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A randomized controlled trial of 24‐hour vaginal dinoprostone pessary compared to gel for induction of labor in term pregnancies with a Bishop score ≤ 4

2010; Informa; Volume: 89; Issue: 5 Linguagem: Inglês

10.3109/00016340903575998

1600-0412

Maria Triglia, F. Palamara, Andrea Lojacono, Federico Prefumo, T. Frusca,

Preterm Birth and Chorioamnionitis

Abstract Objective. To compare 24‐hour controlled‐release vaginal dinoprostone pessary vs. gel for induction of labor at term in women with an unfavorable cervix. Design. Randomized controlled trial. Setting. University hospital. Population. A total of 133 women with singleton pregnancies, fetal cephalic presentation, Bishop score ≤ 4, gestational age of 37–42 weeks, no previous cesarean section and intact membranes admitted for induction of labor. Methods. Random allocation to either 24‐hour 10‐mg controlled‐release vaginal dinoprostone pessary or repeat doses of 2 mg vaginal dinoprostone gel. Main outcome measures. Rate of spontaneous vaginal, operative vaginal and cesarean delivery. Results. The rate of spontaneous vaginal delivery was significantly higher in the pessary group (72%) than in the gel group (54%), paralleled by a lower rate of operative vaginal deliveries (3 vs. 15%). The difference in cesarean section rate (25 vs. 31%) did not reach statistical significance. Both methods of induction of labor appeared to be safe, with no cases of 5‐minute Apgar scores < 7 or episodes of uterine hyperstimulation in either group. The medication cost was lower in the pessary group, with a median saving of 50.20€ compared to the gel group. Conclusions. Both the 24‐hour dinoprostone vaginal pessary and the vaginal gel appear to be safe for labor induction. In women induced at term with a Bishop score ≤ 4 the pessary achieved a significantly higher rate of spontaneous vaginal delivery.