title: A comparison of obstetrical outcomes and costs between misoprostol and dinoprostone for induction of labor.
abstract: OBJECTIVE
  The objective of this study is to compare resource utilization (efficiency) and obstetrical/cost outcomes of single dose misoprostol versus dinoprostone for induction of labor (IOL) at term.
  
  
  METHODS
  Retrospective cohort of induced deliveries 37-41 weeks gestation presenting with a Bishop score ≤4 using single-dose-50 mcg vaginal misoprostol or 10 mg-dinoprostone vaginal-inserts. Dinoprostone patients were compared (5:1) with misoprostol patients. The primary outcome variable was length of L&D stay (proxy for resource utilization). Baseline characteristics, clinical outcomes, and costs were compared.
  
  
  RESULTS
  Three-hundred thirty-one patients were included, 276 received dinoprostone and 55 received misoprostol. The misoprostol group had statistically significant decreased time to active labor [median 8 h (1.6,24) versus 12(0.8,52)], time-to-delivery [median 11 h (4,31) versus 17(2.8,56)] and L&D stay [median 16 h (13,28) versus 24(18,30)]. Differences remained significant after adjustment for race, method of delivery, birth weight, gravidity/parity, gestational age, and BMI (adjusted p values <0.001,  <0.01, and < 0.05, respectively). There were no statistical differences in Apgar scores, tachysystole rate, cesarean section rate, and composite maternal/neonatal morbidity. A policy of using misoprostol would result in annual cost savings of approximately $242 500 at our institution as compared with dinoprostone.
  
  
  CONCLUSIONS
  Single-dose misoprostol is more efficient in IOL at term with respect to L&D utilization and cost and its use is not associated with increased adverse obstetrical outcomes.
authors.affiliation: a Department of Obstetrics and Gynecology , Stony Brook University - Winthrop University Hospitals , Mineola , NY , USA and.|b Department of Obstetrics and Gynecology , Winthrop University Hospital , Mineola , NY , USA.
authors.forename: Kunzier
authors.initials: K
authors.lastname: Nadia Bennett
authors.affiliation: b Department of Obstetrics and Gynecology , Winthrop University Hospital , Mineola , NY , USA.
authors.forename: Hyein
authors.initials: H
authors.lastname: Park
authors.affiliation: b Department of Obstetrics and Gynecology , Winthrop University Hospital , Mineola , NY , USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Cioffi
authors.affiliation: b Department of Obstetrics and Gynecology , Winthrop University Hospital , Mineola , NY , USA.
authors.forename: Rose
authors.initials: R
authors.lastname: Calixte
authors.affiliation: b Department of Obstetrics and Gynecology , Winthrop University Hospital , Mineola , NY , USA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Vintzileos
mesh_terms: D000282:Administration, Intravaginal; D000328:Adult; D003362:Cost-Benefit Analysis; D015232:Dinoprostone / Q000008:administration & dosage / Q000191:economics*; D004334:Drug Administration Schedule; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D007751:Labor, Induced / Q000191:economics / Q000379:methods*; D007902:Length of Stay / Q000191:economics* / Q000706:statistics & numerical data; D016014:Linear Models; D016595:Misoprostol / Q000008:administration & dosage / Q000191:economics*; D009518:New York; D017063:Outcome Assessment, Health Care; D010120:Oxytocics / Q000008:administration & dosage / Q000191:economics*; D011247:Pregnancy; D011256:Pregnancy Outcome; D016016:Proportional Hazards Models; D012189:Retrospective Studies
chemical_list: D010120:Oxytocics; D016595:Misoprostol; D015232:Dinoprostone
keywords: Clinical outcomes; cost analysis; induction of labor; prostaglandin; term gestation