Labor induction with vaginal misoprostol and extra-amniotic prostaglandin F2alpha gel.
OBJECTIVE
To compare the effectiveness of vaginally administered misoprostol with extra-amniotic prostaglandin F2alpha (PGF2alpha) gel for induction of labor.


METHODS
A randomized controlled trial, with women allocated to receive either misoprostol 50 microg intra-vaginally or extra-amniotic PGF2alpha gel 5 mg, was conducted in Harare Maternity Hospital. A total of 152 women were admitted for induction of labor with a term singleton, pregnancy and cephalic presentation were recruited. The main outcome was duration of induction.


RESULTS
There were no differences in the characteristics of women in the two groups at recruitment. In the misoprostol group there was a significantly reduced need for augmentation of labor with oxytocin (OR=0.36; 95% C.I. 0.17-0.73) and delivery by cesarean section for failure to progress (OR=0.11; 95% C.I. 0.00-0.88). The risk for duration of induction to vaginal delivery exceeding 12, 18 or 24 h was reduced by 18%, 38% and 68%, respectively, but only the risk for duration >24 h was significantly reduced (OR=0.32; 95%C.I. 0.11-0.91). The mean duration of induction was shorter in the misoprostol group, 15.2 vs. 23.6 h (P=0.02). There were no differences in fetal outcome.


CONCLUSIONS
Misoprostol 50 microg was associated with less use of oxytocin in labor, a shorter induction to delivery interval and fewer cesarean sections for failure to progress when compared with extra-amniotic PGF2alpha gel.
Majoko
F
F
Department of Obstetrics and Gynecology, University of Zimbabwe Medical School, PO Box A178, Avondale, Harare, Zimbabwe. majokof215@avu.org
Zwizwai
M
M
Lindmark
G
G
Nyström
L
L
D000282:Administration, Intravaginal; D000650:Amnion; D036861:Delivery, Obstetric; D015237:Dinoprost / Q000008:administration & dosage*; D005260:Female; D005782:Gels; D006801:Humans; D007751:Labor, Induced / Q000379:methods*; D016595:Misoprostol / Q000008:administration & dosage*; D010120:Oxytocics / Q000008:administration & dosage*; D010121:Oxytocin / Q000008:administration & dosage; D011247:Pregnancy; D011256:Pregnancy Outcome
D005782:Gels; D010120:Oxytocics; D016595:Misoprostol; D010121:Oxytocin; D015237:Dinoprost