title: [Cervical ripening at term with repeated administration of dinoprostone vaginal pessary].
abstract: OBJECTIVE
  To evaluate efficacy and safety of cervical ripening with repeated administration of dinoprostone slow release vaginal pessary (Propess®) in current practice.
  
  
  METHODS
  An observational study of 111 women who underwent cervical ripening with two Propess® during the study period from 1st July 2007 to 31st October 2011. Modes of delivery, success of cervical ripening, failure of labor induction, maternal and neonatal morbidity were reported.
  
  
  RESULTS
  The nulliparous rate was 75,7%. The main indications for induction of labor were post-term pregnancy in 34,3% (38/111) and premature rupture of membranes in 25,2% (28/111). The rate of vaginal delivery was 53,1% (59/111). Cesarean sections were performed for failure of labor induction in 27/52 (51,9%) and an abnormal fetal heart rate in 17/52 (32.7%). Indication for induction of labor, nulliparous patients (44 [84.6%] versus 40 [67.8%]; P=0.04), initial Bishop score (2.2±1.2 versus 2.9±1.2; P=0.04) before the cervical ripening and Bishop score before administration of second Propess® (3.3±1.4 versus 4.0±1.2; P=0.05) were significant risk factors of cesarean delivery.
  
  
  CONCLUSIONS
  In more than half of the cases, the cervical ripening by two Propess® is efficient and allows a vaginal delivery. This practice does not appear to increase the maternal or neonatal morbidity.
authors.affiliation: Service de gynécologie obstétrique, hôpital La Conception, 147 boulevard Baille, Marseille, France.
authors.forename: M
authors.initials: M
authors.lastname: Petrovic Barbitch
authors.forename: A
authors.initials: A
authors.lastname: Gnisci
authors.forename: M
authors.initials: M
authors.lastname: Marcelli
authors.forename: M
authors.initials: M
authors.lastname: Capelle
authors.forename: B
authors.initials: B
authors.lastname: Guidicelli
authors.forename: L
authors.initials: L
authors.lastname: Cravello
authors.forename: M
authors.initials: M
authors.lastname: Gamerre
authors.forename: A
authors.initials: A
authors.lastname: Agostini
mesh_terms: D000282:Administration, Intravaginal; D000328:Adult; D020070:Cervical Ripening / Q000187:drug effects*; D002585:Cesarean Section; D036861:Delivery, Obstetric; D015232:Dinoprostone / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006340:Heart Rate, Fetal; D006801:Humans; D007231:Infant, Newborn; D007751:Labor, Induced; D010120:Oxytocics / Q000008:administration & dosage*; D010298:Parity; D010570:Pessaries; D011247:Pregnancy; D011256:Pregnancy Outcome; D016896:Treatment Outcome
chemical_list: D010120:Oxytocics; D015232:Dinoprostone