title: Concurrent oxytocin with dinoprostone pessary versus dinoprostone pessary in labour induction of nulliparas with an unfavourable cervix: a randomised placebo-controlled trial.
abstract: OBJECTIVE
  To compare concurrent oxytocin with dinoprostone pessary versus dinoprostone pessary in labour induction for nulliparas with an unfavourable cervix.
  
  
  METHODS
  A randomised double-blind study.
  
  
  METHODS
  University Malaya Medical Centre, Malaysia.
  
  
  METHODS
  Nulliparas at term with intact membranes, Bishop score < or = 6 and admitted for labour induction.
  
  
  METHODS
  All women received 3 mg dinoprostone pessary for labour induction. Those randomised to the oxytocin arm received oxytocin infusion started at 1 micro/minute and doubled every 30 minutes to a maximum 16 micro/minute. Women assigned to placebo received identical volume of saline infusion. After 6 hours, infusion was stopped and vaginal reassessment performed to guide further management.
  
  
  METHODS
  Primary outcome was vaginal delivery within 24 hours.
  
  
  RESULTS
  Concurrent oxytocin infusion with dinoprostone pessary did not significantly increase vaginal delivery rate within 24 hours (48.6 versus 35.9%; P = 0.07, relative risk [RR] 1.4 [95% CI 1.0-1.9]). It reduced the requirement for repeat dinoprostone (37.1 versus 61.2%; P = 0.001, RR 0.61 [95% CI 0.45-0.81]) and improved maternal satisfaction with the birth process (median score of 3 versus 5 on a 10-point visual analogue scale, P = 0.007). Caesarean rates were not different (41.9 versus 44.7%, P = 0.52).
  
  
  CONCLUSIONS
  Labour induction with concurrent oxytocin infusion and vaginal dinoprostone could be considered for nulliparas with an unfavourable cervix. Larger studies are needed.
authors.affiliation: Department of Obstetrics & Gynaecology, University of Malaya, Kuala Lumpur, Malaysia. pctan@um.edu.my
authors.forename: P C
authors.initials: PC
authors.lastname: Tan
authors.forename: S D
authors.initials: SD
authors.lastname: Valiapan
authors.forename: P Y S
authors.initials: PY
authors.lastname: Tay
authors.forename: S Z
authors.initials: SZ
authors.lastname: Omar
mesh_terms: D000328:Adult; D020070:Cervical Ripening / Q000187:drug effects; D015232:Dinoprostone / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007751:Labor, Induced / Q000379:methods*; D010120:Oxytocics / Q000008:administration & dosage*; D010121:Oxytocin / Q000008:administration & dosage*; D010298:Parity; D010570:Pessaries; D011247:Pregnancy; D011256:Pregnancy Outcome
chemical_list: D010120:Oxytocics; D010121:Oxytocin; D015232:Dinoprostone