title: Can we predict successful cervical ripening with prostaglandin E2 vaginal inserts?
abstract: OBJECTIVE
  Previous studies have suggested that a variety of maternal and obstetrical characteristics may predict successful prostaglandin E2 (PGE2) cervical ripening. However, in most studies women were administered vaginal tablets or gel so scarce is known regarding potential predictors in women administrated slow-release vaginal inserts. We aimed to characterize the response of cervical ripening for labor induction using slow-release PGE2 vaginal insert and to identify predictors for success.
  
  
  METHODS
  A retrospective cohort study in a single center (2013-2015). The association between maternal characteristics at admission and cervical ripening success/failure were explored. Cervical ripening failure was defined as a Bishop's score <7 following 24 h from cervical ripening or the need for cesarean delivery (CS) due to arrest of dilatation at cervical dilatation ≤5 cm. Cases with major fetal anomalies, multiple gestations, non-vertex presentation or any contraindication for vaginal delivery were excluded.
  
  
  RESULTS
  Of 15,564 deliveries during the study period, 986 (6.3%) women met inclusion criteria, of them, 774 (78.56%) succeeded and 212 (21.5%) failed cervical ripening. Cervical ripening success was associated with (OR, 95% CI): nulliparity (0.42, 0.22-0.81, p = 0.009, i.e., nulliparity was negatively associated with successful ripening), gestational age (GA) at delivery (1.29, 1.02-1.61, p < 0.03), and cervical dilation at admission (4.58, 2.57-8.17, p < 0.001). The indications for labor induction were not associated with cervical ripening success. A prediction model which included the abovementioned characteristics had an AUC of 0.792 (95% CI 0.743-0.840).
  
  
  CONCLUSIONS
  Overall, basic parameters, such as parity, cervical dilatation at admission and gestational age can predict successful cervical ripening PGE2 vaginal inserts.
authors.affiliation: Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. lirhir@gmail.com.
authors.forename: Liran
authors.initials: L
authors.lastname: Hiersch
authors.affiliation: Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Adi
authors.initials: A
authors.lastname: Borovich
authors.affiliation: Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Rinat
authors.initials: R
authors.lastname: Gabbay-Benziv
authors.affiliation: Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Moria
authors.initials: M
authors.lastname: Maimon-Cohen
authors.affiliation: Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Amir
authors.initials: A
authors.lastname: Aviram
authors.affiliation: Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Yariv
authors.initials: Y
authors.lastname: Yogev
authors.affiliation: Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Eran
authors.initials: E
authors.lastname: Ashwal
mesh_terms: D000282:Administration, Intravaginal; D000328:Adult; D020070:Cervical Ripening / Q000502:physiology*; D015331:Cohort Studies; D015232:Dinoprostone / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D010120:Oxytocics / Q000008:administration & dosage*; D011247:Pregnancy; D012189:Retrospective Studies
chemical_list: D010120:Oxytocics; D015232:Dinoprostone
keywords: Cervical ripening; Induction of labor; Predictors; Prostaglandin E2; Vaginal insert