[Medical indications of labor induction: a comparison between intravaginal misoprostol and intravenous prostaglandin E2]

Abstract

Objectives: To assess the effectiveness and safety of misoprostol compared to dinoprostone at term, in cervical priming and labor induction for medical indications.

Material: and methods. Retrospective analysis of 87 patients. 43 patients received intravaginal misoprostol (50microg) and 44 intravenous dinoprostone (0,225 microg/mn with progressive increasing).

Results: The mean time from administration to delivery was significantly shorter in the misoprostol group than in the dinoprostone group (10,2 vs 26,0 hours, p<0,01). A significantly greater number of deliveries occurred within 24 hours following administration of misoprostol ( 95 vs 55%, p<0,01). There was no difference in the rates of cesarean section (21 vs 23%, NS), in the rates of tachysystole (30 vs 27%, NS). Hyperstimulations (excessive uterine response: hypertony or tachysystole with non reassuring fetal heart rate) were increased in the misoprostol group, but not significantly (16 vs 7%, NS). Three cesarean sections were performed for hyperstimulation syndrome in the misoprostol group. There was no significant difference between the two agents administered in neonatal outcome or meconial fluid.

Conclusion: Misoprostol appears interesting in promoting cervical priming and induction of labour at term, but the increased frequency of hyperstimulation and meconial fluid reported in the literature indicate than larger studies than ours are necessary to accurately define the fine incidence of adverse effect. Moreover, dose and administration modalities should be defined by those studies.