Comparative Study of Misoprostol Versus Dinoprostone for Induction of Labour.

Induction of labour means initiation of uterine contractions (after the period of viability) by any method (medical, surgical or combined) for the purpose of vaginal delivery. It is helpful when the risks of continuation of pregnancy either to the mother or the fetus is more. Some unfavourable conditions like IUGR, PROM, Post –term pregnancy, IUD, Chorioamnionitis, Maternal medical problems like PIH, Diabetes Mellitus, Renal diseases, COPD, Cardiac diseases may call for induction of labour. Various Pharmacological methods have been introduced for both pre-induction cervical ripening and induction of labour are as follows- 1) Prostaglandins 2) Oxytocin 3) Steroid receptor antagonist-Mifepristone 4) Relaxin This study was conducted on nulliparous females in the age group of 20-30yrs, with gestational age more than 34 wks in the Dept. Of Obstetrics and Gynaecology, Index Medical College Hospital and Research Centre Khudel, Indore over a period of 1 year with a sample size of 100 and they were randomized into Group A-receiving 50mcg of misoprost tablet vaginally and Group B -receiving endocervical cerviprime gel. Hence the purpose of this study is to emphasize that misoprostol is a better alternative than dinoprostone for induction of labour at rural hospital setup by comparing their- 1) Success Rate 2) Induction –delivery interval 3) Number of doses required, their cost effectiveness 4) Maternal complications 5) Fetal complications Among these prostaglandins especially prostaglandin E1,because of their short induction delivery interval, easy availability, low price, easy storage at room temperature, low maternal and fetal complication appear to be especially useful.

Maternal serum progesterone, estradiol and estriol levels in successful dinoprostone-induced labor

Hormone-mediated quiescence involves the maintenance of a decreased inflammatory responsiveness. However, no study has investigated whether labor induction with prostanoids is associated with changes in the levels of maternal serum hormones. The objective of this study was to determine whether labor induction with dinoprostone is associated with changes in maternal serum progesterone, estradiol, and estriol levels. Blood samples were obtained from 81 pregnant women at term. Sixteen patients had vaginal birth after spontaneous labor, 12 required cesarean section after spontaneous labor and 16 underwent elective cesarean. Thirty-seven patients had labor induction with dinoprostone. Eligible patients received a vaginal insert of dinoprostone (10 mg) and were followed until delivery. Serum progesterone (P4), estradiol (E2) and estriol (E3) levels and changes in P4/E2, P4/E3 and E3/E2 ratios were monitored from admission to immediately before birth, and the association of these measures with the resulting clinical classification outcome (route of delivery and induction responsiveness) was assessed. Progesterone levels decreased from admission to birth in patients who underwent successful labor induction with dinoprostone [vaginal and cesarean birth after induced labor: 23% (P < 0.001) and 18% (P < 0.025) decrease, respectively], but not in those whose induction failed (6.4% decrease, P > 0.05). Estriol and estradiol levels, P4/E2, P4/E3 and E3/E2 ratios did not differ between groups. Successful dinoprostone-induced labor was associated with reduced maternal progesterone levels from induction to birth. While a causal relationship between progesterone decrease and effective dinoprostone-induced labor cannot be established, it is tempting to propose that dinoprostone may contribute to progesterone withdrawal and favor labor induction in humans.

A Comparison of Intravaginal Misoprostol and Dinoprostone for Cervical Ripening and Labor Induction in Term Pregnancy with Unfavorable Cervix / 대한산부인과학회잡지

OBJECTIVE: To compare the efficacy and safety of intravaginal administerd misoprostol and PGE2 (dinoprostone) with oxytocin for inducing labor in women with an unfavorable cervix. METHODS: One hundred thirteen patients with indicated for labor induction and unfavorable cervix were randomly assigned and received either misoprostol 50microgram intravaginal with oxytocin intravenous injection or prostaglandin E2(dinoprostone) 3mg intravaginal with oxytocin intravenous injection. RESULTS: Thirty-nine subjects were assigned to misoprostol with oxytocin group and 74 to the PGE2 with oxytocin group. The median interval from induction to vaginal delivery was significantly shorter in the misoprostol with oxytocin group(1274+/-496 versus 1512+/-501 minutes)(p<0.001). No significant difference between two groups were mode of delivery, neonatal and maternal outcomes. CONCLUSION: Intravaginal misoprostol and PGE2 vaginal insert appear to be safe agents for cervical ripening and labor induction. Misoprostol is more effective than PGE2 vaginal insert with oxytocin injection.