Labor is induced in up to 20 percen...

Labor is induced in up to 20 percent of pregnancies, and cervical ripening is required in about undivided half of inductions. Several a whole s have been developed to apply the prostaglandin dinoprostone to the cervix for ripening, on the other hand little is known about the comparative effectiveness of the different [i]modus operandi[/i]s Perry and Leaphart compared intracervical placement of sustained-release dinoprostone with posterior fornix placement.

They studied 63 mothers admitted to a university medical center for induction of labor. Participants were required to have a singleton, cephalic fetus of at least 36 weeks of gestation and a Bishop score of les than 6 Patients with more than 2-cm cervical dilation, latter use of cervical ripening agents, a history of cesarean delivery or hysterotomy, or any contraindication to vaginal delivery were exclud from the investigation The mothers were assigned randomly to intracervical or posterior fornix placement of dinoprostone. Patients and staff were blinded to the location of the ripening agent, apart from the physician who performed the practice The insert was retained for 12 hours, and continuous fetal monitoring and tocodynamometry were used. Cervical change was assessed after 12 hours and if the dinoprostone was remov for any reason.

The sum of two units groups of patients were comparable in all important variables. Overall, placement in the cervix was associated with a lower median time to delivery (224 hours compared with 251 hours for placement in the posterior fornix), nevertheless the difference was not statistically significant. Nine mothers in the intracervical clump and eight mothers in the posterior fornix assign places to required multiple inserts of dinoprostone. When data forward the 46 mothers who required merely one dose of dinoprostone were analyzed, intracervical placement was associated with significantly shorter times to delivery and to initial entreaty for pain medication (see accompanying table). The time to charge of labor or regular contractions was not significantly different, however 42 percent of the intracervical clump did not require oxytocin compared with barely 27 percent of the posterior fornix cluster The groups were comparable in all other measures of obstetric and neonatal outcome

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The authors finish that intracervical (rather than posterior fornix) placement of dinoprostone decreases time to delivery without increasing complications of labor in mothers who correspond to a single dose of the sustained-release preparation.

Perry MY, Leaphart WL Randomized trial of intracervical versus posterior fornix dinoprostone for induction of labor. Obstet Gynecol January 2004;103:13-7

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