Labor induction in preeclampsia: is misoprostol more effective than dinoprostone?
OBJECTIVE
To compare the efficacy of vaginal misoprostol versus dinoprostone for induction of labor (IOL) in patients with preeclampsia according to the WHO criteria.


METHODS
Ninety-eight patients were retrospectively analyzed. A total of 47 patients received 3 mg dinoprostone suppositories every 6 h (max. 6 mg/24 h) whereas 51 patients in the misoprostol group received either 50 mug misoprostol vaginally every 12 h, or 25 mug every 6 h (max. 100 mug/24 h). Primary outcomes were vaginal delivery within 24 and 48 h, respectively.


RESULTS
The probability of delivering within 48 h was more than three-fold higher in the misoprostol than in the dinoprostone group: odds ratio (OR)=3.48; 95% confidence interval (CI) 1.24, 10.30, whereas no significant difference was observed within 24 h (P=0.34). No correlation was seen between a ripe cervix prior to IOL and delivery within 24/48 h (P=0.33 and P=1.0, respectively). More cesarean sections were performed in the dinoprostone group due to failed IOL (P=0.0009). No significant differences in adverse maternal outcome were observed between both study groups, whereas more neonates (12 vs. 6) of the dinoprostone group were admitted to the NICU (P=0.068).


CONCLUSIONS
This study suggests that misoprostol may have some advantages compared to dinoprostone, including improved efficacy and lower cost of the drug, even in cases of preeclampsia.
Lapaire
Olav
O
Department of Obstetrics and Gynecology, University Hospital Basel, Switzerland.
Zanetti-Dällenbach
Rosanna
R
Weber
Patrizia
P
Hösli
Irene
I
Holzgreve
Wolfgang
W
Surbek
Daniel
D
D000282:Administration, Intravaginal; D000328:Adult; D015232:Dinoprostone / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007751:Labor, Induced; D008499:Medical Records; D016595:Misoprostol / Q000008:administration & dosage / Q000627:therapeutic use*; D010120:Oxytocics / Q000008:administration & dosage / Q000627:therapeutic use*; D011225:Pre-Eclampsia; D011247:Pregnancy; D012189:Retrospective Studies; D016896:Treatment Outcome
D010120:Oxytocics; D016595:Misoprostol; D015232:Dinoprostone