الفهرس 
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Abstract
Summary
Labor is a clinical diagnosis characterized by regular,
painful uterine contractions that increase in frequency and
intensity which are associated with progressive cervical
effacement or dilatation. More specifically, it is associated with
a change in the myometrial contractility pattern from irregular
”contractures” (long lasting,low-frequency activity) to regular
”contractions” (high-intensity, high frequency activity).
The cervix consists primarily of collagen, a fibrous
connective tissue that undergoes extensive remodeling and
dynamic anatomic and physiologic alterations throughout
pregnancy.The cervix maintains tremendous weight-bearing
potential and tensile strength until gestation is complete. The
cervical remodeling process occurs in four distinct
endocrinologic and structurally unique stages: softening,
ripening, dilation, and postpartum repair.
Induction of labor is an increasingly common practice , it
generally refers to procedures performed in the third trimester,
but occasionally may be applied to pregnancies at gestations
greater than the legal definition of fetal viability (24 weeks in
UK) when fetal survival is an anticipated outcome.
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It is performed when it is considered that there are
benefits to the baby and/or mother if the baby is delivered,
compared with the alternative of the baby remaining in utero. It
is also a common obstetric procedure that is being more widely
used nowadays than ever before, 30-40% of deliveries are
induced. with the most common indication being a postdates
pregnancy,prelabor rupture of membranes; other situations in
which induction of labor may be indicated includes medical
disorders as hypertensive disorders of pregnancy, suspected
fetal macrosomia intrauterine fetal demise, chorioaminonitis
and even maternal request.
Methods for labor induction include pharmacological,
non pharmacological options and surgical methods.
A ripening agents may be used in patient with an
unfavorable cervix. Artificial rupture of the fetal membranes
would be difficult or impossible when the uterine cervix is
unripe so administration of vaginal prostaglandins E2 reduces
the likelihood of failed induction of labor, Dinoprostone is
prostaglandins E2 acts as unique regulator of placental blood
flow because of its dual effect, it induces vasodilatation in the
maternal uterine blood vessels, leading to increase blood flow
during contraction and also induces vasoconstriction of the
placental vessels. PGE2 is an important metabolite in the utero
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144
placental unit throughout pregnancy and plays a major role in
parturition as it softens the cervix and cause uterine contraction.
Misoprostol, which is a methyl ester of prostaglandins E1 is a
recent addition to the list of the prostaglandins. Misoprostol is
rapidly absorbed regardless the route of administration.
It was originally marketed in oral tablet for the treatment of the
duodenal ulcers and prophylaxis against nonsteroidal antiinflammatory
drug-induced gastric ulcer but also has utertonic
properties and is useful for cervical ripening .It is not licensed at
present for the induction of labor, but various groups
successfully used the agent by oral or the sublingual routes for
the induction of labor on the basis of its effect on uterine
contraction. Currently, misopristol is considered at least as
effective as other methods in inducing labor when the cervix is
immature.
The drug has been safely used as ripening agent for more
than 20 years, especially in low-resource countries because of
its low cost and stability at room temperature.
The aim of the work is to compare the safety and
effectiveness of Dinoprostone vaginal inserts versus the
efficacy of Misoprostol vaginal inserts in induction of labor.
Randomized controlled clinical trial has been conducted
on 120 pregnant women at term admitted to Ain Shams
Summary
145
university hospital for induction of labor from January 2013 to
April 2014 who were selected according to inclusion and
exclusion criteria of the study to compare between efficacy of
Misoprostol 25 mcg versus efficiency of Dinoprostone 3 mg
intavaginal inserts to be repeated 6 hourly interval up to a
maximum of four doses for induction of labor.
Included women have been randomized into two groups
each group contained 60 women.
There was no statistically significant difference between
Misoprostol and Dinoprostone as regard the number of doses
needed for active phase of labor, time interval to establishment
of active phase of labor, time interval from active phase of labor
to delivery and induction delivery time.
Also difference as regard mode of delivery not found to
be statistically significant.
As regard uterine hyperstimulation and fetal distress
there were no statistically significant difference between
Misoprostol and Dinoprostone.
There was no difference between the two groups as
regard the effectiveness of Dinoprostone and the efficacy of
Misoprostol in induction of labor. The safety profiles of both
drugs were similar.