Labor induction for premature rupture of membranes using vaginal misoprostol versus dinoprostone vaginal insert

To compare labor induction outcomes using vaginal misoprostol versus dinoprostone insert in women with premature rupture of membranes (PROM) and an unfavorable cervix.

Charts of singleton gestations beyond 34 weeks with PROM and an unfavorable cervix from 2008 to 2011 were reviewed. Group assignment was determined by initial induction agent used. Dinoprostone was administered as a 10-mg vaginal insert left for up to 12 hours. Misoprostol was administered vaginally as a 25-μg tablet every 4 hours for up to six doses. Times to active labor, complete dilatation, and delivery and incidence of adverse outcomes (intrapartum fever, tachysystole, fetal heart rate abnormalities) were compared.

Ninety-eight women were included. Baseline characteristics between groups were not different. Median times to active labor (7 versus 11 hours, p < 0.001) and complete dilatation (13.5 versus 19 hours, p < 0.001) were shorter in the misoprostol group. In the misoprostol group, 41.7 and 88.4% of patients delivered vaginally within 12 and 24 hours, respectively, compared with 20.8 and 58.0% in the dinoprostone group (p < 0.001). There was no difference in incidence of adverse outcomes.

Vaginal misoprostol is more effective than dinoprostone insert for induction secondary to PROM without increasing the incidence of adverse outcomes.