Induction of Labor in Post-Term Nulliparous and Parous Women - Potential Advantages of Misoprostol over Dinoprostone.

INTRODUCTION: We undertook a prospective cohort study to compare the effectiveness and safety of 50 µg misoprostol versus 3 mg dinoprostone in two vaginal doses 6 hours apart, followed if necessary by oxytocin for labor induction in low-risk post-term (> 40 weeks) pregnancies with unfavorable cervix (Bishop score ≤ 6). METHODS: Labor induction and subsequent management were conducted using a standardized protocol. The primary outcome of the study was labor induction rate. Secondary outcomes included mode of delivery, time interval from induction to delivery, maternal complications and neonatal outcome. RESULTS: 107 patients received misoprostol (Group A) and 99 patients received dinoprostone (Group B). Compared with group A, more women in Group B needed a second vaginal dose of prostaglandin or oxytocin infusion in order to proceed to labor (21.5 vs. 43.4 %; p = 0.01). Misoprostol alone as a single or double vaginal dose was more effective than dinoprostone alone in inducing labor without oxytocin administration (85.0 vs. 50.4 %; p = 0.04). Overall, the rate of successful induction of labor did not differ between groups (91.6 vs. 85.8 %; p = 0.75). Vaginal delivery, operative vaginal delivery and Caesarean section rates were not significantly different. Time interval from induction to delivery however, was shorter for Group A (median 11 hours vs. 14.1 hours; p < 0.001). Though emergency Caesarean section due to fetal distress was more frequent in Group A (16.8 vs. 4.0 %; p = 0.007), low Apgar scores < 7 and NICU admissions did not differ significantly. Maternal complications, mostly not serious, were higher in Group A (31.8 vs. 2.0, p < 0.001). CONCLUSION: Misoprostol is a more effective agent than dinoprost in post-term pregnancy for labor induction with few maternal adverse effects.

The effectiveness of misoprostol or dinoprostone in neonatal outcome after labour induction in post-term nulliparas.

OBJECTIVE: The object of this study was to investigate the efficacy of vaginal administration of misoprostol versus dinoprostone in neonatal outcome. MATERIALS AND METHODS: The first Group A included 77 pregnant women, who requested pregnancy termination one week after labour term and received vaginally misoprostol 50 µg, while the other 69 pregnant women in Group B were vaginally administrated three mg dinoprostone. According to the authors' protocol this procedure was repeated after six hours for a maximum of two times. RESULTS: The labour duration was longer in Group B (p = 0.000), while the APGAR score was better in Group A (p = 0.015). In Group A the labour modus was as follows: 86.9% normal vaginal labour, 3.8% vacuum extraction, and 9.3% cesarean section, while in Group B it was 82.83% normal vaginal labour, 3.07% vacuum extraction, and 14.1% cesarean section. CONCLUSION: Misoprostol has advantages according to neonatal outcome compared to administration of dinoprostone.