Abstract
Objective To compare labor induction outcomes using vaginal misoprostol versus dinoprostone
insert in women with premature rupture of membranes (PROM) and an unfavorable cervix.
Study Design Charts of singleton gestations beyond 34 weeks with PROM and an unfavorable cervix
from 2008 to 2011 were reviewed. Group assignment was determined by initial induction
agent used. Dinoprostone was administered as a 10-mg vaginal insert left for up to
12 hours. Misoprostol was administered vaginally as a 25-μg tablet every 4 hours for
up to six doses. Times to active labor, complete dilatation, and delivery and incidence
of adverse outcomes (intrapartum fever, tachysystole, fetal heart rate abnormalities)
were compared.
Results Ninety-eight women were included. Baseline characteristics between groups were not
different. Median times to active labor (7 versus 11 hours, p < 0.001) and complete dilatation (13.5 versus 19 hours, p < 0.001) were shorter in the misoprostol group. In the misoprostol group, 41.7 and
88.4% of patients delivered vaginally within 12 and 24 hours, respectively, compared
with 20.8 and 58.0% in the dinoprostone group (p < 0.001). There was no difference in incidence of adverse outcomes.
Conclusion Vaginal misoprostol is more effective than dinoprostone insert for induction secondary
to PROM without increasing the incidence of adverse outcomes.
Keywords
prostaglandin - unfavorable cervix - cervical ripening - PROM
