title: Sustained-release dinoprostone vaginal pessary with concurrent high-dose oxytocin infusion compared to sustained-release dinoprostone vaginal pessary followed 6 h later by high-dose oxytocin infusion for labor induction in women at term with unfavorable cervix: a randomized controlled trial.
abstract: OBJECTIVE
  To compare the efficacy and safety of sustained-release dinoprostone vaginal pessary and concurrent high-dose oxytocin infusion with sustained-release dinoprostone vaginal pessary followed 6 h later by high-dose oxytocin infusion for cervical ripening and labor induction.
  
  
  METHODS
  A total of 500 nulliparous or multiparous women with a singleton pregnancy, Bishop score ≤4 and admitted for labor induction. Women were randomly assigned to induction of labor using intravaginal dinoprostone with concurrent high-dose oxytocin (n = 250) or intravaginal dinoprostone pessary followed 6 h later by high-dose oxytocin (n = 250). The primary outcome was the number of vaginal deliveries achieved within 24 h of labor induction.
  
  
  RESULTS
  Baseline characteristics of both groups were comparable. Vaginal delivery within 24 h of labor induction was significantly increased with sustained-release dinoprostone followed 6 h later by high-dose oxytocin infusion (92.8 vs. 82.0%, RR 2.82, 95% CI 1.58-5.04). There were more cesarean section deliveries in the dinoprostone with concurrent high-dose oxytocin group (16.8 vs. 6.8%, RR 0.36, 95% CI 0.20-0.65). Maternal outcomes did not differ significantly. An Apgar score of <7 at 5 min was found more often in the dinoprostone with concurrent high-dose oxytocin group (3.6%) in comparison to dinoprostone pessary followed 6 h later by high-dose oxytocin (0.8%), although this was not statistically different (RR 0.21, 95% CI 0.04-1.01).
  
  
  CONCLUSIONS
  Sustained-release dinoprostone followed 6 h later by high-dose oxytocin infusion appears to be safer and more effective than sustained-release dinoprostone with concurrent high-dose oxytocin infusion in achieving cervical ripening and successful vaginal delivery.
authors.affiliation: Department of Obstetrics and Gynecology, Mardin Women's and Children's Hospital, Mardin, Turkey. maidenkemal@yahoo.com
authors.forename: Kemal
authors.initials: K
authors.lastname: Güngördük
authors.forename: Gokhan
authors.initials: G
authors.lastname: Yildirim
authors.forename: Ozgu
authors.initials: O
authors.lastname: Güngördük
authors.forename: Cemal
authors.initials: C
authors.lastname: Ark
authors.forename: Ismet
authors.initials: I
authors.lastname: Tekirdağ
mesh_terms: D000328:Adult; D020070:Cervical Ripening / Q000187:drug effects*; D003692:Delayed-Action Preparations; D036861:Delivery, Obstetric; D015232:Dinoprostone / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007743:Labor, Obstetric / Q000187:drug effects*; D008297:Male; D010120:Oxytocics / Q000008:administration & dosage*; D010121:Oxytocin / Q000008:administration & dosage*; D010570:Pessaries; D011247:Pregnancy; D011256:Pregnancy Outcome; D016896:Treatment Outcome; D014621:Vagina; D055815:Young Adult
chemical_list: D003692:Delayed-Action Preparations; D010120:Oxytocics; D010121:Oxytocin; D015232:Dinoprostone