title: [Delivery induction with slow-release dinoprostone in clinical practice: results of a clinical protocol].
abstract: OBJECTIVE
  The aim of this paper was to evaluate the feasibility of a protocol for the induction of delivery with slow-release dinoprostone in women with unfavourable cervix.
  
  
  METHODS
  Indications for the induction were: pregnancy beyond 40 weeks, amniotic fluid index (AFI) <5, premature rupture of membranes, intrauterine growth retardation, or adverse maternal conditions. Eligibility criteria were: single pregnancy, cephalic presentation, Bishop Score <4, no previous uterine scar. Slow-release vaginal insert containing dinoprostone 10 mg was used to induce delivery according to a dedicated protocol agreed between clinicians and midwifes. Dinoprostone induction failure was defined as no cervical dilation >3 cm at the removal of the insert.
  
  
  RESULTS
  One-hundred-nineteen patients were enrolled. The onset of labour was obtained in 102 (85.7%) patients, 98 (82.3%) with the insert only, and in 4 (3.3%) after the sequential administration of prostaglandins and oxitocin. The mean interval between insert application and delivery was 16.85±11.48 hours. Vaginal delivery was reported in 87 (73.1%) women, whereas Cesarean was necessary in 32 (26.9%) patients [29 nulliparous]. Cesarean section was also required in 15/98 (15.3%) women who responded to prostaglandins and in 17/21 (80.9) non-responders. Protocol violations occurred in 11 (9.2%) patients. Uterine hyperstimulation occurred in 4 (3.3%) patients.
  
  
  CONCLUSIONS
  Induction of delivery with slow-release dinoprostone seems a feasible option, characterized by high efficacy, good adherence to protocol, low incidence of adverse events and easy management. In our opinion the high compliance of the gynecologists and midwifes is based on the insert handiness.
authors.affiliation: Unità Operativa Complessa di Ginecologia e Ostetricia, Ospedale Santa Maria GorettiLatina, Italia. francesco.maneschi@tin.it
authors.forename: F
authors.initials: F
authors.lastname: Maneschi
authors.forename: M
authors.initials: M
authors.lastname: Sarno
authors.forename: A
authors.initials: A
authors.lastname: Mosillo
authors.forename: M
authors.initials: M
authors.lastname: Parisella
authors.forename: F
authors.initials: F
authors.lastname: Gagliardi
authors.forename: M
authors.initials: M
authors.lastname: Algieri
authors.forename: S
authors.initials: S
authors.lastname: Perrone
mesh_terms: D000328:Adult; D002985:Clinical Protocols; D003692:Delayed-Action Preparations / Q000627:therapeutic use; D015232:Dinoprostone / Q000627:therapeutic use*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007751:Labor, Induced / Q000379:methods*; D010120:Oxytocics / Q000627:therapeutic use*; D011247:Pregnancy
chemical_list: D003692:Delayed-Action Preparations; D010120:Oxytocics; D015232:Dinoprostone