Mode of delivery after labor induction with vaginal dinoprostone versus oral misoprostol for women with unfavorable cervix at term

Abstract

Objective: To compare the delivery mode after labor induction with 10 mg vaginal dinoprostone insert versus oral misoprostol 50 µg/4 h for women with an unfavorable cervix.

Material and methods: This is a retrospective observational study comparing the before/after introduction of oral misoprostol for labor induction, conducted at the Saint-Étienne University Hospital on a cohort of 396 women with a Bishop score <6. One hundred and twelve women (28.3%) were treated with a 10 mg vaginal dinoprostone insert versus 284 (71.7%) with oral misoprostol 50 µg/4 h. The primary outcome was the cesarean section rate.

Results: Labor induction with vaginal dinoprostone was independently associated with an increased rate of cesarean sections compared to oral misoprostol (aOR = 2.44; CI95% from 1.35 to 4.40; p = 0.003). The use of vaginal dinoprostone increased the induction rate during more than 48 h (18.8% versus 9.9%; p = 0.02), and the occurrence of fetal heart rate changes (34.8% versus 21.1%; p = 0.005). The maternofetal morbidity was similar.

Conclusion: Labor induction with vaginal dinoprostone was independently associated with an increased rate of cesarean sections compared to oral misoprostol in women with an unfavorable cervix.

Keywords: Cesarean section; Dinoprostone; Labor induction; Misoprostol; Prostaglandin; Unfavorable cervix.