The Efficacy of Misoprostol and Prostaglandin E2 in Induction of Labor

Samreen Burhan; Samdana Anwar

doi:10.70749/ijbr.v3i6.1574

Authors

Samreen Burhan Peshawar Medical College and Affiliated Teaching Hospitals, Peshawar, Pakistan.
Samdana Anwar Peshawar Medical College and Affiliated Teaching Hospitals, Peshawar, Pakistan.

DOI:

https://doi.org/10.70749/ijbr.v3i6.1574

Keywords:

Misoprostol, Prostaglandin E2, Labor Induction, Cervical Ripening

Abstract

Background: In fact, induction of labor (delivery) is commonly performed as an obstetric intervention when the risks of continuing the pregnancy outweigh the benefits. For cervical ripening and labor induction, the pharmacological agents most used are misoprostol (prostaglandin E1 analogue) and dinoprostone (prostaglandin E2). The objective of this study was to compare the efficacy of misoprostol versus prostaglandin E2 in induction of labour in term pregnant women at a tertiary care hospital. Methods: It was an interventional randomized controlled trial lasting three months duration at Mercy Teaching Hospital and Kuwait Hospital, Peshawar from 25 Feb 2025 to 25 March 2025. Random assignment of 230 women who fulfilled the inclusion criteria was undertaken to receive misoprostol (25 µg vaginally every 6 hours, max 4 doses) or Prostaglandin E2 (2 mg vaginally every 12 hours, max 2 doses). Onset of labour with no further intervention was defined as successful induction. SPSS version 25 was used to analyze the data and the p-value < 0.05 was considered significant. Results: The success rate of induction was 97.4% with misoprostol compared with 90.4% with prostaglandin E2 (p = 0.031). Among the significant variables included in subgroups analysis by age, parity, BMI, gestational age and residence, misoprostol consistently demonstrated higher efficacy. Conclusion: Prostaglandin E2 was less effective in inducing labor than was misoprostol. Because of its low cost, ease of storage and high success rate, this reduces the use of its broader use, especially in low resource settings. We recommend further studies evaluating safety outcomes and long term maternal and neonatal implication.

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References

Langley‐Evans, S. C., Pearce, J., & Ellis, S. (2022). Overweight, obesity and excessive weight gain in pregnancy as risk factors for adverse pregnancy outcomes: A narrative review. Journal of Human Nutrition and Dietetics, 35(2), 250-264.

https://doi.org/10.1111/jhn.12999

Edinoff, A. N., Sathivadivel, N., McNeil, S. E., Ly, A. I., Kweon, J., Kelkar, N., ... & Kaye, A. D. (2022). Antipsychotic use in pregnancy: Patient mental health challenges, teratogenicity, pregnancy complications, and postnatal risks. Neurology international, 14(1), 62-74.

https://doi.org/10.3390/neurolint14010005

Ducarme, G., Gilman, S., Sauvee, M., & Planche, L. (2024). Cervical ripening balloon compared with vaginal dinoprostone for cervical ripening in obese women at term: A prospective cohort study. International Journal of Gynecology & Obstetrics, 166(3), 1068-1076.

https://doi.org/10.1002/ijgo.15480

Farah, F. Q., Aynalem, G. L., Seyoum, A. T., & Gedef, G. M. (2023). The prevalence and associated factors of success of labor induction in Hargeisa maternity hospitals, Hargeisa Somaliland 2022: a hospital-based cross-sectional study. BMC Pregnancy and Childbirth, 23(1), 437.

https://doi.org/10.1186/s12884-023-05655-w

Swift, E. M., Gunnarsdottir, J., Zoega, H., Bjarnadottir, R. I., Steingrimsdottir, T., & Einarsdottir, K. (2022). Trends in labor induction indications: a 20‐year population‐based study. Acta obstetricia et gynecologica Scandinavica, 101(12), 1422-1430.

https://doi.org/10.1111/aogs.14447

Kuba, K., Kirby, M. A., Hughes, F., & Yellon, S. M. (2023). Reassessing the Bishop score in clinical practice for induction of labor leading to vaginal delivery and for evaluation of cervix ripening. Placenta and reproductive medicine, 2, 8.

