A randomised controlled trial of low-dose misoprostol and dinoprostone vaginal pessaries for cervical priming.
OBJECTIVE
We studied the efficacy of 25-microg misoprostol pessaries as either single or double dose compared with a 3-mg dinoprostone pessary for cervical priming.


METHODS
A randomised controlled trial in Singapore.


METHODS
One hundred and seventy-one women with term pregnancies and modified Bishop scores (mBS) < or =6 from 2003 to 2004.


METHODS
Patients were randomised to single misoprostol dose, double misoprostol dose or the current dinoprostone regimen.


METHODS
Primary outcome was number of women who achieved favourable mBS >6 or active labour by day 2. Secondary outcomes were time interval from insertion to delivery, cardiotocographic abnormalities, delivery and neonatal outcome.


RESULTS
More women in the misoprostol double-dose group (96.6%) and dinoprostone group (93%) achieved the primary outcome compared with the single-dose group (77.8%) (P = 0.003 and P = 0.03, respectively). There was no difference in secondary outcomes. More multiparous women achieve primary outcome compared with nulliparous women (odds ratio 0.21, 95% confidence interval 0.06-0.77).


CONCLUSIONS
Double-dose misoprostol 25 microg is as effective as dinoprostone 3 mg inserts for cervical priming; both are more efficacious than a single-dose misoprostol pessary. Parity prognosticates the success of induction.
Tan
T-C
TC
Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, University Hospital, Singapore.
Yan
S Y
SY
Chua
T M
TM
Biswas
A
A
Chong
Y-S
YS
D000282:Administration, Intravaginal; D000328:Adult; D001034:Apgar Score; D020070:Cervical Ripening / Q000187:drug effects*; D015232:Dinoprostone / Q000008:administration & dosage* / Q000009:adverse effects; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007751:Labor, Induced / Q000379:methods; D016595:Misoprostol / Q000008:administration & dosage* / Q000009:adverse effects; D015999:Multivariate Analysis; D010120:Oxytocics / Q000008:administration & dosage* / Q000009:adverse effects; D010298:Parity / Q000502:physiology; D010570:Pessaries; D011247:Pregnancy; D011256:Pregnancy Outcome; D012044:Regression Analysis
D010120:Oxytocics; D016595:Misoprostol; D015232:Dinoprostone