Research Article| Volume 116, ISSUE 1, P34-38, September 10, 2004

Influence of misoprostol or prostaglandin E2 for induction of labor on the incidence of pathological CTG tracing: a randomized trial


      Objective: To compare the efficacy and safety of misoprostol (prostaglandin E1 (PGE1)) with dinoprostone (prostaglandin E2 (PGE2)) for third trimester cervical ripening and labor induction. Study design: Patients requiring induction of labor were randomly assigned to receive either 50 μg of intravaginal misoprostol every 4 h or 0.5 mg of intracervical dinoprostone gel every 6 h. Eligibility criteria included gestation = 36 weeks. Primary outcome was the time interval from induction to delivery; secondary outcomes were mode of delivery, perinatal outcome, and interpretation of cardiotocogram (CTG) records. Results: Two hundred women were randomly enrolled to receive either misoprostol (n=100) or dinoprostone (n=100). Time induction-to-delivery at 12, 24 and 48 h and the need for oxytocin were reduced with misoprostol (P<0.05). Pathological CTG tracing according to FIGO and Melchior scores were more frequent in the misoprostol-treated group (P<0.001). Conclusion: Misoprostol shortened the induction-to-delivery interval, but is associated with a higher incidence of abnormal CTG than prostaglandin E2.


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        • Ventura S.J
        • Martin J.A
        • Curtin S.C
        • Mathews T.J
        Births: final data for 1997.
        Natl. Vital Stat. Rep. 1999; 47: 1-96
        • Calder A
        • Embrey M.P
        Prostaglandins and the unfavorable cervix.
        Lancet. 1973; 2: 1322-1323
        • O’Brien W.F
        Cervical ripening and labor induction: progress and challenges.
        Clin. Obstet. Gynecol. 1995; 38: 221-223
        • Sanchez-Ramos L
        • Kaunitz A.M
        • Del Valle G.O
        • Delke I
        • Schroeder P.A
        • Briones D.K
        Labor induction with the prostaglandin E1 methyl analogue misoprostol versus oxytocin: a randomized trial.
        Obstet. Gynecol. 1993; 81: 332-336
        • Sanchez-Ramos L
        • Kaunitz A.M
        • Wears R.L
        • Delke I
        • Gaudier F.L
        Misoprostol for cervical ripening and labor induction: a meta-analysis.
        Obstet. Gynecol. 1997; 89: 633-642
        • Wing D.A
        • Rahall A
        • Jones M.M
        • Goodwin T.M
        • Paul R.H
        Misoprostol: an effective agent for cervical ripening and labor induction.
        Am. J. Obstet. Gynecol. 1995; 172: 1811-1816
        • Wing D.A
        • Jones M.M
        • Rahall A
        • Goodwin T.M
        • Paul R.H
        A comparison of misoprostol and prostaglandin E2 gel for preinduction cervical ripening and labor induction.
        Am. J. Obstet. Gynecol. 1995; 172: 1804-1810
        • Mundle W.R
        • Young D.C
        Vaginal misoprostol for induction of labor: a randomized controlled trial.
        Obstet. Gynecol. 1996; 88: 521-525
        • Margulies M
        • Voto L.S
        • Caruzzi P
        • Uranga Imaz F
        Induccion del trabajo de parto con un analog de la PGE1. Un estudio abierto, no comparativo, de hallazgo de dosis.
        Prensa Med. Arg. 1991; 78: 9-13
        • Margulies M
        • Campos Perez G
        • Voto L.S
        Misopostol to induce labour.
        Lancet. 1992; 339: 64
        • Varaklis K
        • Gumina R
        • Stubblefield P.G
        Randomized controlled trial of vaginal misoprostol and intracervical prostaglandin E2 gel for induction of labor at term.
        Obstet. Gynecol. 1995; 86: 541-544
        • Chuck F.J
        • Huffaker B.J
        Labor induction with intravaginal misoprostol versus intracervical prostaglandin E2 gel (Prepidil gel): randomized comparison.
        Am. J. Obstet. Gynecol. 1995; 173: 1137-1142
        • Wing D.A
        • Ortiz-Omphroy G
        • Paul R.H
        A comparison of intermittent vaginal administration of misoprostol with continuous dinoprostone for cervical ripening and labor induction.
        Am. J. Obstet. Gynecol. 1997; 177: 612-618
        • Surbek D.V
        • Boesiger H
        • Hoesli I
        • Pavic N
        • Holzgreve W
        A double-blind comparison of the safety and efficacy of intravaginal misoprostol and prostaglandin E2 to induce labor.
        Am. J. Obstet. Gynecol. 1997; 177: 1018-1023
        • Sanchez-Ramos L
        • Peterson D.E
        • Delke I
        • Gaudier F.L
        • Kaunitz A.M
        Labor induction with prostaglandin E1 misoprostol compared with dinoprostone vaginal insert: a randomized trial.
        Obstet. Gynecol. 1998; 91: 401-405
        • Perry K.G
        • Larmon J.E
        • May W.L
        • Robinette L.G
        • Martin R.W
        Cervical ripening: a randomized comparison between intravaginal misoprostol and an intracervical balloon catheter combined with intravaginal dinoprostone.
        Am. J. Obstet. Gynecol. 1998; 178: 1333-1340
      1. FIGO News. Guidelines for the use of fetal monitoring. Int J Gynaecol Obstet 1987;25:159–67.

      2. FIGO News. Report of the FIGO Study Group on the assessment of new technology. Evaluation and standardization of fetal monitoring. Int J Gynecol Obstet 1997;59:169–73.

      3. Hofmeyr GJ, Gulmezoglu AM. Vaginal misoprostol for cervical ripening and induction of labor. Cochrane Database Syst Rev 2001;1:CD000941.

      4. American College of Obstetrician and Gynecologist. Induction of labor. ACOG practice bulletin, vol. 10. Washington, DC: ACOG; 1999.

        • Buser D
        • Mora G
        • Arias F
        A randomized comparison between misoprostol and dinoprostone for cervical ripening and labor induction in patients with unfavorable cervices.
        Obstet. Gynecol. 1997; 89: 581-585
        • Sanchez-Ramos L
        • Danner C.J
        • Delke I
        • Kaunitz A.M
        The effect of tablet moistening on labor induction with intravaginal misoprostol: a randomized trial.
        Obstet. Gynecol. 2002; 99: 1080-1084
        • Goldberg A.B
        • Greenberg M.B
        • Darney P.D
        Misoprostol and pregnancy.
        N. Engl. J. Med. 2001; 344: 38-47