Comparison of labour induction with misoprostol and dinoprostone and characterization of uterine response based on electrohysterogram

Abstract

Objective: The objective of this study is to compare the uterine activity response between women administered dinoprostone (prostaglandin E2) and misoprostol (prostaglandin E1) for induction of labour (IOL) by analysing not only the traditional obstetric data but also the parameters extracted from uterine electrohysterogram (EHG).

Methods: Two cohorts were defined: misoprostol (25-µg vaginal tablets; 251 women) and dinoprostone cohort (10 mg vaginal inserts; 249 women). All the mothers were induced by a medical indication of a Bishop Score < = 6.

Results: The misoprostol cohort was associated with a shorter time to achieve active labour (p = .017) and vaginal delivery (p = .009) and with a higher percentage of vaginal delivery in less than 24 h in mothers with a very unfavourable cervix score (risk ratio (RR): 1.41, IC95% 1.17–1.69, p = .002). Successful inductions with misoprostol showed EHG parameter values significantly higher than basal state for amplitude and pseudo Montevideo units (PMU) 60’ after drug administration, while spectral parameters significantly increased after 150’. This response was not observed in failed inductions. In the successful dinoprostone group, the duration and number of contractions increased significantly after 120’, PMU did so after 180’, and no significant differences were found for spectral parameters, possibly due to the slower pharmacokinetics of this drug.

Conclusion: Successful inductions of labour by misoprostol are associated with earlier effective contractions than in labours induced by dinoprostone.

Keywords:

• Cervical ripening
• drug effects
• labour Induction
• signal interpretation
• surface electromyography

Acknowledgements

The authors are grateful to the Obstetrics Unit of the Hospital Universitario La de Valencia, where recording sessions were carried out.

Disclosure statement

This research has received funding from Bial SA a company that may be affected by the research reported in the enclosed paper.

Additional information

Funding

This work was partially supported by the Spanish Ministry of Economy and Competitiveness and the European Regional Development Fund under grant [DPI2015-68397-R] and by the company Bial SA.