Misoprostol vaginal insert versus dinoprostone vaginal insert: A comparison of labour and delivery outcomes

Abstract

Objectives: To compare Misoprostol Vaginal Insert (MVI), a vaginal insert containing 200 μg of misoprostol) versus Dinoprostone Vaginal Insert (DVI), a vaginal insert containing 10 mg of dinoprostone), in the induction of labour.

Study design: We performed a retrospective analysis of the data between February 2016 and September 2017 of women induced with MVI (n = 100) and DVI in UK (n = 100) at NHS Fife. MVI was used for the same indications as DVI, but specifically indicated in women with a Modified Bishops score ≤ 4. Outcome measures included: the incidence of tachysystole and hyperstimulation; further use of prostaglandins; use of pre-delivery oxytocin; mode of delivery; median insertion-to-delivery-interval; and admission to the neonatal unit. Statistical data analysis was performed. A logistic regression analysis was also performed, adjusting for potential confounders such as body mass index (BMI), gestational age, parity and baseline Modified Bishops score.

Results: Demographics such as parity, BMI, baseline Modified Bishops score and gestational age were assessed. A significantly higher rate of tachysystole and hyperstimulation was noted in the MVI group as compared to the DVI group. Only 8% of women in the MVI group as compared to a third (33%) of women in the DVI group required further prostaglandins. There was no difference in the modes of birth in either group and this result was statistically significant. The median induction to delivery interval was 15 h in the MVI group compared to 33 h in the DVI group. There was no difference in neonatal outcomes in either group. There was no significant difference in the use of pre-delivery oxytocin for subsequent augmentation of labour in either group. All the results, when adjusted to potential confounders using logistic regression, were in keeping with the unadjusted statistical analysis.

Conclusion: The results of this study suggest that MVI significantly reduces the induction to delivery interval, has a similar caesarean section rate and neonatal outcomes, when compared with DVI.

Keywords: Comparison; Dinoprostone; Induction of labour; Misoprostol.