Læknablaðið - 15.12.1999, Blaðsíða 25

LÆKNABLAÐIÐ 1999; 85
961
Mísóprostól og dínóprostón
til framköllunar fæðingar
Framskyggn hendingarvalsrannsókn
Hildur Harðardóttir, Ragnheiður Baldursdóttir, Linda Björk Helgadóttir
Harðardóttir H, Baldursdóttir R, Helgadóttir LB
Misoprostol and dinoprostonc for induction of
labor: a prospective randomized study
Læknablaðið 1999; 85: 961-7
Objective: The ideal agent for induction of labor
when the cervix is unripe is unknown, but several
prostaglandin derivatives are currently available. Re-
cently, the synthetic prostaglandin E1 derivative
misoprostol has been used with good success for
induction of labor. The cost of misoprostol is only a
fraction of the cost of the traditionally used dino-
prostone. We conducted a prospective, randomized
trial comparing the efficacy and safety of misopro-
stol and dinoprostone for induction of labor.
Material and methods: One hundred and twenty-
three women with an indication for induction of
labor and an unfavorable cervical score and intact
membranes were randomized to receive either one
dose of misoprostol 100 mcg or two doses of dino-
prostone 3 mg at eight hour intervals, in the posterior
vaginal fornix.
Results: Fifty-one women received misoprostol and
60 dinoprostone. Twelve women dropped out of the
study after randomization, thereof 11 from the miso-
prostol group due to a too favorable cervical score
(n=9) and ruptured membranes (n=2). The mean time
from induction of labor to delivery was 548 and
1,087 minutes in the misoprostol and dinoprostone
groups, respectively (p<0.05). The need for oxytocin
was 40% in the misoprostol and 71% in the dinopro-
stone group (p<0.05). There was no difference in
mode of delivery between the groups; 21.6% and
Frá Kvennadeild Landspítalans, 101 Reykjavík. Fyrirspurn-
ir, bréfaskipti: Hildur Harðardóttir, Kvennadeild Landspítal-
ans, 101 Reykjavík. Sími: 560 1000, 560 1117; bréfsími:
560 1191; netfang: hhard@rsp.is
Lykilorð: fæðing, framköllun fæðingar, prostaglandín,
þungun.
25% were delivered by cesarean section in the miso-
prostol and dinoprostone groups, respectively. The
incidence of fetal distress as evaluated by brady-
cardia, tachycardia or late decelerations was similar
in both groups. The occurrence of meconium was
41% and 20.5% in the misoprostol and dinoprostone
groups, respectively (p=0.056). The incidence of
uterine hyperstimulation was 59.6% in the misopro-
stol group and 18.6% in the dinoprostone group
(p<0.05). The Apgar score at one minute was 6.6 and
7.6 and at five minutes 8.5 and 9.0 in the misoprostol
and dinoprostone groups, respectively (p=0.048 and
0.037). When only vaginal births are examined there
was no difference in Apgar score at one and five
minutes (p=0.11; p=0.21).
Conclusions: Intravaginal misoprostol and dinopro-
stone are both effective in inducing labor when the
cervix is unripe. Delivery is faster with this dose of
misoprostol compared to dinoprostone and there is
less requirement for further augmentation of labor
with oxytocin, but the incidence of uterine hypersti-
mulation is higher. This was, however, not reflected
in an increased incidence of fetal distress, cesarean
section or adverse neonatal outcome. The ideal dose
of misoprostol for induction of labor remains to be
determined.
Key words: labor, induction of labor, prostaglandins,
pregnancy.
Ágrip
Inngangur: Kjörlyf til framköllunar fæð-
ingar þegar legháls er langur og lokaður er
ófundið, en nokkur prostaglandín afbrigði eru
nú notuð. Nýlega hefur verið lýst góðum ár-
angri með notkun syntetísks prostaglandín E1
afbrigðis, mísóprostóls, til framköllunar fæð-
ingar. Verð á mísóprostóli er aðeins brot af
verði prostaglandín E2 efna, sem jafnan eru
notuð til framköllunar fæðingar. Gerð var
framskyggn hendingarvalsrannsókn til að bera
saman árangur og öryggi til framköllunar fæð-