Labor Induction: Why Complicate Things When They Can Be Simple? A Randomized Controlled Clinical Trial

BACKGROUND. Many different medical and mechanical methods have been used for labor induction, but the current gold standard is vaginal dinoprostone which is, unfortunately expensive, unstable, and requiring refrigerated storage. Misoprostol has been used the induction of labor since 1987. It is inexpensive, easily stored at room temperature and has few systemic side effects. So, it seems to be a very interesting alternative to dinoprostone in labor induction. The objective of our study was to compare the efficiency and safety of vaginal misoprostol with vaginal dinoprostone insert.METHODS. A prospective, randomized, clinical trial was carried out in gynecology and obstetrics department at hospital university center in Bizerte (Tunisia). Two hundred thirteen pregnant women at term were randomized to receive every 08 hours 50 mu g of misoprostol or 0.5 mg dose of dinoprostone intravaginally (maximum of 3 doses). Labor characteristics, maternal complications, and neonatal outcomes were analyzed.RESULTS. An average labor input of 8.22 hours in the misoprostol group was significantly shorter compared to the group Dinoprostone with a delay between the onset of maturation and time childbirth significantly shorter in the misoprostol group (14.16 hours against 17.76 hours; P=0.006). The average labor time was more elongated in the dinoprostone group but the difference was not statistically significant. We also did not find difference between the two groups for birth weight of newborns, and for the Apgar score at 1 minute and 5 minutes.CONCLUSIONS. misoprostol can provide an efficacious and safe substitute for the expensive dinoprostone.