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 E-1) and compared it with that of dinoprostone (prostaglandin E-2) 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 E-2 from May 1, 1996, to May 1, 1997. A comparison prospective analysis of 145 patients undergoing the same procedure with prostaglandin E-2 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 E-2 (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 E-2 (7.4% vs 0.7%, P < .007). There were no uterine ruptures with prostaglandin E-2. There were 2 uterine ruptures and I dehiscence with prostaglandin E-1 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 E-2, 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.