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Oral Misoprostol and Intracervical Dinoprostone for Cervical Ripening and Labor Induction: A Randomized Comparison

From the Department of Obstetrics and Gynecology, University Hospital of Puerto Real, Puerto Real, Cadiz, Spain.

Address reprint requests to: Jose L. Bartha, MD Department of Obstetrics and Gynecology Hospital Universitario de Puerto Real Carretera Nacional IV, KM 665 Puerto Real, Cadiz Spain E-mail: jbarthar{at}sego.es

Objective: To compare efficacy, safety, and tolerance of oral misoprostol with intracervical dinoprostone for cervical ripening and labor induction.

Methods: Two hundred women were randomized to receive single doses of oral misoprostol 200 µg or 0.5 mg of dinoprostone intracervically every 6 hours for a maximum four doses.

Results: The intervals from administration of the drug to active phase of labor (11.1 hours [7–24] versus 15.8 hours [7.5–29.62], P = .01), to delivery (14.0 hours [8.42–27.61] versus 20.2 hours [16.7–32.8], P = .01), and to rupture of membranes (10.0 hours [4.95–24.7] versus 15.6 hours [8.2–29.2], P = .003) were significantly shorter in the misoprostol group. All those variables were not distributed normally, so results are presented as median and interquartile range. The rates of women who needed oxytocin (68% versus 52%, P = .03) and cesarean for failed induction (9% versus 1%, P = .01) were higher in the dinoprostone group.

Conclusion: A single dose of 200 µg oral misoprostol was more effective for cervical ripening and labor induction than 0.5 mg of dinoprostone intracervically every 6 hours, with a maximum of four doses.

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