title: Shortening the induction delivery interval with prostaglandins: a randomized controlled trial of solo or in combination.
abstract: OBJECTIVE
  To compare the efficacy and safety of misoprostol alone with dinoprostone followed by misoprostol, all inserted intravaginally in induction of labor at term and the obstetrical outcome.
  
  
  METHODS
  A pilot study comprising 111 primigravidae, >37 gestational weeks with singleton pregnancy in cephalic presentation having an unfavorable Bishop score admitted for labor induction, were considered and randomly allocated into two groups. In group I (n=55) with intravaginal 25mcg misoprostol 4 hourly (six doses at the most) and and group II (n=56), with dinoprostone 0.5mg followed eight hours later by 25mcg misoprostol induction to vaginal delivery time was found to be significantly different, being 14.8 h in group-I and shorter in group-II with a mean of 11.6 h. Vaginal delivery rates within 12 h (groups-I and -II: 47.2%, as compared to 60.7%, respectively) were found to be higher with dinoprostone-misoprostol induction, as well as vaginal delivery rates in 24 h, 80.0% and 91.1%. The need for oxytocin augmentation was more frequent in the misoprostol than in the dinoprostone-misoprostol group, (61.8%, and 39.3%), and all these observations were statistically significant. Abnormal foetal heart rate pattern occurred more frequently (18.2%) in group-I in contrast to 5.3% in group-II, as was the incidence rate of (18.2%) who had passage of meconium in group-I, this rate being significantly different from group-II having meconium passage in 3 cases, a rate of 5.3%.
  
  
  CONCLUSIONS
  Using dinoprostone followed by vaginal misoprostol is safe and effective for induction of labor with less need for oxytocin augmentation and shorter induction delivery interval.
authors.affiliation: Department of Obstetrics and Gynecology, Mmimsr, Mullana, Ambala, India.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Mahendru
authors.affiliation: Department of Obstetrics and Gynecology, Mmimsr, Mullana, Ambala, India.
authors.forename: Shweta
authors.initials: S
authors.lastname: Yadav
keywords: Labor induction; intravaginal; prostaglandin