title: Pre-induction cervical ripening: comparing between two vaginal preparations of dinoprostone in women with an unfavorable cervix.
abstract: OBJECTIVE
  Prostaglandin E2 (PGE2-Dinoprostone) is accepted for both ripening of the cervix and induction of labor. As conflicting data exist concerning the efficiency and safety of different treatment modalities, we aimed to compare slow-release vaginal insert PGE2 with serial vaginal tablets of PGE2 for cervical ripening and induction of labor.
  
  
  METHODS
  A retrospective cohort study comparing all pregnancies who underwent induction of labor by either a single slow-release vaginal insert of 10 mg PGE2 (study group) to a historical control group of women who were treated with serial administration of 3 mg vaginal PGE2 tablets in a 2:1 ratio, matched by parity.
  
  
  RESULTS
  Overall, 639 women were enrolled (213 treated with PGE2 tablets and 426 with slow-release vaginal inserts). Vaginal insert was associated with shorter initiation-to-ripening interval (12.4 ± 7.7 versus 18.6 ± 15.2 h, p < 0.001) and a higher rate of delivery within 24 h (61.5 versus 51.6%, p = 0.018). Vaginal insert was associated with an increased rate of tachysystole (8.0 versus 3.1%, p < 0.01); however, the rates of cesarean section or operative delivery due to non-reassuring fetal heart rate (NRFHR) were similar. On multivariable analysis, slow-release vaginal insert was independently associated with a higher rate of delivery within 24 h (OR 1.50, 95% CI 1.04-2.18).
  
  
  CONCLUSIONS
  Slow-release PGE2 vaginal insert achieves cervical ripening and subsequently delivery over a shorter time period than PGE2 tablets, without increasing uterine hyperstimulation rate.
authors.affiliation: Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center , Petah Tiqwa , Israel and.
authors.forename: Eran
authors.initials: E
authors.lastname: Ashwal
authors.forename: Liran
authors.initials: L
authors.lastname: Hiersch
authors.forename: Nir
authors.initials: N
authors.lastname: Melamed
authors.forename: Yaara
authors.initials: Y
authors.lastname: Manor
authors.forename: Arnon
authors.initials: A
authors.lastname: Wiznitzer
authors.forename: Moshe
authors.initials: M
authors.lastname: Hod
authors.forename: Yariv
authors.initials: Y
authors.lastname: Yogev
mesh_terms: D000282:Administration, Intravaginal; D000328:Adult; D016022:Case-Control Studies; D020070:Cervical Ripening / Q000187:drug effects; D002584:Cervix Uteri / Q000187:drug effects*; D015232:Dinoprostone / Q000008:administration & dosage*; D004343:Drug Implants; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007751:Labor, Induced / Q000379:methods*; D010120:Oxytocics / Q000008:administration & dosage*; D011247:Pregnancy; D014622:Vaginal Creams, Foams, and Jellies
chemical_list: D004343:Drug Implants; D010120:Oxytocics; D014622:Vaginal Creams, Foams, and Jellies; D015232:Dinoprostone
keywords: Cervical ripening; dinoprostone; induction of labor; vaginal insert