COMPARISON OF PROSTAGLANDIN E2 WITH MISOPROSTOL FOR INDUCTION OF LABOUR AT TERM

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Abstract

. Objective: To evaluate the use of vaginal misoprostol compared with vaginal prostaglandin E2
(PGE2) for labour induction at term. Design: Experimental. Setting: Gynae Unit III, Department of Obstetrics and
Gynaecology SIMS / Services Hospital Lahore. Methods: Patients were randomized to two groups with 100 patients
in each group. One group received 50:g of misoprostol vaginally every four hours up till 5 doses , second group was
given 3mg PGE2 vaginal tablet every 6hrs up till 3doses. The drug was stopped earlier if active labour started.
Results: 96% of patients were successfully induced in misoprostol group verses 84%patients in PGE2 group (P=0.01).
Mean induction delivery interval was significantly short in misoprostol group 13.3 + 8.7 hours verses 18.5 + 11.3 hours
in PGE2 group (P=0.01). 35% patients in misoprostol group and 40% in PGE2 group (P=0.46) had C/Sections.
Increase Meconium staining and fetal heart rate abnormalities was seen in misoprostol group (P=0.03). 20% of babies
in misoprostol group had low APGR Score and needed neonatal intensive care unit admission, as compared to 12%
in PGE2 group but failed to show statistical significance (P=0.12). There was no perinatal death in both groups. Hyper
stimulation was seen in only one patient of misoprostol group. Conclusion: Misoprostol is more effective than PGE2
in successfully inducing the patient but it does not reduce C/Section rate. Moreover it is associated with increase
chances of fetal distress. Despite being cheaper than PGE2, it cannot be advocated superior to PGE2 in terms of
fetomaternal outcome. Further studies with lower doses of misoprostol are recommended.