Titrated Oral Misoprostol Compared to Vaginal Dinoprostone for Induction of Labor

Titrated Oral Misoprostol Compared to Vaginal Dinoprostone for Induction of Labor: a Randomized Control Trial

To test the safety and efficacy of titrated oral misoprostol compared to vaginal dinoprostone for labor induction.

• There are many indications for induction of labor in the obstetric practice, of which prolonged gestational age stands as the most common indication. It is well recognized that with an unripe cervix, induction may be difficult and often unsuccessful. The use of an agent to ripen the cervix prior to induction is acceptable in the modern practice.
• Misoprostol, a prostaglandin E1 analogue, is the most interesting alternative to Dinoprostone because of its effectiveness, low cost, and temperature stability. It ripens the cervix by inducing regular uterine contractions. However, it is associated with several adverse effects especially uterine hyperstimulation, which is painful and may result in fetal compromise.
• Testing the efficacy and safety of titrated oral misoprostol versus vaginal dinoprostone may develop a new safe and effective method for labor induction.

Inclusion Criteria:

• Single vertex presentation.
• Gestational age > 37 weeks calculated from last menstrual period or U/S scanning.
• Bishop score <8 .
• Not in labor.
• Reassuring fetal heart rate (CTG for 20 min on the day of induction).
• Valid indication for Induction of labor.

Exclusion Criteria:

• Gestational age <37 weeks.
• Patients with rupture of membranes.
• Previous uterine scar.
• Fetal malpresentation.
• Multiple pregnancy.
• Significant antepartum hemorrhage
• Uncontrolled DM.
• Severe Pre-eclampsia or Eclampsia
• If there are contraindications to receive the drugs, e.g. allergy, history of severe asthma,…..etc.