Comparison between vaginal misoprostol and cervical dinoprostone for cervical ripening and labor induction.

Objective: To compare the efficacy of intravaginal misoprostol (Cytotec) to intracervical dinoprostone (Prepidil) for pre-induction cervical ripening.

Methods: Sixty-one patients admitted for induction of labor, whose cervices were unfavorable (Bishop score: 4), were randomly assigned to either intravaginal placement of a 50 micrograms misoprostol tablet or intracervical administration of dinoprostone gel.

Results: Eighteen women (56%) in the misoprostol group and five (17%) in the dinoprostone group achieved cervical ripening within 12 hours (P = 0.007). Fewer doses of misoprostol were required to achieve cervical ripening, and the interval from induction of labor to delivery was shorter in the misoprostol group. Sixteen patients (50%) in the misoprostol group required oxytocin, whereas 26 (90%) in the dinoprostone group required oxytocin augmentation (P = 0.008). There was no significant difference in mode of delivery or neonatal outcome between the two groups.

Conclusions: Vaginal misoprostol appears to be a more effective cervical ripening agent than cervical dinoprostone.