Afia Ansar Shafiq, Samia Shuja, Faiqa Imran, Nasreen Kishwar, Nagina Liaquat.
Comparison of Misoprostol with Dinoprostone for Induction of Labor in Postdated Pregnancy.
J Surg Pak Jan ;19(1):1-5.

Objective: To compare the efficacy of misoprostol with dinoprostone in induction of labor in nulliparous women at and beyond 41 weeks of gestation. Study design: Experimental comparative study. Place & Duration of study: Department of Obstetrics & Gynecology Unit-II, Jinnah Post Graduate Medical Center, Karachi, from September 2007 to October 2010. Methodology:A total of 105 women with more than 287 days (41weeks) gestation with unfavorable cervix and intact membranes were selected for induction of labor Dinoprostone was inserted in 41 patients while 64 patients were induced with intravaginal misoprostol. The primary outcome measures were induction-delivery interval, number of doses required for induction, rate of spontaneous vaginal delivery, C-section and instrumental delivery. Secondary outcomes were the incidence of meconium stained amniotic fluid, fetal weight at the time of delivery, fetal distress and need for admission to NICU. Results: Out of 63 patients in the misoprostol group, 43 (67.1%) women had spontaneous vaginal delivery (SVD) while 26 (63.4%) patients out of 41 in dinoprostone group had SVD. The induction to delivery interval was 13.03+3.52 hours in misoprostol group while it was 14.12+3.31 hours in dinoprostone group. With misoprostol, induction of labor started in 18, 33 and 13 women with 1, 2 and 3 doses respectively within 24 hours but in dinoprostone group 16 women were successfully induced with 1 tablet only, while 21 patients required 2 doses for induction.. The need for oxytocin infusion was the same in both the groups. The neonatal weight was 3.54+3.38 kg in misoprostol group as compared to 3.10+0.26 kg in dinoprostone group (p=0.41, t=1.57). Four neonatal deaths were reported in the misoprostol group as compared to two with dinoprostone. Sixteen neonates were admitted to NICU in misoprostol group as compared to five patients in dinoprostone group. Twenty-eight (44.4%) patients in misoprostol group had meconium stained liquor as compared to 14 (34%) patients in dinoprostone group. Conclusions: Dinoprostone was most effective in comparison with misoprostol in gravida with 41 weeks and above gestation. Misoprostol though showed comparable results, but is not the drug of first choice.

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