Preinduction cervical ripening by controlled-release vaginal dinoprostone for insufficient cervical ripening at our hospital

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  • SHIGETA Naoya
    Department of Obstetrics and Gynecology, JCHO(Japan community health care organization)Osaka HospitalJCHO(Japan community health care organization)Osaka Hospital
  • MATSUMURA Yuki
    Department of Obstetrics and Gynecology, JCHO(Japan community health care organization)Osaka HospitalJCHO(Japan community health care organization)Osaka Hospital
  • TANAKA Mie
    Department of Obstetrics and Gynecology, JCHO(Japan community health care organization)Osaka HospitalJCHO(Japan community health care organization)Osaka Hospital
  • TANIGUCHI Mariko
    Department of Obstetrics and Gynecology, JCHO(Japan community health care organization)Osaka HospitalJCHO(Japan community health care organization)Osaka Hospital
  • NAKAO Etsuko
    Department of Obstetrics and Gynecology, JCHO(Japan community health care organization)Osaka HospitalJCHO(Japan community health care organization)Osaka Hospital
  • KIYOHARA Yumiko
    Department of Obstetrics and Gynecology, JCHO(Japan community health care organization)Osaka HospitalJCHO(Japan community health care organization)Osaka Hospital
  • OYAGI Chifumi
    Department of Obstetrics and Gynecology, JCHO(Japan community health care organization)Osaka HospitalJCHO(Japan community health care organization)Osaka Hospital
  • TSUTSUI Tateki
    Department of Obstetrics and Gynecology, JCHO(Japan community health care organization)Osaka HospitalJCHO(Japan community health care organization)Osaka Hospital

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  • 当院における子宮頸管熟化不全に対するジノプロストン腟用剤の使用経験
  • トウ イン ニ オケル シキュウ ケイカン ジュクカ フゼン ニ タイスル ジノプロストンチツヨウザイ ノ シヨウ ケイケン

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Abstract

The dinoprostone vaginal insert is a cervical ripening treatment for the prevention of post-term birth and the induction of labor due to maternal complications. The dinoprostone vaginal insert (synthetic prostaglandin E2 analogue), which is a pharmacological technique, became available in Japan from April 2020. We report the results of using the dinoprostone vaginal insert in 73patients (dinoprostone group) in our hospital from April 2020 to December 2021. We propose the standard of selective use of dinoprostone vaginal insert. The rate of successful cervical ripening (vaginal delivery within 12 hours or a Bishop score > seven points) was 39.7%. Forty-six (76.7%) primiparous patients and 100% parous patients achieved vaginal delivery. We compared the results of cervical ripening by mechanical methods in 103 patients in our hospitalfrom April 2019 to march 2020 (conventional group) with dinoprostone group. The rate of vaginal delivery of primiparous patients without ruptured membranes of dinoprostone group was higher than conventional group although the rate was not statistically significant (dinoprostone group vs conventional group; 74.5% : 65.7%, p=0.46). The rate of vaginal delivery was 100% in parous patients in both groups. Time from induction to delivery was significantly shorter in conventional group than dinoprostone group (p<0.05). The onset of labor by dinoprostone vaginal insert was extracted as significant factor of achieved vaginal delivery with using dinoprostone vaginal insert by comparing the results of vaginal cases between cesarean cases. In the most successful cervical ripening cases, the duration of using dinoprostone vaginal insert was under eight hours These results suggested that selective application of dinoprostone vaginal insert for primiparous patents without ruptured membranes for successful induction of labor and we propose the using dinopstone vaginal insert at least eight hours for parous patients in the admission day of induction of labor for cervical ripening. [Adv Obstet Gynecol, 75(3) : 203-211, 2023 (R5.8)]

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