Department of Obstetrics and Feto-maternal Medicine, University Hospital of Bern, University of Bern, Bern, Switzerland.
Department of Obstetrics and Gynecology, center Hospitalier Bienne, Bienne, Switzerland.
Acta Obstet Gynecol Scand. 2024 Nov;103(11):2306-2313. doi: 10.1111/aogs.14956. Epub 2024 Sep 2.
Labor induction exhibits considerable variations in protocols and medication regimens. Limited studies compare vaginal dinoprostone inserts with different oral misoprostol dosages, considering parity influence. This study explores the distinctions among 10 mg vaginal dinoprostone inserts and oral misoprostol 25 μg every 2 and every 4 h for labor induction, stratified by parity.
This retrospective cohort study involved 607 participants across two hospitals. The primary outcome, time from induction to delivery, and secondary outcomes, including mode of delivery and maternal and fetal safety, were assessed.
Patient characteristics revealed differences in indication for labor induction, with the dinoprostone cohort having fewer post-term and premature rupture of membranes cases but more intrauterine growth restriction/small-for-gestational age. Both oral misoprostol regimens showed a shorter time to delivery interval compared to the dinoprostone cohort (median: 1380 min [IQR 1381.0] and 1127.0 min [IQR 1214.0] vs 1631.5 [IQR 1736.2], p < 0.001 and p = 0.014). Only the difference between oral misoprostol q2h and vaginal dinoprostone remained significant for nulliparous but not multiparous women, losing significance over all the population after adjusting for confounding factors. The proportion of women giving birth within 24 h did not significantly differ between misoprostol q2h and dinoprostone after adjusting for confounders. When comparing misoprostol q4h with dinoprostone after confounder adjustment, an increased time to delivery interval for misoprostol q4h was found (p = 0.001). Both oral misoprostol regimens exhibited fewer meconium-stained liquor (miso q4h: OR 0.44, miso q2h: OR 0.34) and cesarean sections (miso q4h: OR 0.48, miso q2h: OR 0.53) compared to dinoprostone, even after adjustment for confounders.
Our study suggests that oral misoprostol 25 μg q4h is less effective than 10 mg vaginal dinoprostone for labor induction if parity and indication for induction are adjusted for, particularly in multiparous women. In terms of side effects, oral misoprostol regimens seem superior to vaginal dinoprostone. Our data support the individualized use of different agents for labor induction according to parity, indication for induction, bishop score, and women's preference.
引产的方案和药物方案存在很大差异。有限的研究比较了不同剂量的口服米索前列醇与不同剂量的阴道地诺前列酮栓剂在经产妇中的效果。本研究旨在探讨不同剂量的口服米索前列醇（25μg，每 2 小时 1 次和每 4 小时 1 次）与阴道地诺前列酮栓剂（10mg）在引产中的差异，按经产妇和初产妇进行分层。
这是一项回顾性队列研究，涉及两家医院的 607 名参与者。主要结局是从引产到分娩的时间，次要结局包括分娩方式以及母婴安全性。
患者特征显示引产的适应证存在差异，地诺前列酮组中过期妊娠和胎膜早破的病例较少，但胎儿宫内生长受限/小于胎龄儿的病例较多。与地诺前列酮组相比，两种口服米索前列醇方案的分娩时间间隔更短（中位数：1380 分钟[IQR 1381.0]和 1127.0 分钟[IQR 1214.0]与 1631.5 分钟[IQR 1736.2]，p<0.001 和 p=0.014）。仅在调整混杂因素后，初产妇中口服米索前列醇 q2h 与阴道地诺前列酮的差异仍具有统计学意义，但在所有人群中无统计学意义。调整混杂因素后，米索前列醇 q2h 和地诺前列酮组在 24 小时内分娩的比例无显著差异。调整混杂因素后，与地诺前列酮相比，米索前列醇 q4h 的分娩时间间隔延长（p=0.001）。与地诺前列酮相比，两种口服米索前列醇方案的羊水粪染（米索前列醇 q4h：OR 0.44，米索前列醇 q2h：OR 0.34）和剖宫产（米索前列醇 q4h：OR 0.48，米索前列醇 q2h：OR 0.53）发生率均较低，即使在调整混杂因素后也是如此。
本研究表明，如果调整经产妇和引产适应证，与 10mg 阴道地诺前列酮相比，口服米索前列醇 25μg，q4h 用于引产的效果较差，尤其是在经产妇中。在副作用方面，口服米索前列醇方案似乎优于阴道地诺前列酮。我们的数据支持根据经产妇、引产适应证、bishop 评分和产妇意愿，个体化使用不同的引产药物。
