Low Doses of Vaginal Misoprostol versus Dinoprostone for Induction of Labor in Uncomplicated Term Pregnancy

Background: Prospective cohort observational study to compare the efficacy low doses (25 micrograms misoprostol) tablet with dinoprostone gel (1 mg) introduced vaginally in term pregnancy for induction of labor as regard maternal and fetal outcome. Methods: Three hundred pregnant women in full term (40-41 weeks) pregnancy were assigned for induction of labor either intravaginal misoprostol tablet or dinoprostone gel. They were divided into 2 groups (A, B). Group A (150 ladies) obtained tablet misoprostol 25 micrograms vaginally 4 hourly and Group B (150 ladies) received dinoprostone gel 1 mg vaginally every 6 hourly, both medications were not to be repeated more than 3 doses. Outcomes were: expression of time interval of induction of labor, augmentation requirement, operative and instrumental rate, expenditure efficiency and neonatal outcome. Results: The demographic criteria as regard the age, body mass index, gestational age, initial Bishop’s score and final Bishop’s score were analogous in both group (the misoprostol and dinoprostone groups), respectively with no significant differences but about parity there was significant difference between them with p value 0.4. No significant differences between both group as regard occurrence of non-reassuring FHR, uterine hyper stimulation and meconium stained amniotic fluid but there was significant differences in spontaneous rupture of the membranes and uterine tachysystole with p value 0.02 and 0.01, respectively. Time of labor induction was shorter in the misoprostol group with p<0.001. The need of more doses was fewer in G1 than G2 with p value 0.03. Also the need to oxytocin for augmentation was lesser in G1 than G2 with p value 0.02. In misoprostol group more deliveries within 24 hour, p<0.04. The vaginal deliveries were more in misoprostol group with lesser percentage of CS but with no significant difference. The fetal outcome in both group was similar according to birth weight, Apgar score and at 5, the requirement for neonatal resuscitation and neonatal intensive care unit admission. Conclusions: The time interval for induction of labor by misoprostol tablet vaginally was shorter than dinoprostone gel, associated with fewer requirements to augmentation of labor with oxytocin and more deliveries in the first 24 hours of induction.