OBJECTIVE: To compare vaginal misoprostol with dinoprostone for induction of labour. DESIGN: Randomised multicentre trial. SETTING:Labour wards of one university hospital and two teaching hospitals. POPULATION: Six hundred and eighty-one women with indication for labour induction at >or=36 weeks of gestation, singleton pregnancy and no previous ceasarean section. METHODS:Misoprostol (25 mcg, hospital-prepared capsule) in the posterior vaginal fornix, every four hours, maximum three times daily or dinoprostone gel (1 mg) every four hours. Oxytocin was administered if necessary. MAIN OUTCOME MEASURES: Primary: 'adverse neonatal outcome' (5-minute Apgar score <7 and/or umbilical cord pH <7.15). Secondary: labour duration, mode of delivery and patient satisfaction. RESULTS:Three hundred and forty-one women receivedmisoprostol and 340 dinoprostone. The median induction-delivery interval was longer in the misoprostol group compared with the dinoprostone group (25 versus 19 hours, P= 0.008). The caesarean section rate was lower in the misoprostol group: 16.1%versus 21%, but this difference was not statistically significant RR = 0.8 (95% CI 0.6-1.04). 'Adverse neonatal outcome' was found to be similar in both groups: 21% in the misoprostol and 23% in the dinoprostone groups. Significantly fewer neonates were admitted to NICU in the misoprostol group compared with dinoprostone 19%versus 26% (RR = 0.7, 95% CI 0.5-0.98). CONCLUSIONS:Misoprostol in this dosing regimen is a safe method of labour induction. NICU admission rates were lower in the misoprostol group. No difference could be detected in patient satisfaction between groups.
RCT Entities:
OBJECTIVE: To compare vaginal misoprostol with dinoprostone for induction of labour. DESIGN: Randomised multicentre trial. SETTING: Labour wards of one university hospital and two teaching hospitals. POPULATION: Six hundred and eighty-one women with indication for labour induction at >or=36 weeks of gestation, singleton pregnancy and no previous ceasarean section. METHODS:Misoprostol (25 mcg, hospital-prepared capsule) in the posterior vaginal fornix, every four hours, maximum three times daily or dinoprostone gel (1 mg) every four hours. Oxytocin was administered if necessary. MAIN OUTCOME MEASURES: Primary: 'adverse neonatal outcome' (5-minute Apgar score <7 and/or umbilical cord pH <7.15). Secondary: labour duration, mode of delivery and patient satisfaction. RESULTS: Three hundred and forty-one women received misoprostol and 340 dinoprostone. The median induction-delivery interval was longer in the misoprostol group compared with the dinoprostone group (25 versus 19 hours, P= 0.008). The caesarean section rate was lower in the misoprostol group: 16.1%versus 21%, but this difference was not statistically significant RR = 0.8 (95% CI 0.6-1.04). 'Adverse neonatal outcome' was found to be similar in both groups: 21% in the misoprostol and 23% in the dinoprostone groups. Significantly fewer neonates were admitted to NICU in the misoprostol group compared with dinoprostone 19%versus 26% (RR = 0.7, 95% CI 0.5-0.98). CONCLUSIONS:Misoprostol in this dosing regimen is a safe method of labour induction. NICU admission rates were lower in the misoprostol group. No difference could be detected in patient satisfaction between groups.
Authors: Gary L Darmstadt; Mohammad Yawar Yakoob; Rachel A Haws; Esme V Menezes; Tanya Soomro; Zulfiqar A Bhutta Journal: BMC Pregnancy Childbirth Date: 2009-05-07 Impact factor: 3.007
Authors: Mieke L G Ten Eikelder; Femke Neervoort; Katrien Oude Rengerink; Gert J van Baaren; Marta Jozwiak; Jan-Willem de Leeuw; Irene de Graaf; Maria G van Pampus; Maureen Franssen; Martijn Oudijk; Paulien van der Salm; Mallory Woiski; Paula Jm Pernet; A Hanneke Feitsma; Huib van Vliet; Martina Porath; Frans Roumen; Erik van Beek; Hans Versendaal; Marion Heres; Ben Willem J Mol; Kitty W M Bloemenkamp Journal: BMC Pregnancy Childbirth Date: 2013-03-19 Impact factor: 3.007