| 11 Juin 2013
Amsterdam, June 7, 2013 - Data from the EXPEDITE study presented on the May, 24th at the First European Congress on Intrapartum Care (ECIC) demonstrated that use of a controlled release misoprostol vaginal insert significantly reduced time to vaginal delivery compared to a dinoprostone vaginal insert.1
“The increased incidence of labour induction has prompted the need for safe and more efficacious techniques and induction agents”, said Dr. Deborah Wing, University of California, Irvine. “These results point toward significant efficacy advantages for the misoprostol vaginal delivery system”.
Misoprostol is a synthetic prostaglandin E1 (PGE1) analogue. The World Health Organisation (WHO)2 recommends prostaglandins for cervical ripening and labour induction and misoprostol is one of the compounds on the “WHO essential drug list” for labour induction. Many current clinical guidelines also recommend the use of prostaglandins for the induction of labour 3,4.
The EXPEDITE study compared the efficacy and safety of a controlled release vaginal insert containing a reservoir of 200 μg of misoprostol (MVDS) versus a reservoir of 10 mg dinoprostone in a vaginal insert (DVI) when used for labour induction in a randomised phase III double-blinded study.
The research was done at over 30 sites across the USA where a total of 1,358 women were randomly assigned to receive either a single dose of MVDS (n=678) or dinoprostone vaginal insert (DVI) (n=680).
The co-primary efficacy endpoint of median time to vaginal delivery was found to be significantly shorter for women treated with MVDS compared with DVI (MVDS: 21.5 hours [95% CI: 20.0–23.4], DVI: 32.8 hours [95% CI: 30.2–34.9]; p<0.001). MVDS also decreased time to any delivery, time to active labour and pre-delivery oxytocin administration, compared with DVI.
The rates of caesarean delivery, co-primary safety endpoint, were not significantly different between MVDS and DVI (26.0% vs. 27.2%; p = 0.65). Furthermore, no significant differences between groups were observed in overall rates of neonatal treatment-emergent adverse events.
About labour induction
Labour induction has been increasingly used in obstetric practice over the last three decades. In Europe, the incidence of labour induction has risen from 10.4% to 20.5% (1981-1998)5. One explanation for the constantly rising rates of labour induction could be the increasing average maternal age at delivery across Europe. Induction of labour in older mothers is widely practiced as an intervention perceived to reduce the risk of late stillbirth6. For example, in the UK, the mean maternal age has increased dramatically over the past two decades, with statistics showing that between 1987 and 2008 pregnancies in women aged 35 and over rose from 8% to 20% and pregnancies in women aged 40 years and older trebled from 1.2% to 3.6%7. However, labour induction rates differ widely across Europe and the rise is not linear.
About Ferring Pharmaceuticals
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1 1st European Congress of Intrapartum Care. Amsterdam, May 2013. Abstract 303. Lead Author:
Hugh Miller - Coauthor(s): Hugh Miller; Deborah A Wing; Lauren A Plante; Olof Rugarn; Barbara L Powers - MISOPROSTOL VAGINAL INSERT SIGNIFICANTLY REDUCED TIME TO VAGINAL DELIVERY COMPARED WITH DINOPROSTONE VAGINAL INSERT WHEN USED FOR LABOR INDUCTION.
2 World Health Organization. Managing complications in pregnancy and childbirth. A guide for midwives and doctors (2007). Accessed April 2013. Available from: http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/9241545879/en/index.html.
3 RCOG & NICE. Induction of Labour Clinical Guideline (2008). Available at: http://www.nice.org.uk/nicemedia/live/12012/41255/41255.pdf (Last accessed May 2013).
4 ACOG. Obstet Gynecol 2009;114:386–97.
5 EURO-PERISTAT, SCPE, EUROCAT & EURONEOSTAT. European perinatal health report: better statistics for better health for pregnant women and their babies (2008). Accessed March 2013. Available from: www.sante.public.lu/publications/sante-fil-vie/petite-enfance/european-perinatal-health-report/european-perinatal-health-report.pdf, accessed May, 15th, 2013, 14:00 pm.
6 Carolan M, Davey MA, Biro MA, Kealy M. Older Maternal Age and Intervention in Labor: A
Population-Based Study Comparing Older and Younger First-Time Mothers in Victoria,
Australia. Birth 2011;38:24–9. Available at http://www.ncbi.nlm.nih.gov/pubmed/?term=Carolan+M%2C+Davey+MA%2C+Biro+MA%2C+Kealy+M.+Older+Maternal+Age+and+Intervention+in+Labor%3A+A+Population-Based+Study+Comparing+Older+and+Younger+First-Time+Mothers+in+Victoria%2C+Australia.+Birth
7 RCOG. Induction of labour at Term in Older Mothers (2013). Available at: http://www.rcog.org.uk/files/rcog-corp/1.2.13%20SIP34%20IOL.pdf