https://doi.org/10.54844/prm.2023.0353

Azad, A., Pourtaheri, M., Darsareh, F., Heidari, S., & Mehrnoush, V. (2022). Evening primrose oil for cervical ripening prior to labor induction in post-term pregnancies: A randomized controlled trial. European Journal of Integrative Medicine, 51, 102123.

https://doi.org/10.1016/j.eujim.2022.102123

Lee, D. S., Tandel, M. D., Kwan, L., Francoeur, A. A., Duong, H. L., & Negi, M. (2022). Favorable Simplified Bishop Score after cervical ripening associated with decreased cesarean birth rate. American Journal of Obstetrics & Gynecology MFM, 4(2), 100534.

https://doi.org/10.1016/j.ajogmf.2021.100534

Shahabuddin, Y., & Murphy, D. J. (2022). Cervical ripening and labour induction: a critical review of the available methods. Best Practice & Research Clinical Obstetrics & Gynaecology, 79, 3-17.

https://doi.org/10.1016/j.bpobgyn.2021.11.008

Socha, M. W., Flis, W., Pietrus, M., Wartęga, M., & Stankiewicz, M. (2022). Signaling pathways regulating human cervical ripening in preterm and term delivery. Cells, 11(22), 3690.

https://doi.org/10.3390/cells11223690

Socha, M. W., Flis, W., Pietrus, M., & Wartęga, M. (2023). Results of induction of labor with prostaglandins E1 and E2 (the RIPE study): a real-world data analysis of obstetrical effectiveness and clinical outcomes of pharmacological induction of labor with vaginal inserts. Pharmaceuticals, 16(7), 982.

https://doi.org/10.3390/ph16070982

Taliento, C., Manservigi, M., Tormen, M., Cappadona, R., Piccolotti, I., Salvioli, S., ... & Greco, P. (2023). Safety of misoprostol vs dinoprostone for induction of labor: A systematic review and meta-analysis. European Journal of Obstetrics & Gynecology and Reproductive Biology, 289, 108-128.

https://doi.org/10.1016/j.ejogrb.2023.08.382

Szpot, P., Wachełko, O., & Zawadzki, M. (2023). Determination of Prostaglandins (Carboprost, Cloprostenol, Dinoprost, Dinoprostone, Misoprostol, Sulprostone) by UHPLC-MS/MS in Toxicological Investigations. Toxics, 11(10), 802.

https://doi.org/10.3390/toxics11100802

Resch, B. (2023). Clinical Basics and Remarks: Why and When Do Neonatologists Need Imaging. In Imaging in Neonates (pp. 5-18). Cham: Springer International Publishing.

https://doi.org/10.1007/978-3-031-15729-5_2

da Silva, J. W. V., Duarte, M. L., Ribeiro, J. I., Kishishita, J., Souza, A. T. M., Leal, L. B., ... & Bedor, D. C. G. (2024). Development and validation of a stability‐indicating method, structural elucidation of new degradation products from misoprostol by LC–MS time‐of‐flight, and an ex vivo study of vaginal permeation. Biomedical Chromatography, 38(8), e5897.

https://doi.org/10.1002/bmc.5897

Mohammed, Y., Holmes, A., Kwok, P. C. L., Kumeria, T., Namjoshi, S., Imran, M., ... & Roberts, M. S. (2022). Advances and future perspectives in epithelial drug delivery. Advanced Drug Delivery Reviews, 186, 114293.

https://doi.org/10.1016/j.addr.2022.114293

Sanchez-Ramos, L., Levine, L. D., Sciscione, A. C., Mozurkewich, E. L., Ramsey, P. S., Adair, C. D., ... & McKinney, J. A. (2024). Methods for the induction of labor: efficacy and safety. American Journal of Obstetrics and Gynecology, 230(3), S669-S695.

https://doi.org/10.1016/j.ajog.2023.02.009

Hawker, L. A., Mundle, S., Tripathy, J. P., Deshmukh, P., Winikoff, B., Weeks, A. D., ... & Lightly, K. (2024). Preferences for induction of labor methods in India: a qualitative study of views and experiences of women, clinicians, and researchers. AJOG Global Reports, 4(4), 100389.

https://doi.org/10.1016/j.xagr.2024.100389