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A randomized clinical trial comparing misoprostol suppositories with continuous dinoprostone for cervical ripening and labor induction



A randomized clinical trial comparing misoprostol suppositories with continuous dinoprostone for cervical ripening and labor induction



American Journal of Obstetrics & Gynecology 184(1): S118



OBJECTIVE: To compare the efficacy of continuous dinoprostone vaginal insert with 2 different doses of misoprostol vaginal suppositories for cervical ripening and labor induction in women with an unfavorable cervix. STUDY DESIGN: One hundred eighteen patients with indications for induction of labor and an unfavorable Bishop score (ltoreq4) were randomly assigned to receive either continuous dinoprostone, misoprostol 35-mg suppositories, or misoprostol 50-mg suppositories. Misoprostol suppositories were repeated every 4.5 hours for a maximum of 6 doses. RESULTS: No significant differences were noted among the 3 groups in the change of Bishop score, induction of active labor, or the time from initial treatment to delivery. Active labor occurred in roughly two thirds of the patients with an average time of 5.7-6.7 hours regardless of treatment assignment. When the 2 misoprostol groups were combined, a shorter insertion to vaginal delivery interval was observed in the nulliparous women receiving misoprostol than those receiving dinoprostone (21.3 vs 27.2 hours, P = .019). We noted a significantly higher incidence of tachysystole in the dinoprostone group (15.4% vs 3.8%, P = .036). There were no other significant differences between the groups in mode of delivery, adverse maternal, fetal, or neonatal outcomes. The cesarean delivery rate was 32.9% for the combined misoprostol group and 28.2% for the dinoprostone group. The incidence rate of hypertonus was 6.4% in the combined misoprostol group and 12.8% in the dinoprostone group. The rate for nonreassuring FHR was identical (12.8%) while the rate for hyperstimulation was similar (3.8% vs 2.6%) in the combined misoprostol group and in the continuous dinoprostone group. No serious adverse effect occurred in this study. CONCLUSION: The results appear to support that induction of labor with misoprostol suppositories containing either 35 mg or 50 mg is as effective and safe as continuous dinoprostone.

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Accession: 034318911

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