Efficacy and safety of misoprostol vaginal insert vs. oral misoprostol for induction of labor

Objectives: To compare the oral application form of misoprostol with the misoprostol vaginal insert (MVI) in a Swiss cohort with special regards to the efficacy and safety. Methods: We performed a retrospective case series including a historical group induced with oral misoprostol (MO, n =101) and an MVI group (n =101). The primary outcome was time to delivery. Secondary outcomes were mode of delivery, occurrence of tachysystole, use of analgesia and neonatal adverse outcome. Results: A total of 202 women were included in the analysis (101 in the MVI as well as in the MO group). Time from start of induction to delivery was significantly shorter in the MVI group compared to the MO group (15.91 h vs. 37.68 h, P < 0.001). Within the first 24 h, 78.2% of the women in the MVI group had given birth compared to 28.7% in the MO group (p < 0.001). Tachysystole occurred more often in the MVI group (22.8% vs. 5.0%, P < 0.001). Women in the MVI group more often needed opioid analgesia during the induction before onset of active labor (31.7% vs. 2.0%, P < 0.001). There was no significant difference between neonatal outcomes in the two groups. Conclusion: Time to delivery was significantly shorter in the MVI group with a higher rate of vaginal deliveries within the first 24 h. However, patients needed more opioids for pain relief during induction with MVI. There was no difference in neonatal outcomes.