90528
document
A comparison of intermittent vaginal administration of misoprostol with continuous dinoprostone for cervical ripening and labor induction . OBJECTIVE Our purpose was to compare the effect of vaginal administration of misoprostol ( Cytotec ) with that of dinoprostone ( Cervidil ) on cervical ripening and labor induction . STUDY DESIGN Two hundred patients with indications for induction of labor and unfavorable cervical examinations were randomly assigned to receive vaginally administered misoprostol ( prostaglandin E1 ) or the dinoprostone ( prostaglandin E2 ) vaginal insert . Twenty-five microgram tablets of misoprostol were placed in the posterior vaginal fornix every 4 hours for a maximum of six doses . Additional misoprostol was not given after either spontaneous rupture of membranes , adequate cervical ripening ( Bishop score of > or = 8 or cervical dilatation of > or = 3 cm ) , or beginning of active labor . The vaginal insert , Cervidil , containing 10 mg of dinoprostone in a timed-release preparation was placed in the posterior vaginal formix for a maximum period of 24 hours . The vaginal insert was removed for spontaneous rupture of membranes , entry into active labor , adequate cervical ripening , or abnormality of uterine contractile pattern or fetal cardiac activity . RESULTS Of the 200 patients enrolled , 99 were randomized to misoprostol and 101 to dinoprostone . The average interval from start of induction to vaginal delivery was 1 hour shorter in the misoprostol group ( 1296.7 +/- 722.1 minutes ) than in the dinoprostone group ( 1360.0 +/- 792.0 minutes ) , but this difference was not statistically significant ( p = 0.97 ) . Oxytocin augmentation of labor was used in 50 ( 50.5 % ) misoprostol-treated patients and 43 ( 43.5 % ) dinoprostone-treated patients ( relative risk 1.14 , 95 % confidence interval 0.86 to 1.51 , p = 0.35 ) . There were no significant differences between routes of delivery with misoprostol or dinoprostone . Overall , 38 patients ( 19.3 % ) had cesarean deliveries . There was a significantly lower prevalence of tachysystole ( six or more uterine contractions in a 10-minute window for two consecutive 10-minute periods ) in the misoprostol group ( 7.1 % ) than in the dinoprostone group ( 18.4 % ) ( relative risk 0.52 , 95 % confidence interval 0.31 to 0.89 , p = 0.02 ) . There were no significant differences in frequency of uterine hyperstimulation or hypertonus . Abnormal fetal heart rate tracings were found in 23 ( 23.2 % ) of misoprostol-treated patients and 35 ( 35.7 % ) of dinoprostone-treated patients ( relative risk 0.73 , 95 % confidence interval 0.52 to 1.01 , p = 0.0546 ) . No significant differences were found in meconium passage , 1- or 5-minute Apgar scores < 7 , neonatal resuscitations , or admissions to the neonatal intensive care unit between the two groups . CONCLUSIONS Vaginally administered misoprostol is as effective as dinoprostone for cervical ripening and the induction of labor . Mean time intervals to delivery , need for oxytocin augmentation , and routes of delivery were similar between the two groups . Incidence of uterine tachysystole with misoprostol every 4 hours was significantly less than with dinoprostone .
90529
Intervention_Pharmacological
vaginal administration of misoprostol ( Cytotec )
90530
Intervention_Pharmacological
dinoprostone ( Cervidil )
90531
Intervention_Pharmacological
misoprostol ( prostaglandin E1 )
90532
Intervention_Pharmacological
dinoprostone ( prostaglandin E2 )
90533
Intervention_Pharmacological
misoprostol
90534
Intervention_Pharmacological
misoprostol
90535
Intervention_Pharmacological
Cervidil
90536
Intervention_Pharmacological
dinoprostone
90537
Intervention_Pharmacological
misoprostol
90538
Intervention_Pharmacological
dinoprostone
90539
Intervention_Pharmacological
misoprostol
90540
Intervention_Pharmacological
dinoprostone
90541
Intervention_Pharmacological
Oxytocin
90542
Intervention_Pharmacological
misoprostol-treated
90543
Intervention_Pharmacological
dinoprostone-treated
90544
Intervention_Pharmacological
misoprostol
90545
Intervention_Pharmacological
dinoprostone
90546
Intervention_Pharmacological
misoprostol
90547
Intervention_Pharmacological
dinoprostone
90548
Intervention_Pharmacological
misoprostol-treated
90549
Intervention_Pharmacological
dinoprostone-treated
90550
Intervention_Pharmacological
misoprostol
90551
Intervention_Pharmacological
oxytocin
90552
Intervention_Pharmacological
misoprostol
90553
Intervention_Pharmacological
dinoprostone
90554
Outcome_Physical
cervical ripening and labor induction .
90555
Outcome_Physical
cervical ripening and labor induction .
90556
Outcome_Physical
average interval from start of induction to vaginal delivery
90557
Outcome_Physical
Oxytocin augmentation of labor
90558
Outcome_Other
routes of delivery
90559
Outcome_Physical
cesarean deliveries .
90560
Outcome_Physical
tachysystole
90561
Outcome_Physical
frequency of uterine hyperstimulation or hypertonus . Abnormal fetal heart rate tracings
90562
Outcome_Physical
meconium passage
90563
Outcome_Physical
Apgar scores
90564
Outcome_Physical
neonatal resuscitations
90565
Outcome_Other
, or admissions to the neonatal intensive care unit
90566
Outcome_Other
effective
90567
Outcome_Physical
cervical ripening and the induction of labor . Mean time intervals to delivery , need for oxytocin augmentation , and routes of delivery
90568
Outcome_Physical
uterine tachysystole
90569
Participant_Sample-size
Two hundred patients
90570
Participant_Condition
indications for induction of labor and unfavorable cervical examinations
90571
Participant_Sample-size
200
90572
Participant_Sample-size
99
90573
Participant_Sample-size
misoprostol
90574
Participant_Sample-size
101
90575
Participant_Sample-size
dinoprostone
90576
Participant_Condition
cesarean deliveries