COMPARISON OF DINOPROSTONE PLUS OXYTOCIN AND OXYTOCIN ALONE FOR INDUCTION OF LABOR
Role of labor induction has increased in the last decade due to the early detection of fetal jeopardy. Although very useful, oxytocin alone is not always successful for induction of labor. In a randomized clinical trial we compared vaginal dinoprostone plus oxytocin with oxytocin alone for induction of labor in 91 pregnant women at 40 weeks or greater gestation with Bishop scores ≤ 4. Forty six patients assigned to the dinoprostone group received 3 mg intravaginal dinoprostone. Six hours later the Bishop score was evaluated and if the patient had not at least 3 contractions in 10 minutes lasting for more than 40 seconds, intravenous oxytocin was started at a dose of 6 mu/min and increased by 6 mu/min at 40 minute intervals until adequate uterine activity. Forty five patients assigned to the oxytocin group underwent oxytocin induction from the start of labor induction. Although the Bishop score change after 6 hours of receiving vaginal dinoprostone from 2.54 to 4.97 was statistically significant, the oxytocin only group had a much better response with a change from 2.60 to 6.28. Median time between induction to the start of active labor was significantly shorter in the oxytocin alone group (P = 0.04). Median time between induction to delivery and the rate of cesarean did not differ significantly in these groups (P > 0.05). It was concluded that single dose of dinoprostone is effective for initiating labor in patients with an unfavorable cervix and appears safe but it is not as effective as oxytocin.