Comparative Study Between Using Only Vaginal Misoprostol and Using Vaginal Misoprostol and Estradiol Cream for Induction of Labor: A Randomized Controlled Trial

Mortada E. Ahmed, Fekria A. Salama, Amira M. Ahmed, Rania G. El-Skaan


Background: The aim of the study was to evaluate the effectiveness of vaginal misoprostol versus vaginal misoprostol and estradiol cream for ripening of the very unfavorable cervix in patients requiring induction of labor (IOL) to shorten induction delivery interval.

Methods: This study was a randomized controlled trial conducted on 120 women with unfavorable cervix during the period from April 2021 to October 2021. Patients were randomized into two equal groups as follows: group I included 60 patients who were given only vaginal misoprostol 25 µg, and group II included 60 patients in which women were given vaginal misoprostol 25 µg with vaginal estradiol 150 mg.

Results: Thirty-two patients (53.3%) in the misoprostol group and 38 patients (63.3%) in the estradiol group reached the active phase. According to the mode of delivery, 29 patients (48.3%) in the misoprostol and 24 patients (40%) in the estradiol group underwent cesarean section (CS). The most common causes of CS were failed induction and fetal distress. With exception of the first minute Apgar score, no statistically significant difference in IOL between both groups was reported.

Conclusion: We found that a combination of the misoprostol and estradiol does not achieve a significant difference in IOL compared to vaginal misoprostol alone.

J Clin Gynecol Obstet. 2022;11(2):39-46



Misoprostol; Estradiol; Induction of labor

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