Novel misoprostol insert reduces labor time, need for oxytocin

(HealthDay)—Use of a 200-microgram misoprostol vaginal insert significantly reduces the time to vaginal delivery and the need for oxytocin, in women with an unfavorable cervix, compared to those using a dinoprostone vaginal insert, according to a study published online July 8 in Obstetrics & Gynecology.

Deborah A. Wing, M.D., from the University of California at Irvine, and colleagues randomly assigned women being induced with a modified Bishop score of 4 or less to receive either a 200-microgram misoprostol vaginal insert (678 patients) or a 10-mg dinoprostone vaginal insert (680 patients).

The researchers found that women receiving the misoprostol vaginal insert had a significantly shorter median time to vaginal delivery compared with patients receiving the dinoprostone vaginal insert (21.5 hours versus 32.8 hours). Twenty-six percent of women receiving the misoprostol vaginal insert and 27.1 percent of those with the dinoprostone vaginal insert had a cesarean delivery. The misoprostol vaginal insert was significantly associated with a reduction in time to any delivery (18.3 versus 27.3 hours), time to onset of active labor (12.1 versus 18.6 hours), and proportion of women requiring predelivery oxytocin (48.1 versus 74.1 percent), compared with the dinoprostone vaginal insert. Participants experienced uterine tachysystole requiring intervention in 13.3 and 4.0 percent of cases receiving the misoprostol vaginal insert and dinoprostone vaginal insert, respectively.

"Use of a 200-microgram misoprostol vaginal inset significantly reduced times to vaginal delivery and active labor with reduced need for oxytocin compared with the dinoprostone vaginal insert," the authors write.

The authors disclosed financial ties to Ferring Pharmaceuticals, which manufactures the misoprostol vaginal insert and contributed funding to the study.

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