Elective cervical ripening in women beyond the 290th day of pregnancy - A Randomized trial comparing 2 dinoprostone preparations

OBJECTIVE: To determine the better performer among cervical ripening agents for the elective induction of labor. STUDY DESIGN: An open label, randomized study was done in consecutive patients undergoing elective induction of labor at the 41st week and beyond. Inclusion criteria were: singleton pregnancy, gestational age ascertained through first-trimes ter ultrasound, Bishop score < 4 and nulliparity. Exclusion criteria were: oligohydramnios, maternallfetal disorder or pregnancy complication, previous uterine surgery, rupture of membranes and presence of uterine activity. Patients received either slowrelease dinoprostone vaginal insert (VI) or 0.5-mg dinoprostone intracervical (IC) gel, twice, 6 hours apart. RESULTS: Women receiving VI showed increased risk of entering labor without further stimulation (OR= 6.48, 95% CI 2.06-21.67, p < 0.001) and delivering vaginally within 24 hours (OR = 2.71, 95% Cl 1.19-6.21, p = 0.01) in comparison to those receiving IC gel. A stay in the hospital (> 4 days) was more prevalent in women treated with IC gel in comparison to those treated with VI (OR= 2.35, 95% CI 1.04-5.37). CONCLUSION: Preinduction cervical ripening with the dinoprostone slow-release vaginal insert is associated with a high rate of women undergoing vaginal delivery within 24 hours, with a shorter stay. Considering its good performance, the dinoprostone slow-release vaginal insert is the first choice for elective induction of labor in postdate pregnancy. The dinoprostone slow-release vaginal insert seems to be the est performer when nulliparous women with an unripe cervix require preinduction of labor.