A comparison of the safety and efficacy of intravaginal prostaglandin E1 ( Misoprostol ) and prostaglandin E2 ( Dinoprostone ) to induce labor

Joo, Seon Ha; Hur, Eui Jong; Park, Jin Wan; Lee, Won Ki

Abstract

OBJECTIVE
Our purpose was to compare the safety and efficacy of intravaginally administered misoprostol(PGE1) versus dinoprostone(PGE2) for labor induction in a prospective controlled trial. METHOD: One hundred eleven patients for labor induction (including preterm rupture of membranes) were randomly assigned to receive either misoprostol 50microgram or dinoprostone 3mg intravaginally. The interval of doses was 8 hours after first dose, with a potential maximum of six dose until active labor pain was achieved. RESULTS: Among 111 patients enrolled, 55 were randomized to receive misoprostol 50microgram and 56 to receive dinoprostone 3mg with every 8 hours interval intravaginally. There were no significant differences in demographic characteristics except in Bishop score(3.81+/-1.52 vs 4.38+/-1.29, P<0.05). There were no significant differences in indications for labor induction. The interval of induction to delivery was shorter in the misoprostol group(750.8+/-518.8min) than in the dinoprostone group(1264.1+/-730.7min). Delivery within 24 hours after administration occurred more often in the misoprostol group than in the dinoprostone group (86.3% vs 65.2%, P<0.05). More than two doses for completion of delivery were frequent in dinoprostone group(36.96% vs 9.8% in misoprostol group, P<0.05). Additional Oxytocin augmentation was needed more commonly in the misoprostol group(3.64%) than in the dinoprostone group(14.29%)(P<0.05), but no significant differences were noted between two groups in total oxytocin doses and indications. Tachysystole occurred more often in the misoprostol group (12.73% vs 1.79% in the dinoprostone, P<0.05) Precipitating delivery occurred more commonly in the misoprostol group(21.82% vs 7.14% in the dinoprostone group, P<0.05). No differences in the cesarean section rate, fetal heart rate abnormalities, hyperstimulation syndrome, meconium staining, fetal outcome (Apgar score at 1 and 5 minutes, birth weight), and marternal outcome (nausea and vomitting, postpartum bleeding) were noted. The cost of misoprosl is one hundredth cheaper than dinoprostone. There was no significant differences in the fetal outcome and maternal outcome.
CONCLUSION
These results suggest that intravaginal misoprostol(PGE1) is a safe drug for labor induction which is more effective and cheaper compare to intravaginal dinoprostone(PGE2).