safe induction of labour with low-dose misoprostol, but less effective than the conventional dinoprostone regimen

TY - JOUR

T1 - safe induction of labour with low-dose misoprostol, but less effective than the conventional dinoprostone regimen

AU - Petersen, Jesper Friis

AU - Bergholt, Thomas

AU - Løkkegaard, Ellen Christine L

PY - 2013/9

Y1 - 2013/9

N2 - INTRODUCTION: Off-label use of the prostaglandin-E1 analogue misoprostol has become standard practice when inducing labour. In Denmark, a low-dosage misoprostol regimen is common. The regimen consists of one 25 μg application on the first day of induction. The registered prostaglandin-E2 analogue dinoprostone is used in three and 6 mg doses. This study compared induction procedures with dinoprostone and misoprostol in terms of induction time, foetal outcome and maternal outcome. MATERIAL AND METHODS: This retrospective study included 1,645 induced deliveries from two periods: 2003-2005, when dinoprostone was standard treatment (n = 635), and 2008-2010, when misoprostol was standard treatment (n = 633). We evaluated the induction method, outcomes and confounders using Kaplan-Meier, Cox and logistic regression analyses. RESULTS: In the first 24 h, 38% and 59% of women delivered in the misoprostol and dinoprostone groups, respect ively. Compared with dinoprostone, misoprostol was associated with a longer induction time (hazard ratio (HR) = 0.79, 95% confidence interval (CI): 0.69-0.90). Both regimens showed similar risks of caesarean section (odds ratio (OR) = 0.88, 95% CI: 0.64-1.12), rates of meconium-stained amniotic fluid (OR = 0.85, 95% CI: 0.63-1.15), 5-min Apgar scores < 7 (OR = 1.73, 95% CI: 0.34-8.75), and transfers to neonatal intensive care units (OR = 0.64, 95% CI: 0.38-1.08). CONCLUSION: Low-dosage misoprostol required more time than dinoprostone to induce labour, but the two drugs were equally safe in terms of the risk of caesarean section and foetal outcomes.

AB - INTRODUCTION: Off-label use of the prostaglandin-E1 analogue misoprostol has become standard practice when inducing labour. In Denmark, a low-dosage misoprostol regimen is common. The regimen consists of one 25 μg application on the first day of induction. The registered prostaglandin-E2 analogue dinoprostone is used in three and 6 mg doses. This study compared induction procedures with dinoprostone and misoprostol in terms of induction time, foetal outcome and maternal outcome. MATERIAL AND METHODS: This retrospective study included 1,645 induced deliveries from two periods: 2003-2005, when dinoprostone was standard treatment (n = 635), and 2008-2010, when misoprostol was standard treatment (n = 633). We evaluated the induction method, outcomes and confounders using Kaplan-Meier, Cox and logistic regression analyses. RESULTS: In the first 24 h, 38% and 59% of women delivered in the misoprostol and dinoprostone groups, respect ively. Compared with dinoprostone, misoprostol was associated with a longer induction time (hazard ratio (HR) = 0.79, 95% confidence interval (CI): 0.69-0.90). Both regimens showed similar risks of caesarean section (odds ratio (OR) = 0.88, 95% CI: 0.64-1.12), rates of meconium-stained amniotic fluid (OR = 0.85, 95% CI: 0.63-1.15), 5-min Apgar scores < 7 (OR = 1.73, 95% CI: 0.34-8.75), and transfers to neonatal intensive care units (OR = 0.64, 95% CI: 0.38-1.08). CONCLUSION: Low-dosage misoprostol required more time than dinoprostone to induce labour, but the two drugs were equally safe in terms of the risk of caesarean section and foetal outcomes.

M3 - Journal article

SN - 1603-9629

VL - 60

SP - 1

EP - 5

JO - Danish Medical Bulletin (Online)

JF - Danish Medical Bulletin (Online)

IS - 9

M1 - A4706

ER -