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Geburtshilfe Frauenheilkd 2016; 76(07): 785-792
DOI: 10.1055/s-0042-105287
Original Article
GebFra Science
Georg Thieme Verlag KG Stuttgart · New York

Induction of Labor in Post-Term Nulliparous and Parous Women – Potential Advantages of Misoprostol over Dinoprostone

Geburtseinleitung bei übertragenen Schwangerschaften in Nulliparae und Parae – mögliche Vorteile von Misoprostol gegenüber Dinoproston
P. Tsikouras
1   Department of Obstetrics and Gynecology, Democritus University of Thrace, Greece
,
Z. Koukouli
1   Department of Obstetrics and Gynecology, Democritus University of Thrace, Greece
,
B. Manav
1   Department of Obstetrics and Gynecology, Democritus University of Thrace, Greece
,
M. Soilemetzidis
1   Department of Obstetrics and Gynecology, Democritus University of Thrace, Greece
,
A. Liberis
1   Department of Obstetrics and Gynecology, Democritus University of Thrace, Greece
,
R. Csorba
2   Department of Obstetrics and Gynecology, Clinicum Aschaffenburg, Teaching Hospital of University Würzburg, Germany
,
G. Trypsianis
3   Department of Medical Statistic, Democritus University of Thrace, Greece
,
G. Galazios
1   Department of Obstetrics and Gynecology, Democritus University of Thrace, Greece
› Author Affiliations
Further Information

Publication History

received 24 December 2015
revised 19 February 2016

accepted 20 March 2016

Publication Date:
20 July 2016 (online)

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Abstract

Introduction: We undertook a prospective cohort study to compare the effectiveness and safety of 50 µg misoprostol versus 3 mg dinoprostone in two vaginal doses 6 hours apart, followed if necessary by oxytocin for labor induction in low-risk post-term (> 40 weeks) pregnancies with unfavorable cervix (Bishop score ≤ 6). Methods: Labor induction and subsequent management were conducted using a standardized protocol. The primary outcome of the study was labor induction rate. Secondary outcomes included mode of delivery, time interval from induction to delivery, maternal complications and neonatal outcome. Results: 107 patients received misoprostol (Group A) and 99 patients received dinoprostone (Group B). Compared with group A, more women in Group B needed a second vaginal dose of prostaglandin or oxytocin infusion in order to proceed to labor (21.5 vs. 43.4 %; p = 0.01). Misoprostol alone as a single or double vaginal dose was more effective than dinoprostone alone in inducing labor without oxytocin administration (85.0 vs. 50.4 %; p = 0.04). Overall, the rate of successful induction of labor did not differ between groups (91.6 vs. 85.8 %; p = 0.75). Vaginal delivery, operative vaginal delivery and Caesarean section rates were not significantly different. Time interval from induction to delivery however, was shorter for Group A (median 11 hours vs. 14.1 hours; p < 0.001). Though emergency Caesarean section due to fetal distress was more frequent in Group A (16.8 vs. 4.0 %; p = 0.007), low Apgar scores < 7 and NICU admissions did not differ significantly. Maternal complications, mostly not serious, were higher in Group A (31.8 vs. 2.0, p < 0.001). Conclusion: Misoprostol is a more effective agent than dinoprost in post-term pregnancy for labor induction with few maternal adverse effects.

Zusammenfassung

Einleitung: Das Ziel dieser prospektiven Kohortenstudie war, die Wirksamkeit und Sicherheit der vaginalen Verabreichung von 50-µg-Misoprostol-Tabletten im Vergleich zu 3-mg-Prostaglandin-E2-Dinoproston-Tabletten in 2 vaginalen Dosen mit 6 Stunden Abstand und anschließender Oxytocin-Verabreichung zur Geburtseinleitung (falls erforderlich) bei übertragenen Niedrig-Risiko-Schwangerschaften (> 40 Wochen) mit unreifer Zervix (Bishop-Score ≤ 6) zu untersuchen. Patientinnen und Methode: Die Geburtseinleitung und das sich anschließende Geburtsmanagement wurden nach einem standardisierten Protokoll durchgeführt. Das primäre Ziel der Studie war die Bestimmung der Geburtseinleitungsrate. Sekundäre Endpunkte waren die Auswertung des Geburtsmodus, des Zeitintervalls von der Induktion bis zur Geburt, der mütterlichen Morbidität und des Neugeborenenstatus. Ergebnisse: 107 Patienten erhielten Misoprostol (Gruppe A) und 99 Patienten Dinoproston (Gruppe B). Im Vergleich zu Gruppe A benötigten mehr Studienteilnehmerinnen der Gruppe B eine 2. vaginale Prostaglandin-Dosis oder Oxytocin-Infusion für den Geburtsverlauf (21,5 vs. 43,4 %; p = 0,01). Misoprostol allein als vaginale Einzel- oder Doppeldosis war wirksamer als Dinoproston allein zur Geburtseinleitung ohne Oxytocin-Verabreichung (85,0 vs. 50,4 %; p = 0,04). Insgesamt wurde kein Unterschied bezüglich der Erfolgsrate bei der Geburtseinleitung zwischen den beiden Studiengruppen festgestellt (91,6 vs. 85,8 %; p = 0,75). Es gab keinen signifikanten Unterschied bei Spontanentbindungs-, operativen vaginalen Entbindungs- und Kaiserschnittraten zwischen den beiden Gruppen. Das Zeitintervall von der Induktion bis zur Geburt war jedoch kürzer in Gruppe A (Median 11 vs. 14,1 Stunden; p < 0,001). Obwohl Notfallkaiserschnitte aufgrund fetaler kardiotokografisch pathologischer Befunde in Gruppe A häufiger durchgeführt wurden (16,8 vs. 4,0 %, p = 0,007), unterschieden sich pathologische Apgar-Werte von < 7 und Aufnahmen auf der Neugeborenenintensivstation dennoch nicht wesentlich. Die Anzahl (größtenteils leicht zu therapierender) mütterlicher Komplikationen war in Gruppe A höher (31,8 vs. 2,0, p < 0,001). Schlussfolgerung: Bei übertragenen Schwangerschaften ist Misoprostol ein wirksameres Mittel zur Geburtseinleitung als Dinoproston und mit geringen mütterlichen Nebenwirkungen verbunden.

Key words

misoprostol - dinoprostone - labor induction - post-term pregnancy

Schlüsselwörter

Misoprostol - Dinoproston - Geburtseinleitung - übertragene Schwangerschaft
 

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