title: Retention of dinoprostone vaginal insert beyond 12 hours for induction of labor.
abstract: We evaluate the likelihood of cesarean delivery and identify risks of retaining a sustained-release dinoprostone vaginal insert beyond 12 hours. In a secondary analysis of outcomes, data were collected during a large, randomized trial comparing different sustained-release prostaglandin vaginal inserts for labor induction. Outcomes were compared between cases in whom the dinoprostone insert was removed early (within 12 hours) or late (12 to 24 hours). A total of 431 subjects had the dinoprostone vaginal insert in place for 12 to 24 hours ( N = 226, 52.4%) or within 12 hours ( N = 205, 47.6%). Insert removal for labor complications was less frequent in the late group than in the early group (5.8% versus 21.5%; P ≤ 0.001). Abnormal uterine contractility patterns were less common in the late than early group (25.2% versus 37.6%; P = 0.03). Rates of cesarean delivery during the first hospitalization were similar for late and early groups (25.0% versus 29.2%; P = 0.33). Percentages of infants requiring immediate attention or intensive care were low and similar between groups. Sustained-release intravaginal dinoprostone left in place beyond 12 hours did not increase the risks of intrapartum complications, cesarean delivery, or immediate adverse neonatal events.
authors.affiliation: Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, Albuquerque, USA. mcbrennan@salud.unm.edu
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Brennan
authors.forename: Leo
authors.initials: L
authors.lastname: Pevzner
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Wing
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Powers
authors.forename: William F
authors.initials: WF
authors.lastname: Rayburn
mesh_terms: D000282:Administration, Intravaginal; D000328:Adult; D001034:Apgar Score; D002584:Cervix Uteri / Q000187:drug effects; D003692:Delayed-Action Preparations; D015232:Dinoprostone / Q000008:administration & dosage* / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006340:Heart Rate, Fetal; D006801:Humans; D007231:Infant, Newborn; D007751:Labor, Induced / Q000379:methods*; D010120:Oxytocics / Q000008:administration & dosage* / Q000009:adverse effects* / Q000627:therapeutic use; D010121:Oxytocin / Q000627:therapeutic use; D011247:Pregnancy; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
chemical_list: D003692:Delayed-Action Preparations; D010120:Oxytocics; D010121:Oxytocin; D015232:Dinoprostone