A randomized clinical trial to compare the efficacy of different doses of intravaginal misoprostol with intracervical dinoprostone for cervical ripening and labor induction

Objectives: To compare the efficacy of 25 vs. 50 mu g of intravaginal misoprostol vs. intracervical dinoprostone for cervical ripening and labor induction. Materials and Methods: 210 women with Bishop's score <6 were randomized into 3 groups of 70 each to receive 6 hourly doses of either 25 or 50 mu g of intravaginal misoprostol or 0.5 mg intracervical dinoprostone to maximum of 3 doses and outcome parameters were compared. Results: Induction to vaginal delivery interval was significantly lower (p<0. 05) for 50 mu g (13.8 +/- 6.62 hours) as compared to 25 mu g misoprostol (16.4 +/- 7.34 hours) or dinoprostone group (16.3 +/- 7.49 hours). Maximum improvement (p<0.05) in Bishop's score and minimum oxytocin requirement (p<0.05) was seen with misoprostol 50 mu g. No significant difference was observed for women delivering vaginally within 24 hours (93.8 vs. 89.7 vs. 85.4%), patients delivering after one dose (24.3 vs. 21.4 vs. 20%), cesarean deliveries, fetal outcome, complications like hyperstimulation and fetal heart abnormalities for the 50 vs. 25 mu g misoprostol vs. dinoprostone group. Conclusion: Intravaginal misoprostol 50 mu g administered 6 hourly appears to be most effective as it has least induction to delivery time, has maximum improvement in Bishop's score, least oxytocin requirement without any increase in complication rate.