Comparison of perinatal outcomes using oral misoprostol, vaginal misoprostol, and intracervical dinoprostone for induction of labor

Česká verze

Authors: Petra Szekeresová ¹ ; Lukáš Hruban ^1,2 ; Anna Jouzová ¹ ; Petr Janků ^1,2 ; Romana Gerychová ^1,2 ; Michal Huptych ³
Authors place of work: Gynekologicko-porodnická klinika LF MU a FN Brno ¹; Ústav zdravotnických věd, LF MU a FN Brno ²; Český institut informatiky, robotiky a kybernetiky, ČVUT v Praze ³
Published in the journal: Ceska Gynekol 2025; 90(2): 105-112
Category: Původní práce
doi: https://doi.org/10.48095/cccg2025105

Summary

Objective: To compare the effectiveness and safety of the methods of pharmacological induction of labor. To identify the advantages and disadvantages of oral and vaginal administration of misoprostol and intracervical administration of dinoprostone. Materials and methods: Analysis of a group of women who gave birth at the Faculty Hospital Brno from 1^st August 2019 to 31^st January 2020, and one of the following labor induction schemes was used: group A: misoprostol 25 µg orally every 2 hours, group B: misoprostol 50 µg vaginally every 6 hours, group C: intracervical dinoprostone 1 mg every 2 hours. Inclusion criteria were: singleton pregnancy, completed 36^th gestational week, live fetus, cephalic presentation, and cervix score ≥ 6. Exclusion criteria were uterine scars and fetal growth restriction. Time factors of induction, occurrence of acute hypoxia during labor, mode of delivery, use of tocolysis during labor, necessity of oxytocin infusion, use of epidural analgesia, blood loss, uterine rupture, umbilical artery pH, and Apgar score at the 5th min were evaluated. Results: A total of 378 women were included (133 vs. 145 vs. 100). A statistically significantly higher success rate of vaginal delivery was demonstrated in group A compared to groups B and C (88 vs. 77.9 vs. 76%; P = 0.035). The longest time from the administration of the first dose of the preparation to delivery of the fetus was in group A (medians in minutes 700 vs. 565 vs. 375; P < 0.0001). There was no difference between the groups in the I. and II. labor stage duration. Cesarean delivery rate due to acute hypoxia was the lowest in group A (2.3 vs. 10.3 vs. 9%; P = 0.023). Uterine rupture was not recorded; there were no differences in neonatal outcome parameters. Conclusion: The highest success rate of vaginal delivery was achieved with the use of low-dose oral misoprostol. The disadvantage of this method is a significant increase in the time from the start of induction to the delivery of the fetus. There was no difference in the occurrence of severe perinatal complications between the induction methods.

Keywords:

Oral administration – labor – prostaglandins E – misoprostol – dinoprostone – vaginal administration – labor induction

Zdroje

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ORCID autorů

P. Szekeresová 0009-0004-6472-3571

L. Hruban 0000-0001-8594-2678

A. Jouzová 0000-0002-1229-4283

P. Janků 0000-0002-6306-8294

R. Gerychová 0000-0003-4150-2472

M. Huptych 0000-0001-8422-9694

Doručeno/Submitted: 24. 10. 2024

Přijato/Accepted: 6. 1. 2025

doc. MUDr. Lukáš Hruban, Ph.D., MBA

Gynekologicko-porodnická klinika

LF MU a FN Brno