Comparison of Dinoprostone Controlled Release Vaginal Pessary with Dinoprostone Intracervical Gel for Preinduction Cervical Ripening and Induction of Labor at Term

Abstract

Context: There is limited experience of use of dinoprostone controlled release vaginal pessary in Indian scenario. Hence, we aim to find its efficacy for induction of labor (IOL). Aims: To compare two formulations of dinoprostone: intracervical gel and controlled release vaginal pessary for IOL. Settings and Design: Randomized controlled study in a tertiary care center. Methods: A double-blinded randomized controlled study was done on 106 women with singleton pregnancy, 37 to 41 weeks with vertex presentation, no obvious fetal compromise, and planned for IOL. They were randomly divided into equal groups to receive either dinoprostone intracervical gel (Group A) or dinoprostone controlled release vaginal pessary (Group B). The main outcome measures: change in Bishop score (using simplified Bishop score) at 0 to 6 hours and 6 to 12 hours after application and success to initiate active labor. The secondary outcome measures: maternal adverse effect, induction to delivery time, requirement of oxytocin infusion, cesarean section rate, APGAR score, and neonatal intensive care unit admission. Statistical Analysis: Statistical Package for Social Sciences (SPSS) version 17.0. Results: Increase in Bishop score and women achieving active labor were more in Group B (90.6% vs. 41.5%; P < 0.01). Mean time from induction to delivery was higher in Group A (19.72 hours vs. 12.53 hours; P < 0.01). Requirement of oxytocin was lesser in Group B (35.8% vs. 75.5%; P < 0.001). No adverse maternal or fetal outcome was noted in either of the groups. Conclusions: Dinoprostone controlled release vaginal pessary has significantly better outcomes than intracervical gel for IOL.