Misoprostol versus Dinoprostone for induction of labor at term: a randomized controlled trial

Objective: To compare the safety and efficacy of 25 microgram of sublingual misoprostol with 2 mg of vaginal dinoprostone for induction of labor at term. Methodology: This randomized controlled trial was conducted in the Department of Obstetrics and Gynecology of Cantonment General Hospital, Rawalpindi, Pakistan. All pregnant women aged 20-40, at 37-41 weeks with a live singleton fetus who required induction of labor were eligible for the study. 106 patients were randomized into 2 groups; one group received 25 microgram misoprostol sublingual 4 hourly up to a maximum of four doses and other group received 2mg dinoprostone gel vaginally 6 hourly up to a maximum of 2 doses. Both groups were compared for induction to delivery interval and number of doses, which were the primary outcome measures. Results: A larger number of women in the misoprostol group delivered within 24 hours although this difference did not reach clinical significance (p value 0.301). Lesser number of doses of dinoprostone were required and a larger number of women in the dinoprostone group delivered with a single dose (29 vs 16). This was a clinically significant difference (p=0.04). However, larger number of women in the dinoprostone group required augmentation with syntocinon (p=0.03). Conclusion: A 25 microgram of sublingual misoprostol has been found to be a safe and effective alternate to 2 mg of vaginal dinoprostone for induction of labor at term. The difference between the two groups did not reach clinical significance (p<0.103).