title: Labor induction with prostaglandin E1 misoprostol compared with dinoprostone vaginal insert: a randomized trial.
abstract: OBJECTIVE
  To compare the safety, efficacy, and costs of intravaginal misoprostol versus dinoprostone vaginal inserts for cervical ripening and labor induction.
  
  
  METHODS
  Two hundred twenty-three labor induction patients were assigned randomly to one of two treatment groups: 1) intravaginal misoprostol or 2) dinoprostone vaginal inserts. Fifty micrograms of misoprostol were placed in the posterior vaginal fornix every 3 hours for a maximum period of 24 hours. Ten milligrams of dinoprostone was administered in a single application as a vaginal insert for 12 hours.
  
  
  RESULTS
  Among 223 patients evaluated, 108 were allocated to the misoprostol group and 115 to the dinoprostone group. The median interval from induction to vaginal delivery was significantly shorter in the misoprostol group: 698 (range 395-1053) versus 1041 (range 792-1531) minutes (P < .001). Vaginal delivery within 12 hours of ripening occurred in 40.7% of patients who received misoprostol compared with 19.1% for those receiving dinoprostone (P < .001); no significant difference between the groups was noted for vaginal delivery within 24 hours. Uterine tachysystole occurred more frequently in patients in the misoprostol group (21.3%) than in the dinoprostone group (7.0%) (P = .004). Nevertheless, no statistically significant differences were noted between the groups with respect to intrapartum complications, including uterine hyperstimulation, mode of delivery, and neonatal or maternal adverse outcomes. The average cost per patient for misoprostol treatment was $85 compared with $606 for treatment with the vaginal insert.
  
  
  CONCLUSIONS
  Intravaginal misoprostol and the dinoprostone vaginal insert appear to be safe agents for cervical ripening and labor induction. However, misoprostol is less expensive and more effective than the dinoprostone vaginal insert.
authors.affiliation: Department of Obstetrics and Gynecology, University of Florida Health Science Center, Jacksonville 32209, USA.
authors.forename: L
authors.initials: L
authors.lastname: Sanchez-Ramos
authors.forename: D E
authors.initials: DE
authors.lastname: Peterson
authors.forename: I
authors.initials: I
authors.lastname: Delke
authors.forename: F L
authors.initials: FL
authors.lastname: Gaudier
authors.forename: A M
authors.initials: AM
authors.lastname: Kaunitz
mesh_terms: D015232:Dinoprostone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007751:Labor, Induced / Q000379:methods*; D016595:Misoprostol / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D010120:Oxytocics / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D011247:Pregnancy; D013488:Suppositories; D014621:Vagina
chemical_list: D010120:Oxytocics; D013488:Suppositories; D016595:Misoprostol; D015232:Dinoprostone