Intracervical misoprostol and prostaglandin E2 for labor induction

Objectives: To compare the safety and efficacy of misoprostol with PGE(2) for induction of labor by intracervical administration. Methods: Eighty-six women with indications for labor induction at term were randomly assigned to two groups. Each woman received either 50 mug of misoprostol or 0.5 mg of prostaglandin E-2 intracervically. If labor was not initiated after 4 h, the same dose was repeated every 4 h to a maximum of 200 mug of misoprostol or 1.5 mg of PGE(2) until adequate labor was achieved. Results: Forty-three women were allocated to the misoprostol group and 43 to the prostaglandin E-2 group. Misoprostol was more effective than PGE(2) in producing cervical changes (P<0.025). Delivery within 12 h after the first administration occurred more often in the misoprostol group than in the PGE(2) one (85% vs. 56%, P<0.05). Less patients in the misoprostol group required oxytocin augmentation than in the PGE(2) one (16.3% vs. 39.5%, P<0.05). Uterine tachysystole and hyperstimulation occurred more frequently in the misoprostol group (44.1%) than in the PGE(2) group (18.7%) (P<0.05). Nevertheless, no statistically significant differences were noted between the two groups including mode of delivery and neonatal or maternal adverse outcome. The interval from induction to vaginal delivery was significantly shorter in the misoprostol group (480+/-172 min vs. 657+/-436 min, P<0.01). Conclusions: Compared with prostaglandin E-2, intracervical misoprostol is more effective in cervical ripening and labor induction at term. The higher frequency of uterine hypercontractility associated with the use of misoprostol did not increase the risk of adverse intrapartum and neonatal outcomes. (C) 2002 International Federation of Gynecology and Obstetrics. Published by Elsevier Science Ireland Ltd. All rights reserved.