Comparative Study between PGE1 Misoprostol and PGE2 Dinoprostone in Preinduction Cervical Ripening

ABSTRACT

Prostaglandin E2(cerviprime gel), an inducing agent is instilled intracervically or placed high in the posterior fornix of the vagina and may need to be re-in- stilled after 6 h if required. Another alternative is misoprostol (15-deoxy-16- hydroxy-16-methyl prostoglandin E1) which is used in various dosages. Methods: This was a prospective observational study of nulliparous women undergoing labor induction for one year, 100 womens, in a tertiary care center. Participants were then randomly assigned to pre-induction cervical ripening with a dinoprostone vaginal insert (0.5mg) (group I), and with misoprostol (50 microg) intravaginally(group II). Result: From our study observation, maximum patients delivered normal vaginal delivery. Of the vaginal deliveries six (18%) of PGE2 group and five patients(10%) of PGE1 having meconium stained liquor after ARM or spontaneous rupture of membrane, fetal heart was reassuring i.e, no fetal distress was there. The caesarean section rate in both groups nine (18%) and (10%) was statistically insignificant. Mean change in bishop score was also not significant in both groups. Need for oxytocine after 8hrs of induction between both group was significant, 84% in dinoprostone group and 56% in misoprostol group. Gastrointestinal side effects, uterine tacchysystole, uterine hyperstimulation was more common in misoprostol group than dinoprostone group, that is statistically significant. Induction to delivery time was shorter in misoprostol group that is statistically significant. No adverse neonatal outcomes that can directly be related with both drugs. Both agents are equally efficacious in causing cervical repining and almost equal changes in mean bishops. Conclusion: Misoprostol is an excellent labour-inducing agent and can be used liberally for labour induction, unlike PGE2 gel, is comparatively cheaper and is stable at room temperature; thus, it could be an ideal inducing agent in poor resource settings. Local application of misoprostol tablet in posterior vagina is easier method than dinoprostone insertion. Intravaginal insertion of misoprostol tablet is superior to dinoprostone gel in inducing labour and shorter interval between induction and delivery.