Oral misoprostol versus intravaginal prostaglandin E2 for preinduction cervical ripening: a randomized trial

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Abstract
Objective: To compare orally administered misoprostol with intravaginal prostaglandin E2 (dinoprostone vaginal suppository) for cervical ripening and labor induction. Methods: Patients presenting with medical or obstetric indications for labor induction whose Bishop score was 6 or less were randomly allocated to receive either 50 μg of oral misoprostol or 4 mg of dinoprostone. If adequate cervical ripening or active labor did not ensue, repeat doses of each medication were administered every 4 hours. A maximum of six doses of either oral misoprostol or dinoprostone was permitted; intravenous oxytocin was subsequently administered. Results: Among the 60 enrolled patients, the mean interval from start of induction to delivery was similar between the misoprostol and dinoprostone groups (1,495 ± 119 versus 1,692 ± 242 minutes, P = 0.47). Vaginal delivery occurred within 24 hours in 46% of those administered oral misoprostol, compared with 37% of those who received dinoprostone (P = 0.5). A similar number of medication doses was administered in each group (2.6 ± 0.3 for misoprostol, 2.9 ± 0.3 for dinoprostone; P = 0.4). No statistically significant differences existed between the two groups with respect to tachysystole, uterine hyperstimulation, or fetal heart rate changes. Conclusions: Oral administration of misoprostol is an effective alternative to intravaginal prostaglandin E2 for preinduction cervical ripening.

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