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Efficacy and safety of six hourly vaginal misoprostol versus intracervical dinoprostone: a randomized controlled trial

Archives of Gynecology and Obstetrics volume 276, pages 119–124 (2007)Cite this article

Abstract

Objective

To compare the efficacy and safety of intravaginal misoprostol versus dinoprostone cervical gel for cervical ripening and labour induction.

Methods

We carried out an experimental clinical trial in which we enrolled 130 cervical consecutive patients with cervical ripening, randomly assigned to one of the following two treatment groups: (1) intravaginal misoprostol and (2) intracervical dinoprostone gel. A total of 50 μm of misoprostol was placed in the posterior vaginal fornix every 6 h for a maximum period of 24 h and 0.5 mg of dinoprostone was administrated in the uterine cervix every 6 h, for a maximum period of 24 h. The primary outcome measure was the number (rate) of women who went to vaginally deliver within 24 h of the protocol initiation.

Results

Among 130 patients evaluated, 65 were allocated to the misoprostol group and 65 to the dinoprostone group. The proportion of vaginal delivery within 24 h was significantly higher in the misoprostol group (75%) than in the dinoprostone group (53.8%) (RR = 1.40, 95% CI [1.07–1.45], P = 0.02). There was no significant difference between the mean time interval of delivery in the misoprostol group and the dinoprostone group (14.9 vs.15.8 h) (P = 0.51). The Bishop score was significantly higher in the misoprostol group, 6 h after the onset of the study (1.38; relative risk, 95% CI [1.02–1.85], P = 0.03). The Caesarean delivery rate for fetal distress was higher in the dinoprostone group (21 vs. 10.8%, P = 0.15). The tachysystole (Misoprostol 6.1% vs. dinoprostone 4.6%, relative risk 1.15, 95% CI [0.6–2.24]) and hyperstimulation syndrome rates (Misoprostol 7.6% vs. dinoprostone 4.6%, relative risk 1.26, 95% CI [0.72–2.24]) were slightly increased in the misoprostol group than in the dinoprostone group without reaching the level of statistical signification.

Conclusion

Misoprostol as used in this protocol is more effective than cervical dinoprostone gel application in the cervical ripening and labour induction. There is a tendency for an increase in the rate of tachysystole and hyperstimulation syndrome.

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Affiliations

  1. University Hospital Fattouma Bourguiba, Unit of Obstetrics and Gynaecology, 5000, Monastir, Tunisia

    Walid Denguezli, Adnene Trimech, Anis Haddad, Awatef Hajjaji, Zahra Saidani, Raja Faleh & Mohamed Sakouhi

  2. 2 Avenue jelloul Ben Chérifa 4051, Sousse, Tunisia

    Walid Denguezli

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  1. Walid Denguezli
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  2. Adnene Trimech
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  3. Anis Haddad
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  5. Zahra Saidani
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  6. Raja Faleh
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  7. Mohamed Sakouhi
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Correspondence to Walid Denguezli.

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Denguezli, W., Trimech, A., Haddad, A. et al. Efficacy and safety of six hourly vaginal misoprostol versus intracervical dinoprostone: a randomized controlled trial. Arch Gynecol Obstet 276, 119–124 (2007). https://doi.org/10.1007/s00404-006-0313-1

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  • DOI: https://doi.org/10.1007/s00404-006-0313-1

Keywords

  • Misoprostol
  • Dinoprostone
  • Cervical ripening
  • Labour induction