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Can we predict successful cervical ripening with prostaglandin E2 vaginal inserts?

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

Previous studies have suggested that a variety of maternal and obstetrical characteristics may predict successful prostaglandin E2 (PGE2) cervical ripening. However, in most studies women were administered vaginal tablets or gel so scarce is known regarding potential predictors in women administrated slow-release vaginal inserts. We aimed to characterize the response of cervical ripening for labor induction using slow-release PGE2 vaginal insert and to identify predictors for success.

Methods

A retrospective cohort study in a single center (2013–2015). The association between maternal characteristics at admission and cervical ripening success/failure were explored. Cervical ripening failure was defined as a Bishop’s score <7 following 24 h from cervical ripening or the need for cesarean delivery (CS) due to arrest of dilatation at cervical dilatation ≤5 cm. Cases with major fetal anomalies, multiple gestations, non-vertex presentation or any contraindication for vaginal delivery were excluded.

Results

Of 15,564 deliveries during the study period, 986 (6.3%) women met inclusion criteria, of them, 774 (78.56%) succeeded and 212 (21.5%) failed cervical ripening. Cervical ripening success was associated with (OR, 95% CI): nulliparity (0.42, 0.22–0.81, p = 0.009, i.e., nulliparity was negatively associated with successful ripening), gestational age (GA) at delivery (1.29, 1.02–1.61, p < 0.03), and cervical dilation at admission (4.58, 2.57–8.17, p < 0.001). The indications for labor induction were not associated with cervical ripening success. A prediction model which included the abovementioned characteristics had an AUC of 0.792 (95% CI 0.743–0.840).

Conclusions

Overall, basic parameters, such as parity, cervical dilatation at admission and gestational age can predict successful cervical ripening PGE2 vaginal inserts.

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References

  1. The American College of Obstetricians and Gynecologists (2009) ACOG practice bulletin: induction of labor. Obstet Gynecol Surv 114:386–397. doi:10.1097/AOG.0b013e3181b48ef5

    Article  Google Scholar 

  2. Caughey AB, Sundaram V, Kaimal AJ et al (2009) Maternal and neonatal outcomes of elective induction of labor. Evid Rep Technol Assess (Full Rep) 176:1–257

    Google Scholar 

  3. Prysak M, Castronova FC (1998) Elective induction versus spontaneous labor: a case-control analysis of safety and efficacy. Obstet Gynecol 92:47–52

    Article  CAS  PubMed  Google Scholar 

  4. Alfirevic Z, Keeney E, Dowswell T et al (2016) Methods to induce labour: a systematic review, network meta-analysis and cost-effectiveness analysis. BJOG. doi:10.1111/1471-0528.13981

    Google Scholar 

  5. Mozurkewich EL, Chilimigras JL, Berman DR et al (2011) Methods of induction of labour: a systematic review. BMC Pregnancy Childbirth 11:84. doi:10.1186/1471-2393-11-84

    Article  PubMed  PubMed Central  Google Scholar 

  6. Kalkat RK, McMillan E, Cooper H, Palmer K (2008) Comparison of Dinoprostone slow-release pessary (Propess) with gel (Prostin) for induction of labour at term-a randomised trial. J Obstet Gynaecol 28:695–699. doi:10.1080/01443610802462522

    Article  CAS  PubMed  Google Scholar 

  7. Ashwal E, Hiersch L, Melamed N et al (2014) Pre-induction cervical ripening: comparing between two vaginal preparations of dinoprostone in women with an unfavorable cervix. J Matern Fetal Neonatal Med 7058:1–6. doi:10.3109/14767058.2014.883375

    Google Scholar 

  8. Hou L, Zhu Y, Ma X et al (2012) Clinical parameters for prediction of successful labor induction after application of intravaginal dinoprostone in nulliparous Chinese women. Med Sci Monit 18:CR518–CR522

    CAS  PubMed  PubMed Central  Google Scholar 

  9. Pevzner L, Rayburn WF, Rumney P, Wing DA (2009) Factors predicting successful labor induction with dinoprostone and misoprostol vaginal inserts. Obstet Gynecol 114:261–267. doi:10.1097/AOG.0b013e3181ad9377

    Article  CAS  PubMed  Google Scholar 

  10. Melamed N, Yariv O, Hiersch L et al (2012) Labor induction with prostaglandin E2: characteristics of response and prediction of failure. J Matern Neonatal Med 26:1–5. doi:10.3109/14767058.2012.722729

    Google Scholar 

  11. Jozwiak M, Oude Rengerink K, Ten Eikelder MLG et al (2013) Foley catheter or prostaglandin E2 inserts for induction of labour at term: an open-label randomized controlled trial (PROBAAT-P trial) and systematic review of literature. Eur J Obstet Gynecol Reprod Biol 170:137–145. doi:10.1016/j.ejogrb.2013.06.017

    Article  CAS  PubMed  Google Scholar 

  12. Ducarme G, Chesnoy V, Petit L (2015) Factors predicting unsuccessful labor induction with dinoprostone in post-term pregnancy with unfavorable cervix. J gynécologie, Obs Biol la Reprod 44:28–33. doi:10.1016/j.jgyn.2013.10.007

    Article  CAS  Google Scholar 

  13. Rouzi AA, Alsibiani S, Mansouri N et al (2014) Randomized clinical trial between hourly titrated oral misoprostol and vaginal dinoprostone for induction of labor. Am J Obstet Gynecol 210(56):56.e1–56.e6. doi:10.1016/j.ajog.2013.08.033

    Article  CAS  Google Scholar 

  14. Melamed N, Ben-Haroush A, Kremer S et al (2010) Failure of cervical ripening with prostaglandin-E2 can it be predicted? J Matern Fetal Neonatal Med 23:536–540. doi:10.3109/14767050903197076

