Comparison of the safety and efficacy of intravaginal misoprostol (prostaglandin E1 ) with those of dinoprostone (prostaglandin E2 ) for cervical ripening and induction of labor in a community hospital,

Objective: This clinical trial evaluated the efficacy of intravaginal misoprostol (prostaglandin E1 ) and compared it with that of dinoprostone (prostaglandin E2 ) for cervical ripening and induction of labor in a community hospital. Study Design: This study involved a retrospective analysis of 81 patients undergoing cervical ripening and induction of labor with prostaglandin E2 from May 1, 1996, to May 1, 1997. A comparison prospective analysis of 145 patients undergoing the same procedure with prostaglandin E1 from May 1, 1997 to May 1, 1998, was performed. Results: The mean time to delivery was significantly shorter with misoprostol (19.8 ± 10.4 hours) than with prostaglandin E2 (31.3 ± 13.0 hours, P< .001). Delivery within 24 hours of induction was significantly more frequent with misoprostol (71.9% of subjects vs 31.3%, P< .001). There was no difference in the cesarean delivery rate with misoprostol (25.6% vs 22.2%, P< .67). The incidence of uterine hyperstimulation was higher with prostaglandin E2 (7.4% vs 0.7%, P< .007). There were no uterine ruptures with prostaglandin E2 . There were 2 uterine ruptures and 1 dehiscence with prostaglandin E1 in 3 patients with previous cesarean deliveries and 1 rupture in a patient without a history of uterine scarring. There was no difference in neonatal outcome, with the exception of a fetal death related to uterine rupture in the misoprostol group. Conclusions: Compared with prostaglandin E2 , misoprostol is more effective in cervical ripening and induction of labor, is as safe for patients who do not have a history of cesarean birth, may carry a higher incidence of uterine rupture, and should not be used for patients attempting vaginal birth after previous cesarean delivery. (Am J Obstet Gynecol 1999;180:1551-9.)