European journal of obstetrics, gynecology, and reproductive biology · 2025
Oral misoprostol versus vaginal dinoprostone for term labor induction among women requiring oxytocin before 4 cm: A secondary analysis of the STOPOXY trial.
СтатьяРандомизированное исследованиеСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Nkobetchou Maëlys, Ray Camille Le, Girault Aude
Аннотация
OBJECTIVES: Labor induction is increasing worldwide. Dinoprostone pessary(PGE2) is widely used in France, while oral misoprostol is increasingly used since its approval (April 2018). We aimed to compare the efficacy, safety, and childbirth experience of term inductions using oral misoprostol versus vaginal dinoprostone in women requiring oxytocin before 4 cm dilation.
DESIGN: We conducted a secondary analysis of the STOPOXY randomized trial (assessing the impact of discontinuing oxytocin during active labor on neonatal morbidity). We included term labor inductions with oral misoprostol or vaginal dinoprostone. The primary outcome was the vaginal delivery rate. Secondary outcomes included efficacy, safety outcomes, and childbirth experience (Labor Agentry Scale). We performed an univariate analysis then a multilevel multivariate analysis with the center as a random effect and adjusted the model for parity, maternal age, BMI, gestational diabetes, and Bishop score. Finally, we built a Kaplan-Meier survival curve showing time to delivery in the two groups.
RESULTS: Among 581patients, 311 were induced using dinoprostone and 270 with oral misoprostol. In the univariate and multivariate analysis, there was no significant differences between the two groups regarding the vaginal delivery rate (aOR = 1.03-95 %CI[0.55-1.96]). The time from induction to delivery was significantly longer in the oral misoprostol group(P < 0.01, log-rank test). No significant differences were observed in maternal or neonatal safety outcomes or in childbirth experience.
CONCLUSION: In women requiring early oxytocin during labor induction, oral misoprostol and vaginal dinoprostone showed comparable efficacy, safety, and childbirth experience, allowing the choice to be guided by patient preferences and clinical context.
DESIGN: We conducted a secondary analysis of the STOPOXY randomized trial (assessing the impact of discontinuing oxytocin during active labor on neonatal morbidity). We included term labor inductions with oral misoprostol or vaginal dinoprostone. The primary outcome was the vaginal delivery rate. Secondary outcomes included efficacy, safety outcomes, and childbirth experience (Labor Agentry Scale). We performed an univariate analysis then a multilevel multivariate analysis with the center as a random effect and adjusted the model for parity, maternal age, BMI, gestational diabetes, and Bishop score. Finally, we built a Kaplan-Meier survival curve showing time to delivery in the two groups.
RESULTS: Among 581patients, 311 were induced using dinoprostone and 270 with oral misoprostol. In the univariate and multivariate analysis, there was no significant differences between the two groups regarding the vaginal delivery rate (aOR = 1.03-95 %CI[0.55-1.96]). The time from induction to delivery was significantly longer in the oral misoprostol group(P < 0.01, log-rank test). No significant differences were observed in maternal or neonatal safety outcomes or in childbirth experience.
CONCLUSION: In women requiring early oxytocin during labor induction, oral misoprostol and vaginal dinoprostone showed comparable efficacy, safety, and childbirth experience, allowing the choice to be guided by patient preferences and clinical context.