Induction of labour with dinoprostone in patients with unfavorable Bishop score: Vaginal gel compared to controlled release vaginal pessary

Objective: to compare costs, efficacy and safety of intravaginal PGE2gel application to intravaginal PGE2pessary in the induction of labour in patients with unfavourable Bishop score. Methods: 40 patients induced by intravaginal pessary (case population) were compared to 80 patients induced by intravaginal gel (control population), matched for parity and clinical condition at time of induction. Criteria for inclusion in the study were: singleton pregnancy, fetal-cephalic presentation, Bishop score ≤ 4, gestational age ≥ 37 weeks, no previous caesarean section. Results: the case and the control groups were similar in patient characteristics and indication for induction. Application-delivery interval was shorter in control group (1416 vs. 765 minutes). Incidence of caesarean section was not statistically different (40% vs. 27,5%). Number of patients with blood loss ≥ 500 cc was similar in the two groups as was the number of babies with Apgar score at 5 min ≤ 7, with pH ≤ 7,20 and with BE < -12. No maternal and fetal complications were found in both groups. Induction by intravaginal gel was less expensive than by controlled release vaginal pessary. Conclusions: both PGE2gel and pessary are safe and effective in achieving cervical ripening and induction of labour. Induction with PGE2gel was less expensive. We suggest a randomized prospective study in which the intravaginal pessary is applied two times, for a total of 24 hours. © Copyright 2007, CIC Edizioni Internazionali, Roma.