Comparison of Efficacy and Safety Between Vaginal Misoprostol Tablets and Dinoprostone Insert for Labor Induction in a Pilot Study.

To compare the efficacy and safety of vaginal misoprostol 25 µg tablets vs dinoprostone controlled-release insert for labor induction in multiparous women with an unfavorable cervix. This single-center pilot cohort study included a prospective misoprostol cohort (n = 23) and a retrospective historical dinoprostone control (n = 26). Participants were term multiparous women with singleton pregnancies, cephalic presentation, Bishop score < 6, and no contraindications for vaginal delivery. Primary outcomes were the 24 h vaginal delivery rate and clinician-determined tocolytic use for uterine tachysystole. Secondary outcomes included cesarean section rate, meconium-stained amniotic fluid, postpartum hemorrhage, and neonatal outcomes. The 24 h vaginal delivery rates were similar between groups (82.6% vs 80.8%, p = 0.840). The misoprostol group had significantly lower tocolytic use (8.7% vs 38.5%, p = 0.037) and lower meconium-stained amniotic fluid incidence (4.3% vs 23.1%, p = 0.037). Cesarean section rates were <5% in both groups (4.3% vs 3.8%, p = 1.000). No significant differences were seen in postpartum hemorrhage or neonatal outcomes. Misoprostol 25 µg vaginal tablets achieved comparable 24 h vaginal delivery rates to dinoprostone, with reduced tocolytic use in this pilot cohort.