Dinoprostone vaginal insert for cervical ripening and labor induction: a meta-analysis

Area of Science:

• Obstetrics and Gynecology
• Reproductive Medicine
• Clinical Pharmacology

Background:

• Cervical ripening is crucial for labor induction in term pregnancies.
• Prostaglandins are commonly used for cervical ripening, with various formulations available.
• Dinoprostone vaginal insert offers a controlled-release option.

Purpose of the Study:

• To compare the efficacy and safety of dinoprostone 10 mg controlled-release vaginal insert against other vaginal or cervical prostaglandin agents for cervical ripening.
• To evaluate key outcomes including delivery within 24 hours, uterine hypertonus with fetal heart rate changes, and cesarean delivery rates.

Main Methods:

• Systematic review and meta-analysis of randomized controlled trials.
• Literature search included Cochrane database, MEDLINE, and hand-searched bibliographies.
• Included trials compared dinoprostone slow-release vaginal insert with alternative prostaglandins for cervical ripening and labor induction in term singleton gestations.

Main Results:

• Nine trials were analyzed, comparing the vaginal insert to dinoprostone gel (7 trials) and misoprostol (2 trials).
• No significant differences were found in delivery by 24 hours (OR 0.80, 95% CI 0.56-1.15), uterine hypertonus with fetal heart change (OR 1.19, 95% CI 0.56-2.54), or cesarean delivery rates (OR 0.78, 95% CI 0.56-1.08).
• Secondary outcomes suggested potential benefits for misoprostol-dinoprostone gel, but data heterogeneity limited interpretation.

Conclusions:

• The dinoprostone 10 mg controlled-release vaginal insert demonstrates comparable clinical effectiveness and safety to other vaginal/cervical prostaglandin formulations for cervical ripening at term.
• No clinically significant differences were observed in primary outcomes between the studied methods.