Comparing two dinoprostone agents for cervical ripening and induction of labor: a randomized trial.
OBJECTIVE
To compare dinoprostone gel and insert in achieving successful vaginal delivery in nulliparous and multiparous women.


METHODS
220 nulliparous and 100 multiparous with a Bishop score < or =7 were randomized to receive dinoprostone either gel or insert for cervical ripening. The main outcome measures were the rate and latency of vaginal delivery.


RESULTS
In nulliparous women no significant differences were found between the gel and insert groups in the rate of vaginal delivery (85.6% vs. 80.7%) delivery < or =12 (36.8% vs. 32.9%) and < or =24h (85.3% vs. 93.4%) regardless of the preinduction Bishop score. Nulliparous with Bishop score < or =4 treated with the insert had a decreased risk (p<0.05) of post partum hemorrhage (4.8%) when compared with nulliparous treated with gel (16.7%). On the contrary, in multiparous the time to delivery interval was significantly shorter in the gel treated group (9.9+/-4.9h vs. 13.1+/-5h; p<0.001) with more patients delivering vaginally < or =12h (75% vs. 37.5%, p<0.001), regardless of the preinduction Bishop score.


CONCLUSIONS
Both dinoprostone gel and insert are efficient in achieving cervical ripening and successful labor in nulliparous and multiparous. In multiparous, however, the gel significantly reduces the time to vaginal delivery with more patients delivering vaginally < or =12h, regardless of the Bishop score.
Marconi
Anna Maria
AM
Department of Obstetrics & Gynecology, DMSD San Paolo, University of Milano, Via A. di Rudiní 8, Milan, Italy. annamaria.marconi@unimi.it
Bozzetti
Patrizia
P
Morabito
Alberto
A
Pardi
Giorgio
G
D000328:Adult; D020070:Cervical Ripening / Q000187:drug effects*; D015232:Dinoprostone / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D007751:Labor, Induced; D007902:Length of Stay; D011247:Pregnancy; D011446:Prospective Studies; D013997:Time Factors; D014622:Vaginal Creams, Foams, and Jellies
D014622:Vaginal Creams, Foams, and Jellies; D015232:Dinoprostone