title: Safe induction of labour with low-dose misoprostol, but less effective than the conventional dinoprostone regimen.
abstract: BACKGROUND
  Off-label use of the prostaglandin-E1 analogue misoprostol has become standard practice when inducing labour. In Denmark, a low-dosage misoprostol regimen is common. The regimen consists of one 25 µg application on the first day of induction. The registered prostaglandin-E2 analogue dinoprostone is used in 3 and 6 mg doses. This study compared induction procedures with dinoprostone and misoprostol in terms of induction time, foetal outcome and maternal outcome.
  
  
  METHODS
  This retrospective study included 1,645 induced deliveries from two periods: 2003-2005, when dinoprostone was standard treatment (n = 635), and 2008-2010, when misoprostol was standard treatment (n = 633). We evaluated the induction method, outcomes and confounders using Kaplan-Meier, Cox and logistic regression analyses.
  
  
  RESULTS
  In the first 24 h, 38% and 59% of women delivered in the misoprostol and dinoprostone groups, respectively. Compared with dinoprostone, misoprostol was associated with a longer induction time (hazard ratio = 0.79, 95% confidence interval (CI): 0.69-0.90). Both regimens showed similar risks of caesarean section (odds ratio (OR) = 0.88, 95% CI: 0.64-1.12), rates of meconium-stained amniotic fluid (OR = 0.85, 95% CI: 0.63-1.15), 5-min Apgar scores < 7 (OR = 1.73, 95% CI: 0.34-8.75), and transfers to neonatal intensive care units (OR = 0.64, 95% CI: 0.38-1.08).
  
  
  CONCLUSIONS
  Low-dosage misoprostol required more time than dinoprostone to induce labour, but the two drugs were equally safe in terms of the risk of caesarean section and foetal outcomes.
  
  
  BACKGROUND
  The Danish Ministry of Research and Innovation (#10-093833).
  
  
  BACKGROUND
  The Danish Data Protection Agency (#2011-41-5794).
authors.affiliation: Department of Gynaecology and Obstetrics, Hillerød Hospital, 3400 Hillerød, Denmark. jesperfriis@dadlnet.dk
authors.forename: Jesper Friis
authors.initials: JF
authors.lastname: Petersen
authors.forename: Thomas
authors.initials: T
authors.lastname: Bergholt
authors.forename: Ellen Christine L
authors.initials: EC
authors.lastname: Løkkegaard
mesh_terms: D000328:Adult; D000653:Amniotic Fluid; D001034:Apgar Score; D002585:Cesarean Section / Q000706:statistics & numerical data; D003718:Denmark; D015232:Dinoprostone / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006801:Humans; D015931:Intensive Care, Neonatal / Q000706:statistics & numerical data; D007751:Labor, Induced / Q000009:adverse effects / Q000379:methods*; D008470:Meconium; D016595:Misoprostol / Q000008:administration & dosage* / Q000009:adverse effects; D010120:Oxytocics / Q000008:administration & dosage* / Q000009:adverse effects; D011247:Pregnancy; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
chemical_list: D010120:Oxytocics; D016595:Misoprostol; D015232:Dinoprostone