Use of dinoprostone vaginal insert followed by mechanical dilation for poor cervical maturation shorten the time length for uterotonics administration

Objective

The clinical efficacy of the combined usage of a dinoprostone vaginal insert (DVI) with mechanical cervical dilatation for the labor induction with poor cervical maturation has not been established. A retrospective observational study was conducted aiming to evaluate the efficacy of this approach on labor induction.

Materials and methods

The clinical features of 71 pregnant women with Bishop score of 0–2 treated with DVI were analyzed to identify the clinical factors associated with the necessity for additional mechanical dilation after DVI use and whether DVI was removed due to labor progression. Further analysis was focused on the subgroup of 43 women who went through labor induction with DVI due to post-date pregnancy. The delivery outcome of DVI group was compared with the historical control group of 71 women who underwent mechanical dilatation without DVI due to post-date pregnancy.

Results

Among the 71 women treated with DVI, 38 did not require additional mechanical dilation and 24 had DVI removed after labor progressed. Lower pre-pregnancy body mass index was significantly associated with DVI efficacy. Whereas the success rate for vaginal delivery was comparable between Control group and DVI group, the time duration of uterotonics administration was shorter in DVI group than that in the Control group (13.9 h vs 29.2 h, p = 0.01).

Conclusion

Low BMI was a factor that facilitates the effectiveness of DVI. A cervical maturation approach using DVI in combination with a mechanical dilator reduced the time of uterotonics administration among populations with extremely poor cervical maturation.