A blinded randomized controlled trial of misoprostol, dinoprostone, and oxytocin for labor induction

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Abstract
Objectives: Our objectives were to compare misoprostol via oral and vaginal routes in a randomized, controlled, blinded fashion; to compare misoprostol with a standard regimen of dinoprostone and oxytocin; to include a broad range of gestational ages; and to include patients with rupture of membranes prior to labor onset. Methods: 156 consecutive patients were enrolled. They were randomly assigned to one of three groups. Group A received oral misoprostol, 50 μg, and an inert vaginal placebo every 4 hours for 24 hours, with an optional additional dose of 50 μg after the second dose. Group B received misoprostol, 25 μg, intravaginally and an inert oral placebo every 4 hours for 24 hours, with an optional oral placebo after the second dose. Group C received dinoprostone intravaginally for 12 hours followed by oxytocin, or only oxytocin based on admitting bishop’s score. Results: Induction in groups A and B resulted in 86% and 87% vaginal delivery rate, compared with 79% for Group C. Of those delivered vaginally, groups B and C resulted in 20.0 and 20.3 hours to delivery versus 25.9 hours in group A. These differences reached statistical significance. Rates of tachysystole for groups A and B were 16% and 20%, whereas group C was 2%. Hyperstimulation rates were not statistically different (4%, 7%, and 2%, respectively). Conclusions: Misoprostol is superior to dinoprostone/oxytocin in producing vaginal deliveries. Vaginal misoprostol resulted in similar times to delivery as dinoprostone/oxytocin, whereas oral misoprostol required longer induction times. While misoprostol created more tachysystole than dinoprostone/oxytocin, rates of hyperstimulation were similar.

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