The Misoprostol Vaginal Insert for Cervical Ripening: Is Faster Always Better?

Ongoing efforts are aimed at improving the efficacy and acceptability of labor induction, an increasingly common procedure in the U.S. Vaginal misoprostol is extensively used off-label for cervical ripening; dinoprostone is the only prostaglandin approved for this purpose. Investigators conducted an industry-supported, randomized controlled trial of a 200-µg misoprostol vaginal insert versus a 10-mg dinoprostone insert. Primary outcomes were time to vaginal delivery and likelihood of cesarean delivery. Inserts were placed in 1358 eligible women, with planned removal at the onset of active labor or within 24 hours (although the dinoprostone insert is designed for 12-hour release). Further management of labor induction was at the discretion o…