Randomized comparison of misoprostol and dinoprostone for preinduction cervical ripening and labor induction

This study attempts to evaluate the clinical effects of prostaglandin (PG) E analogues in preinduction cervical ripening and labor induction and to compare the perinatal outcomes of these medications. Sixty women with term singleton pregnancies were randomized to receive dinoprostone vaginal tablets (group I) or misoprostol vaginal tablets (group II). The Bishop scores were evaluated before drug insertion and every 4 hours during induction. Clinical data and perinatal outcomes were also recorded. There were no significant differences in the pre-induction conditions on mean initial Bishop scores between these two groups. Twelve hours after drug insertion, the mean Bishop scores were significantly better in group II (9.7 ±3.1 vs 7.3 ± 2.5. p < 0.05). The mean time from insertion to delivery was shorter in group II (16.5 ± 2.7 h vs 25.7 ± 3.8 h, p < 0.001). There were no significant differences in spontaneous labor rate, need for oxytocin augmentation, type of delivery, and Doppler flow velocity waveforms of the umbilical artery. The average number of doses given per patient was 1.8 ± 1.4 in group II vs 2.7 ± 0.3 in group I (p < 0.05). The perinatal outcome was similar in the two groups. In conclusion, misoprostol not only appears to be a safe and effective agent for cervical ripening and labor induction but is also more efficient than dinoprostone.