Vaginal Misoprostol as effective as Dinoprostone pessary for
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In a recent development, the noninferiority of 25 microgram misoprostol every four hours to the dinoprostone pessary for cesarean delivery (CD) rates after induction of labor (IOL) at term could not be demonstrated, although results from the study highlighted that the confidence limit of the difference barely exceeded the noninferiority margin.

Induction of labor is among the most common procedures for pregnant women. The objective was to test the noninferiority of vaginal misoprostol (PGE1) (25 μg) to a slow-release dinoprostone (PGE2) pessary (10 μg) for induction of labor with an unfavorable cervix at term.

Investigators recruited 1674 women with labor induced for medical reasons, a Bishop scores ≤ 5 at ≥ 36 weeks, and a cephalic-presenting singleton pregnancy with no prior CD. Women were randomly allocated to receive either vaginal misoprostol at 4-hour intervals (25 μg) or a 10-mg slow-release dinoprostone pessary. The primary outcome was the total CD rate. Noninferiority was defined as a difference in the CD rates between the groups of no more than 5%. Secondary outcomes included neonatal and maternal morbidity, vaginal delivery < 24 hours after starting the induction process, and maternal satisfaction.

--The total cesarean delivery rate in the misoprostol group was 22.1% and in the dinoprostone group, 19.9%, for a difference between the groups of 2.2%. Results in the intention-to-treat analysis were similar.

--Neonatal and maternal morbidity were similar between groups.

--Vaginal delivery within 24 hours was significantly higher in the misoprostol group as was maternal satisfaction, assessed in the postpartum period by a visual analog scale: mean score: 7.1 vs 5.8.

In particular, the noninferiority of 25-μg vaginal misoprostol every four hours to the dinoprostone pessary for CD rates after IOL at term could not be demonstrated, although the confidence limit of the difference barely exceeded the noninferiority margin. Nonetheless, given the small difference between these cesarean rates and the similarity of neonatal and maternal morbidity rates in this large study, the clinical risk-benefit ratio justifies the use of both drugs.

American Journal Of Obstetrics and Gynecology
Source: https://doi.org/10.1016/j.ajog.2021.04.226
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