Comparison of Efficacy and Safety Between Vaginal Misoprostol Tablets and Dinoprostone Insert for Labor Induction in...

To compare the efficacy and safety of vaginal misoprostol 25 µg tablets vs dinoprostone controlled-release insert for labor induction in multiparous women with an unfavorable cervix. This single-center pilot cohort study included a prospective misoprostol cohort (n = 23) and a retrospective historical dinoprostone control (n = 26). Participants were term multiparous women with singleton pregnancies, cephalic presentation, Bishop score < 6, and no contraindications for vaginal delivery. Primary outcomes were the 24 h vaginal delivery rate and clinician-determined tocolytic use for uterine tachysystole. Secondary outcomes included cesarean section rate, meconium-stained amniotic fluid, postpartum hemorrhage, and neonatal outcomes. The 24 h vaginal delivery rates were similar between groups (82.6% vs 80.8%, p = 0.840). The misoprostol group had significantly lower tocolytic use (8.7% vs 38.5%, p = 0.037) and lower meconium-stained amniotic fluid incidence (4.3% vs 23.1%, p = 0.037). Cesarean section rates were <5% in both groups (4.3% vs 3.8%, p = 1.000). No significant differences were seen in postpartum hemorrhage or neonatal outcomes. Misoprostol 25 µg vaginal tablets achieved comparable 24 h vaginal delivery rates to dinoprostone, with reduced tocolytic use in this pilot cohort.