A Comparative Study of the Efficacy and Safety of Oral Misoprostol, Intravenous Oxytocin, and Intravaginal Dinoprostone for Labor Induction in Pakistani Women

Asad Ullah Wasim; Muhammad Muneeb Khan; Fnu Aneela; Haris Khan; Mirna Denise Díaz Solís; Insha Shabir; Syed Saem Ul Hassan; Umer Bin Tariq

doi:10.7759/cureus.39768

A Comparative Study of the Efficacy and Safety of Oral Misoprostol, Intravenous Oxytocin, and Intravaginal Dinoprostone for Labor Induction in Pakistani Women

Cureus. 2023 May 31;15(5):e39768. doi: 10.7759/cureus.39768. eCollection 2023 May.

Authors

Asad Ullah Wasim^{1

2}, Muhammad Muneeb Khan³, Fnu Aneela⁴, Haris Khan⁵, Mirna Denise Díaz Solís⁶, Insha Shabir⁷, Syed Saem Ul Hassan¹, Umer Bin Tariq⁸

Affiliations

¹ Medicine, Fazaia Medical College, Islamabad, PAK.
² Clinical and Translational Research, Larkin Community Hospital, South Miami, USA.
³ Medicine and Surgery, Ayub Medical College, Abbottabad, PAK.
⁴ Medicine and Surgery, Liaquat University of Medical and Health Science, Jamshoro, PAK.
⁵ Medicine and Surgery, Jinnah Medical College, Peshawar, PAK.
⁶ Obstetrics and Gynaecology, UMAE Obstetrics and Gynecology Hospital, Mexico City, MEX.
⁷ Medicine and Surgery, Fatima Jinnah Medical University, Lahore, PAK.
⁸ Medicine, Nawaz Sharif Medical College, Gujrat, PAK.

Abstract

Introduction: A frequent medical procedure to accelerate labor is the induction of labor. There are different methods of labor induction, including the use of medications such as misoprostol, oxytocin, and dinoprostone.

Objective: This research compared the effectiveness and safety of oral misoprostol, intravenous oxytocin, and intravaginal dinoprostone for labor induction in Pakistani women.

Methodology: A study was conducted in the Department of Obstetrics and Gynaecology, Hayatabad Medical Complex-Medical Teaching Institute (MTI) and Lady Reading Hospital-MTI, Peshawar, Pakistan, over two years. It included 378 women between 38 and 42 gestational weeks, divided into three groups of 126 women each. The oral misoprostol group was given a maximum of six doses of a 25 μg oral misoprostol solution (oral misoprostol tablet of 200 μg dissolved in 200 ml) at intervals of two hours. The drip rate for the intravenous oxytocin group ranged from 6 mIU/minute to 37 mIU/minute. The intravaginal dinoprostone group received a controlled-release vaginal insert containing 10mg of intravaginal dinoprostone, which was left in place for 12 hours.

Results: More women in the oral misoprostol group (n=94; 74.6%) had successful inductions when compared to the intravaginal dinoprostone (n=83; 65.9%) and intravenous oxytocin (n = 77; 64.71%) groups. Oral misoprostol had the greatest proportion of normal vaginal deliveries (n=62; 65.95%), followed by intravaginal dinoprostone (n=47; 56.63%), and intravenous oxytocin had the lowest rate (n=33; 42.85%). Cesarean section rates were greatest in the intravenous oxytocin group (n=31; 40.26%), followed by the intravaginal dinoprostone group (n=29; 34.94%), and lowest in the oral misoprostol group (n=24; 25.53%).

Conclusion: Oral misoprostol induces labor in women safely and effectively, resulting in the lowest percentage of cesarean deliveries and the highest percentage of normal vaginal deliveries, respectively. Intravaginal dinoprostone showed the lowest rate of side effects, followed by oral misoprostol while intravenous oxytocin had the highest rate of side effects.

Keywords: dinoprostone; labor induction; maternal and perinatal outcome; misoprostol; obstetric outcome; oxytocin.