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Efficacy of misoprostol over dinoprostone gel and Foley’s catheter as a cervical ripening agent

Parul S Jani, Mayur R Gandhi, Nilesh Thakor.

Abstract
Background: Induction of labor is one of the most important and irrevocable interventions in obstetric practice. Timely induction could reduce maternal mortality and morbidity and assure a delivery of a healthy baby.

Objective: To evaluate the efficacy of misoprostol as a cervical ripening agent and its comparison with dinoprostone gel and Foley’s catheter in terms of success rate, safety, side effects, patient’s compliance, and cost factor.

Materials and Methods: A total of 175 pregnant women requiring induction of labor were recruited. Of the 175 cases, 75 were induced with 50 µg misoprostol, 50 cases with intracervical Foley’s catheter No. 18, and 50 cases with 0.5 mg intracervical dinoprostone gel, selected by purposive sampling method during April to August 2002, at the Department of Obstetrics and Gynecology, Guru Gobind Singh Hospital, Jamnagar, and M.P. Shah Medical College, Jamnagar, Gujarat, India. Written and informed consent was taken from the patients. Outcome measures such as change in Bishop’s score, need of augmentation, and induction delivery interval and complications such as hyperstimulation, fever, and meconium passage were compared between the three groups. Statistical analysis was performed by ANOVA test.

Results: The age range of the patients was 21 to 35 years; 76% of the patients were in the 21–25 years age group. Thirty-eight (50.6%) patients were multigravida, and 45 (60%) patients reported more than 37 weeks of pregnancy. Thirty-five (46.6%) of the patients showed premature rupture of membrane as indication of labor. The mean Bishop’s score for induction was 3.20 in misoprostol group. Only 12% of the patients required augmentation in misoprostol group, while it was 48% in dinoprostone group and 72% in Foley’s catheter group. Sixty-three (84%) patients in misoprostol group and 94% of patients in dinoprostone group delivered by vaginal delivery; 57.3% patients delivered within 6 h in misoprostol group (misoprostol: 57.3%, dinoprostone: 28%, Foley’s catheter: 8%; p < 0.001). Incidence of thin meconium occurred in 12% in misoprostol group, 10% in dinoprostone group, and 18% in Foley’s catheter group. In misoprostol and Foley’s catheter groups, three patients developed fever after induction. No patient reported diarrhea and vomiting. Incidence of cervical tear and vaginal laceration was similar in all the groups. No case of hyperstimulation was observed in our study. Misoprostol is quite cheaper than dinoprostone gel and Foley’s catheter.

Conclusion: Vaginal misoprostol is safe and effective for induction of labor with lesser need of oxytocin augmentation and shorter induction delivery interval and possess some advantages compared with dinoprostone and Foley’s catheter including improved efficacy and lower cost of the drug.

Key words: Misoprostol, dinoprostone, Foley’s catheter, cervical ripening, induction of labor, Bishop’s score



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