[Misoprostol--a safe preparation for induction of labor?]

Vaginal application of prostaglandins is well known and accepted for induction of labor. In this study we compared 50 microg misoprostol to 25 microg misoprostol and 3 mg Minprostin, applied as a single dose every 24 hours.

Three periods in which three different prostaglandin preparations were given to induce labor were retrospectively evaluated.

The median time from induction to delivery showed 50 microg misoprostol (25 hours) to be more potent than 25 microg (38 hours) and Minprostin (35 hours). As a consequence, hyperstimulation was more frequent (10% vs. 4% & 1%), as well as caesarean section on the indication of foetus mortuus imminens. The advantages were fewer caesarean sections on the indication of dystocia and therefore no difference in the overall section rate. The oxytocin augmentation rate was also less frequent, as were the instrumental delivery rate, anal sphincter disruptions and postpartum hemorrhage.

This study indicates that one must choose between a potent treatment, which implies a 10% risk of uterine hyperstimulation, and a less potent treatment with an enhanced risk of instrumental delivery and disruption of the anal sphincter.