A comparison of intravaginal misoprostol and intracervical prostaglandin E2 gel for ripening of unfavorable cervix and labor induction.

OBJECTIVE: To study the effectiveness of single application of intravaginal misoprostol versus intracervical prostaglandin E2 gel for ripening the unfavorable cervix and labor induction.

METHOD: One hundred and ten patients with indications for induction of labor with unfavorable cervices were randomized to receive either 100 microgram tablets of misoprostol placed in the posterior vaginal fornix or prostaglandin E2 1.5 mg in gel placed into the endocervix. Those, who were not in active labor after 24 hours, had labor induced with amniotomy and oxytocin.

RESULTS: Among 110 patients recruited, 60 received misoprostol and 50 received prostaglandin E2 gel. The average interval from start of induction to vaginal delivery was 19.14 +/- 10.64 hours in misoprostol group and 21.37 +/- 13.09 hours in the prostaglandin E2 group (p = 0.33). Five patients (8%) in the misoprostol group had induction of labor after 24 hours of the treatment compared with 13 patients (26%) in the PGE2 group. The difference was significant (p = 0.03). Oxytocin augmentation was 35% in the misoprostol group and 34% in the prostaglandin E2 group (p = 0.86). There were no significant differences between routes of delivery. Nineteen patients (31%) in misoprostol group and 16 patients (32%) in the PGE2 gel group had cesarean deliveries. There was one case (1.7%) of uterine hyperstimulation in the misoprostol group and none in the PGE2 gel group. There were no significant difference in Apgar scores < 7 at 1 and 5 minutes, or admission to the neonatal intensive care unit between the 2 groups.

CONCLUSION: Vaginal misoprostol is an effective agent for cervical ripening and induction of labor. Complications associated with prostaglandin administration were not statistically different between the 2 groups, but hyperstimulation occurred more in misoprostol group.