Comparative Efficacy of Dinoprostone–Misoprostol Versus Estradiol–Misoprostol for Cervical Ripening in Term Pregnancies with Unfavorable Cervix: A Randomized Controlled Trial
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2025,
Vol. 11 No. 02 > Comparative Efficacy of Dinoprostone–Misoprostol Versus Estradiol–Misoprostol for Cervical Ripening in Term Pregnancies with Unfavorable Cervix: A Randomized Controlled Trial
Published: October 7, 2025
Authors
Zeel Dakshay Shah, Sangeeta Singhal, Harshita Verma, Deepshikha Singla, Jaydeep Dangi, and Sachin Bhariya
Keywords
Cervical ripening, Dinoprostone, Misoprostol, Estradiol, Labor induction.
Abstract
Background: Cervical ripening is a pivotal step in the induction of labor (IOL), particularly in term pregnancies with an unfavorable cervix. While prostaglandins remain the cornerstone agents for this purpose, interest has grown in exploring the synergistic role of estrogen.
Purpose: This study aimed to compare the efficacy and safety of dinoprostone followed by misoprostol (MC group) versus estradiol followed by misoprostol (ME group) in primigravida women undergoing IOL at term.
Methods: A single-blind randomized controlled trial was conducted on 172 primigravida women (86 per group) at term with singleton, cephalic presentation and Bishop score ≤6. The MC group received intracervical dinoprostone gel followed by up to three misoprostol doses; the ME group received vaginal estradiol followed by misoprostol similarly. Primary outcomes included change in Bishop score, number of misoprostol doses, and onset of active labor.
Results: The mean pre-induction Bishop score was lower in the MC group (2.77 ± 1.15) compared to the ME group (3.17 ± 0.86; p = 0.009), though final scores were similar (9.70 ± 1.53 vs. 9.73 ± 1.29; p = 0.872). Only 36% of women in the MC group required a third dose of misoprostol versus 100% in the ME group (p = 0.001). Successful ripening was achieved in 84.9% (MC) and 83.7% (ME), while establishment of active labor occurred in 86% (MC) and 90.7% (ME). Rupture of membranes was more frequent in the MC group (33.7% vs. 20.9%; p = 0.043). Maternal and neonatal outcomes, including cesarean section rates and NICU admissions, were comparable between groups.
Conclusion: Both protocols demonstrated comparable efficacy for cervical ripening and showed similar obstetric outcomes within the limits of this study. Dinoprostone may reduce the need for repeated misoprostol dosing. Agent selection should be tailored based on clinical context.
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How to Cite
Zeel Dakshay Shah, Sangeeta Singhal, Harshita Verma, Deepshikha Singla, Jaydeep Dangi, and Sachin Bhariya. Comparative Efficacy of Dinoprostone–Misoprostol Versus Estradiol–Misoprostol for Cervical Ripening in Term Pregnancies with Unfavorable Cervix: A Randomized Controlled Trial.
J. Multidiscip. Res. Healthcare. 2025, 11, 30-36
