Research Article| Volume 138, ISSUE 2, P135-140, June 2008

Comparing two dinoprostone agents for cervical ripening and induction of labor: A randomized trial

Published:September 03, 2007DOI:



      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.


      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.


      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.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      1. Kelly AJ, Kavanagh J, Thomas J. Vaginal prostaglandin (PGE2 and PGF2a) for induction of labour at term. Cochrane Database Syst Rev 2003 (4). Art. No.: CD003101. doi:10.1002/14651858.CD003101.

        • Chyu J.K.
        • Strassner H.T.
        Prostaglandin E2 for cervical ripening: a randomized comparison of Cervidil versus Prepidil.
        Am J Obstet Gynecol. 1997; 177: 606-611
        • Ottinger W.S.
        • Menard M.K.
        • Brost B.C.
        A randomized clinical trial of prostaglandin E2 intracervical gel and a slow release vaginal pessary for preinduction cervical ripening.
        Am J Obstet Gynecol. 1998; 179: 349-353
        • Wieland D.
        • Friedman Jr., F.
        Comparing two dinoprostone agents for preinduction cervical ripening at term.
        J Reprod Med. 1999; 44: 724-728
        • Vollebregt A.
        • van’t Hof D.B.
        • Exalto N.
        Prepidil compared to Propess for cervical ripening.
        Eur J Obstet Gynecol Reprod Biol. 2002; 104: 116-119
        • Miller A.M.
        • Rayburn W.F.
        • Smith C.V.
        Patterns of uterine activity after intravaginal prostaglandin E2 during preinduction cervical ripening.
        Am J Obstet Gynecol. 1991; 165: 1006-1009
        • Green C.
        • Pedder G.
        • Mason G.
        A randomized trial of Propess against prostin gel for the induction of labour at term.
        Br J Obstet Gynaecol. 1998; 105: 82
        • Rabl M.
        • Joura E.A.
        • Yűcel Y.
        • Egarter C.
        A randomized trial of vaginal prostaglandin E2 for induction of labor. Insert vs tablet.
        J Reprod Med. 2002; 47: 115-119
        • Mukhopadhyay M.
        • Lim K.J.H.
        • Fairlie F.M.
        Is propess a better method of induction of labour in nulliparous women?.
        J Obstet Gynaecol. 2002; 22: 294-295
        • D’Aniello G.
        • Bocchi C.
        • Florio P.
        • et al.
        Cervical ripening and induction of labor by prostaglandin E2: comparison between intracervical gel and vaginal pessary.
        J Matern Fetal Neonatal Med. 2003; 14: 158-162
        • Facchinetti F.
        • Venturini P.
        • Verocchi G.
        • Volpe A.
        Comparison of two preparations of dinoprostone for pre-induction of labour in nulliparous women with very unfavourable cervical condition: a randomized clinical trial.
        Eur J Obstet Gynecol Reprod Biol. 2005; 119: 189-193
        • Strobelt N.
        • Meregalli V.
        • Ratti M.
        • Mariani S.
        • Zani G.
        • Morana S.
        Randomized study on removable PGE2 vaginal insert versus PGE2 cervical gel for cervical priming and labor induction in low-Bishop-score pregnancy.
        Acta Obstet Gynecol Scand. 2006; 85: 302-305
      2. ACOG technical bulletin: induction of labor. Int J Gynaecol Obstet 1996; 53:65–72.

        • Freeman R.K.
        Problems with intrapartum fetal heart rate monitoring interpretation and patient management.
        Obstet Gynecol. 2002; 100: 813-826
        • Zanini A.
        • Ghidini A.
        • Norchi S.
        • Beretta E.
        • Cortinovis I.
        • Bottino S.
        Pre-induction cervical ripening with prostaglandin E2 gel: intracervical versus intravaginal route.
        Obstet Gynecol. 1990; 76: 681-683
        • Arias F.
        Pharmacology of oxytocin and prostaglandins.
        Clin Obstet Gynecol. 2000; 43: 455-468
        • Stewart J.D.
        • Rayburn W.F.
        • Farmer K.C.
        • Liles E.M.
        • Schipul A.H.
        • Stanley J.R.
        Effectiveness of prostaglandin E2 intracervical gel (Prepidil), with immediate oxytocin, versus vaginal insert (Cervidil) for induction of labor.
        Am J Obstet Gynecol. 1998; 179: 1175-1180
        • Hennessey M.H.
        • Rayburn W.F.
        • Stewart J.D.
        • Liles E.C.
        Pre-eclampsia and induction of labor: a randomized comparison of prostaglandin E2 as an intracervical gel, with oxytocin immediately, or a sustained-release vaginal insert.
        Am J Obstet Gynecol. 1998; 179: 1204-1209
        • Bolnick J.M.
        • Velazquez M.D.
        • Gonzalez J.L.
        • Rappaport V.J.
        • McIlwain-Dunivan G.
        • Rayburn W.F.
        Randomized trial between two active labor management protocols in the presence of an unfavorable cervix.
        Am J Obstet Gynecol. 2004; 190: 124-128
        • Papanikolaou E.G.
        • Plachouras N.
        • Drougia A.
        • et al.
        Comparison of misoprostol and dinoprostone for elective induction of labour in nulliparous women at full term: a randomized prospective study.
        Reprod Biol Endocrinol. 2004; 2: 70-77
        • Ramsey P.S.
        • Meyer L.
        • Walkes B.A.
        • et al.
        Cardiotocographic abnormalities associated with dinoprostone and misoprostol cervical ripening.
        Obstet Gynecol. 2005; 105: 85-90
        • Megalo A.
        • Petignat P.
        • Hohlfeld P.
        Influence of misoprostol or prostaglandin E(2) for induction of labor on the incidence of pathological CTG tracing: a randomized trial.
        Eur J Obstet Gynecol Reprod Biol. 2004; 116: 34-38
        • Sanchez-Ramos L.
        • Kaunitz A.M.
        Misoprostol for cervical ripening and labor induction: a systematic review of the literature.
        Clin Obstet Gynecol. 2000; 43: 475-488