الفهرس 
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Abstract
SUMMARY AND CONCLUSION
It is now generally accepted that the uterine cervix plays an active role during pregnancy and parturition and that it depends on an active ripening process within the cervix. Abnormalities in this process may cause considerable obstetric problems, endangering both the fetus and the mother.
Pharmacologically and physiologically prostaglandins have two direct actions associated with labor : ripening of the cervix and a direct oxytocin action. Prostaglandins are effective in enhancing cervical effacement and dilatation, reduction of induction failure rate, shortening the induction delivery interval, reducing oxytocin dose and lowering rate of Cesarean section due to failure to progress.
Prostaglandin E2 (dinoprostone) is the only agent currently approved for pre-induction cervical ripening although there are disadvantages to it’s administration. These include the simultaneous uterine activity stimulation, its cost and also the need for oxytocin augmentation in the patients.
The prostaglandin E1 methyl analogue (misoprostol) was recently tried for preinduction cervical ripening and / or labor induction. Several studies have been conducted to delineate its optimal dose and to compare its safety with that of dinoprostone.
The aim of the present study was to compare the effectiveness and safety of prostaglandin analogues misoprostol versus prostaglandin E2 dinoprostone for cervical ripening and induction of labor in full term pregnancy. In the present study 60 patients were included. They were divided to two groups each of 30 patients. One group received 100g misoprostol, the other group received 3 mg dinoprostone, both applied in the posterior vaginal fornix. All patients underwent carefull history, examination both general and local, exact gestational age was calculated by reliable last menstrual date and exclusion criteria and the patients were under very close observation during the whole study.
Comparing the results of both groups, the percentage of patients delivering vaginally was higher in the misoprostol group versus the dinoprostone group. The mean induction delivery interval was shorter in the misoprostol patients with significant difference than the dinoprostone patients. Concerning induction delivery time in both groups, the percentage of patients delivering vaginally in the misoprostol group in the first 6 hours was higher than in the dinoprostone group. Besides, all of the cases delivering vaginally in the misoprostol group delivered 18 hours after the initial dose while the cases in the dinoprostone group delivered vaginally after 24 hours from the initial dose. The need for oxytocin augmentation was similar in both groups. The need for a second dose of the drugs showed no significant difference in both the misoprostol and the dinoprostone group. The mean induction delivery interval was shorter in the misoprostol group versus the dinoprostone group although it showed no significant difference. The incidence of uterine tachysystol was higher in the dinoprostone group although there was no significant between the two groups. Intrapartum characteristics, side effects and complications, both drugs are comparable with equal safety.
The fetal outcome was almost the same among both groups with no significant difference in the apgar score. Only one case developed fetal distress and was in the misoprostol group but other fetal heart rate anomalies including tachycardia, bradycardia and late deceleration showed no significant difference. Maternal side effects including nausea, vomiting and fever developed in both the dinoprostone as well as in the misoprostol group, but these results showed no significant difference among the two groups. These results state that concerning fetal outcome.
Misoprostol also proved to be cheaper than dinoprostone with easily storage at room temperature with absolutely no precautions to be taken and this is comparison to dinoprostone which is expensive and should be refrigerated and could be only kept for months.