Dinoprostone vaginal inserts faster in inducing labor compared to Foley catheter: Study

Malaysia: In a new study conducted by Sofiah Sulaiman and team, it was shown that controlled-release dinoprostone vaginal inserts shorten the time of delivery induction in term women who have had one prior cesarean delivery and have unripe cervixes when compared to Foley catheters. The findings of this study were published in the International Journal of Gynecology & Obstetrics. 

Labor induction is seen as dangerous for individuals who have previously had a C-section due to more significant risks of uterine scar rupture, which range from 2.5% when done with prostaglandins to 0.7 percent when done without them to 0.5% when labor starts naturally. However, with informed patient consent, labor induction is permitted in high-resource settings and is carried out in 27–32.7% of women who attempt a vaginal birth after a C-section (VBAC). 

From December 12, 2018, to May 28, 2019, this randomized controlled experiment was carried out at the University Malaya Medical Center in Kuala Lumpur, Malaysia. 78 term women who have had one prior cesarean delivery are scheduled for labor induction. Foley catheter or dinoprostone insert was randomly assigned to women with a singleton gestation, unripe cervixes, cephalic presentation, intact membranes, and a positive cardiotocogram. The induction to delivery time (in hours) was the major outcome, while maternal satisfaction with the birth process was one of the secondary outcomes (assessed by the 100mm Visual Analog Scale VAS).

The key findings of this study were as follows:

1. For the Foley and controlled-release dinoprostone arms, respectively, the induction to delivery intervals were median 33.5 vs. 23.5 hours, and maternal satisfaction during the birth process was 100 mm VAS 80 vs. 82mm.

2. Cesarean delivery rates for Foley vs. controlled-release dinoprostone were 23/39 (59%) vs. 20/39 (51%) RR 1.15), and trial device insertion to removal time mean±standard deviation 20.17.1 vs. 14.27.3 hours, respectively.

In conclusion, this study showed that controlled-release dinoprostone labor initiation was considerably faster than a Foley catheter balloon for patients who had previously undergone a C-section, despite no changes in patient satisfaction.

Reference: 

Sulaiman, S., Sivaranjani, S., Razali, N., Lim, B. K., Hamdan, M., & Tan, P. C. (2022). Foley Catheter Compared with Controlled Release Dinoprostone Vaginal Insert for Labor Induction after One Previous Cesarean Delivery: A Randomized Trial. In International Journal of Gynecology & Obstetrics. Wiley. https://doi.org/10.1002/ijgo.14364