Abstract
Objective
To compare dinoprostone gel and insert in achieving successful vaginal delivery in
nulliparous and multiparous women.
Study design
220 nulliparous and 100 multiparous with a Bishop score ≤7 were randomized to receive
dinoprostone either gel or insert for cervical ripening. The main outcome measures
were the rate and latency of vaginal delivery.
Results
In nulliparous women no significant differences were found between the gel and insert
groups in the rate of vaginal delivery (85.6% vs. 80.7%) delivery ≤12 (36.8% vs. 32.9%)
and ≤24 h (85.3% vs. 93.4%) regardless of the preinduction Bishop score. Nulliparous with
Bishop score ≤4 treated with the insert had a decreased risk (p < 0.05) of post partum hemorrhage (4.8%) when compared with nulliparous treated with
gel (16.7%). On the contrary, in multiparous the time to delivery interval was significantly
shorter in the gel treated group (9.9 ± 4.9 h vs. 13.1 ± 5 h; p < 0.001) with more patients delivering vaginally ≤12 h (75% vs. 37.5%, p < 0.001), regardless of the preinduction Bishop score.
Conclusion
Both dinoprostone gel and insert are efficient in achieving cervical ripening and
successful labor in nulliparous and multiparous. In multiparous, however, the gel
significantly reduces the time to vaginal delivery with more patients delivering vaginally
≤12 h, regardless of the Bishop score.
Keywords
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Article info
Publication history
Published online: September 03, 2007
Accepted:
August 8,
2007
Received in revised form:
August 6,
2007
Received:
July 16,
2006
Footnotes
☆Preliminary account of this work was presented at the 2003 Annual Meeting of the Society for Gynecologic Investigation, Washington, DC.
Identification
Copyright
© 2007 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