    Article  CAS  PubMed  Google Scholar 

  15. Dollberg S, Haklai Z, Mimouni FB et al (2005) Birth weight standards in the live-born population in Israel. Isr Med Assoc J 7:311–314

    PubMed  Google Scholar 

  16. Macones GA, Hankins GDV, Spong CY et al (2008) The 2008 National Institute of Child Health and Human Development workshop report on electronic fetal monitoring: update on definitions, interpretation, and research guidelines. J Obstet Gynecol Neonatal Nurs 37:510–515. doi:10.1111/j.1552-6909.2008.00284.x

    Article  PubMed  Google Scholar 

  17. Hanley JA, McNeil BJ (1983) A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology 148:839–843. doi:10.1148/radiology.148.3.6878708

    Article  CAS  PubMed  Google Scholar 

  18. Baños N, Migliorelli F, Posadas E et al (2015) Definition of failed induction of labor and its predictive factors: two unsolved issues of an everyday clinical situation. Fetal Diagn Ther 38:161–169. doi:10.1159/000433429

    Article  PubMed  Google Scholar 

  19. Jozwiak M, Oude Rengerink K, Benthem M et al (2011) Foley catheter versus vaginal prostaglandin E2 gel for induction of labour at term (PROBAAT trial): an open-label, randomised controlled trial. Lancet (London, England) 378:2095–2103. doi:10.1016/S0140-6736(11)61484-0

    Article  Google Scholar 

  20. Cromi A, Ghezzi F, Uccella S et al (2012) A randomized trial of preinduction cervical ripening: dinoprostone vaginal insert versus double-balloon catheter. Am J Obstet Gynecol 207(125):e1–e7. doi:10.1016/j.ajog.2012.05.020

    Google Scholar 

  21. Hernández-Martínez A, Pascual-Pedreño AI, Baño-Garnés AB et al (2016) Predictive model for risk of cesarean section in pregnant women after induction of labor. Arch Gynecol Obstet 293:529–538

    Article  PubMed  Google Scholar 

  22. Gabbay-Benziv R, Hadar E, Ashwal E et al (2016) Induction of labor: does indication matter? Arch Gynecol Obstet 294:1195–1201

    Article  PubMed  Google Scholar 

  23. Du C, Liu Y, Liu Y et al (2015) Double-balloon catheter vs. dinoprostone vaginal insert for induction of labor with an unfavorable cervix. Arch Gynecol Obstet 291:1221–1227

    Article  PubMed  Google Scholar 

  24. Verhoeven CJM, Oudenaarden A, Hermus MAA et al (2009) Validation of models that predict Cesarean section after induction of labor. Ultrasound Obstet Gynecol 34:316–321. doi:10.1002/uog.7315

    Article  CAS  PubMed  Google Scholar 

  25. Rane SM, Guirgis RR, Higgins B, Nicolaides KH (2005) Models for the prediction of successful induction of labor based on pre-induction sonographic measurement of cervical length. J Matern Fetal Neonatal Med 17:315–322. doi:10.1080/14767050500127690

    Article  CAS  PubMed  Google Scholar 

  26. Peregrine E, O’Brien P, Omar R, Jauniaux E (2006) Clinical and ultrasound parameters to predict the risk of cesarean delivery after induction of labor. Obstet Gynecol 107:227–233. doi:10.1097/01.AOG.0000196508.11431.c0

    Article  PubMed  Google Scholar 

  27. Beckwith L, Magner K, Kritzer S, Warshak CR (2016) Prostaglandin versus mechanical dilation and the effect of maternal obesity on failure to achieve active labor: a cohort study. J Matern Fetal Neonatal Med. doi:10.1080/14767058.2016.1220523

    PubMed  Google Scholar 

  28. Bortolus R (1999) Determinants of response to intracervical prostaglandin E2 for cervical ripening. Gruppo di Studio sull’Induzione del Travaglio di Parto. Eur J Obstet Gynecol Reprod Biol 87:137–141

    Article  CAS  PubMed  Google Scholar 

  29. Oxlund BS, Ørtoft G, Brüel A et al (2010) Collagen concentration and biomechanical properties of samples from the lower uterine cervix in relation to age and parity in non-pregnant women. Reprod Biol Endocrinol 8:82. doi:10.1186/1477-7827-8-82

    Article  PubMed  PubMed Central  Google Scholar 

  30. Johnston TA, Greer IA, Kelly RW, Calder AA (1993) Plasma prostaglandin metabolite concentrations in normal and dysfunctional labour. Br J Obstet Gynaecol 100:483–488

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Liran Hiersch, Adi Borovich, Rinat Gabbay-Benziv & Moria Maimon-Cohen

  2. Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Amir Aviram, Yariv Yogev & Eran Ashwal

Authors
  1. Liran Hiersch
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  2. Adi Borovich
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  3. Rinat Gabbay-Benziv
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  4. Moria Maimon-Cohen
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  5. Amir Aviram
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  6. Yariv Yogev
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  7. Eran Ashwal
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Corresponding author

Correspondence to Liran Hiersch.

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This study was not funded

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of interest

All authors declare that we have no conflict of interest. This work was performed in partial fulfillment of the M.D. thesis requirements of the Sackler Faculty of Medicine, Tel Aviv University.

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Hiersch, L., Borovich, A., Gabbay-Benziv, R. et al. Can we predict successful cervical ripening with prostaglandin E2 vaginal inserts?. Arch Gynecol Obstet 295, 343–349 (2017). https://doi.org/10.1007/s00404-016-4260-1

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  • DOI: https://doi.org/10.1007/s00404-016-4260-1

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