women with unfavourable cervices after 37 completed weeks with live foetuses were randomized to received either 25 μg intravaginal Misoprostol or 0.5 mg intracervical Dinoprostone. The doses were repeated after 6 hrs if the Bishop Score was less than 6. In cases, in which cervical ripening was not reached even after two doses of ripening agents, oxytocin induction was started at least 6 hours apart. Insertion delivery interval (IDI), complications and pregnancy outcome associated with the use of drugs were compared.

RESULTS

Two hundred women--100 in each group were evaluated. Comparatively more women (62% vs. 58%) in the Misoprostol group achieved cervical ripening (BS≥6) after one dose. The mean IDI was significantly shorter (3.91 hrs) in the Misoprostol group. The difference was marked more among the multipara at 5.72 hrs, mean difference (p=0.045). In the Misoprostol group 76.92% delivered within 24 hrs whereas, only 70.4% in the Dinoprostone group. Vaginal deliveries were achieved more in the Misoprostol group (78% vs. 71%). No significant differences found in terms of intrapartum complications and foetal outcome. Meconium stained liquor was found more in the Dinoprostone group (23% vs. 32%).

CONCLUSIONS

A 25 μg dose of Misoprostol is superior in promoting cervical ripening, significantly shortened the insertion delivery interval. It is safe and effective for cervical ripening when applied in the hospital setting with close monitoring.