Vaginal Dinoprostone vs. oral Misoprostol in labor induction: A retrospective cohort study

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Created On: 18/12/2024

This retrospective cohort study compared the effectiveness of 10 mg vaginal Dinoprostone inserts with oral Misoprostol 25 μg administered every 2 and 4 hours for delivery induction, focusing on differences based on parity.

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Key take away

In multiparous women, oral Misoprostol 25 μg given every 4 hours is less effective than 10 mg vaginal Dinoprostone for labor stimulation when accounting for parity and induction indications, supporting the need for individualized choices in labor induction agents.

Background

Method

Data from 607 volunteers across two hospitals were analyzed. Women having singleton pregnancies with cephalic presentation, a Bishop score below six, gestational age of 32 weeks or more, and no contraindications for vaginal birth were included. The primary focus was on the time from induction to delivery, with secondary outcomes including mode of delivery and safety for mothers and babies.

Result

Dinoprostone group exhibited fewer cases of post-term and premature rupture of membranes but more instances of intrauterine growth restriction/small-for-gestational age. Both oral Misoprostol regimens led to shorter delivery times than vaginal Dinoprostone, with median times of 1380 minutes and 1127 minutes compared to 1631.5 minutes for Dinoprostone. The pivotal difference for Misoprostol every 2 hours was only seen in first-time mothers, and it lost significance following adjustments for other factors.

No prominent difference was noted in the number of women giving birth within 24 hours between Misoprostol every 2 hours and Dinoprostone after adjustments. However, Misoprostol every 4 hours took longer to deliver than Dinoprostone. Both Misoprostol regimens also illustrated fewer cases of meconium-stained amniotic fluid (Odds ratio [OR] 0.44 for every 4 hours, OR 0.34 for every 2 hours) and cesarean sections (OR 0.48 for every 4 hours, OR 0.53 for every 2 hours) as opposed to Dinoprostone, even after accounting for other factors.

Conclusion

Oral Misoprostol 25 μg administered every 4 hours is less potent than 10 mg vaginal Dinoprostone for triggering labor, particularly after adjusting for parity and the specific indications for induction. This difference is especially notable in multiparous women, highlighting the importance of considering these factors when choosing an induction method.

However, Misoprostol was linked with milder side effects. Further research is essential to refine labor induction practices tailored to women's preferences, parity, indication for induction, and Bishop score.