Labor induction with intravaginal misoprostol compared with the dinoprostone vaginal insert: a systematic review and metaanalysis.

OBJECTIVE: The purpose of this study was to review randomized trials that compared the efficacy of the dinoprostone 10-mg controlled-release vaginal insert with that of vaginally administered misoprostol tablets in cervical ripening and labor induction.

STUDY DESIGN: Electronic databases were used to identify randomized clinical trials that compared dinoprostone with misoprostol. Estimates of the relative risk for individual studies and risk difference from dichotomous outcomes with the use of random and fixed-effects models were calculated.

RESULTS: Women who received misoprostol had a higher incidence of vaginal delivery within 12 and 24 hours of prostaglandin application, compared with dinoprostone. Both modalities had similar incidences of cesarean delivery, uterine hyperstimulation, and fetal tachysystole. There was an increased need for oxytocin augmentation in the dinoprostone group. No significant difference in neonatal outcomes was noted between the 2 groups.

CONCLUSION: Vaginally administered misoprostol was more effective than the dinoprostone vaginal insert for cervical ripening and labor induction. The safety profiles of both drugs were similar.