LABOR INDUCTION WITH PROSTAGLANDIN E-1 MISOPROSTOL COMPARED WITH DINOPROSTONE VAGINAL INSERT - A RANDOMIZED TRIAL

Objective: To compare the safety, efficacy, and costs of intravaginal misoprostol versus dinoprostone vaginal inserts for cervical ripening and labor induction. Methods: Two hundred twenty-three labor induction patients were assigned randomly to one of two treatment groups: 1) in travaginal misoprostol or 2) dinoprostone vaginal inserts. Fifty micro grams of misoprostol were placed in the posterior vaginal fornix every 3 hours for a maximum period of 24 hours. Ten milligrams of dinoprost one was administered in a single application as a vaginal insert for 1 2 hours. Results: Among 223 patients evaluated, 108 were allocated to the misoprostol group and 115 to the dinoprostone group. The median in terval from induction to vaginal delivery was significantly shorter in the misoprostol group: 698 (range 395-1053) versus 1041 (range 792-15 31) minutes (P < .001). Vaginal delivery within 12 hours of ripening o ccurred in 40.7% of patients who received misoprostol compared with 19 .1% for those receiving dinoprostone (P < .001); no significant differ ence between the groups was noted for vaginal delivery within 24 hours . Uterine tachysystole occurred more frequently in patients in the mis oprostol group (21.3%) than in the dinoprostone group (7.0%) (P = .004 ). Nevertheless, no statistically significant differences were noted b etween, the groups with respect to intrapartum complications, includin g uterine hyperstimulation, mode of delivery, and neonatal or maternal adverse outcomes. The average cost per patient for misoprostol treatm ent was $85 compared with $606 for treatment with the vaginal insert. Conclusion: Intravaginal misoprostol and the dinoprostone vaginal inse rt appear to be safe agents for cervical ripening and labor induction. However, misoprostol is less expensive and more effective than the di noprostone vaginal insert. (C) 1998 by The American College of Obstetr icians and Gynecologists.