Failed induction of labor in term nulliparous women with an unfavorable cervix: Comparison of cervical ripening by two forms of vaginal prostaglandins (slow-release pessary and vaginal gel) - 23/03/23

Doi : 10.1016/j.jogoh.2023.102546

Marie Salvator ^a,^b,^⁎ , Aude Girault ^b,^c,^d, Jeanne Sibiude ^d,^e,^f, Laurent Mandelbrot ^d,^e,^f, François Goffinet ^b,^c, Emmanuelle Cohen ^g
^a Université Paris Descartes - Paris V, Faculté de Médecine, Paris, France
^b Port-Royal Maternity Unit, Department of Obstetrics Paris, Cochin Broca Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
^c INSERM UMR 1153, Obstetrical, Perinatal and Paediatric Epidemiology Research Team (Epopé), Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris, France
^d DHU Risks in Pregnancy, Paris Descartes University, Paris, France
^e Louis Mourier Hospital, Department of Gynecology and Obstetrics, Colombes, Assistance Publique-Hôpitaux de Paris, University Paris Diderot, Paris, France
^f INSERM IAME-U1137, Groupe de Recherche Sur Les Infections Pendant la Grossesse (GRIG), Paris, France
^g Department of Gynecology and Obstetrics, Institut Mutualiste Montsouris, Assistance Publique-Hôpitaux de Paris, Paris, France

^⁎Corresponding author at: Port-Royal Maternity Unit, Department of Obstetrics Paris, 123 boulevard de Port Royal, Paris, France.Port-Royal Maternity Unit, Department of Obstetrics Paris123 boulevard de Port RoyalParisFrance

Abstract

Objective

To compare the rate of failed induction after cervical ripening by two forms of vaginal prostaglandins.

Material and methods

This two-year retrospective study (January 1, 2016, through December 31, 2017) in two tertiary maternity units included nulliparous women with a singleton fetus in cephalic presentation and an unfavorable cervix requiring labor induction for prolonged pregnancy. The principal endpoint was the rate of failed induction, defined by the performance of a cesarean delivery before 6 cm of dilation. Cervical ripening was initiated by prostaglandins for 24 h, using a slow-release pessary (unit A) or a vaginal gel (unit B). The care protocol of the two groups after the first 24 h were similar. The women's individual characteristics were compared between the two units. The rates of failed induction were then compared between the two units, first by univariate and then by multivariable analysis adjusted for the characteristics that differed significantly between the units.

Results

Among the 17,217 women delivered in the two maternity units during the study period, 178 met our inclusion criteria (125 in unit A (slow-release pessary) and 53 in unit B (vaginal gel)). The rate of failed induction was similar: 21.6% in unit A (slow-release pessary) and 17.0% in unit B (vaginal gel) (P = 0.48). The multivariate analysis did not show any difference about failed induction, time from the onset of induction to delivery, and vaginal delivery rate within 24h.

Conclusion

The rate of failed induction of labor did not differ between slow-release pessary and vaginal gel.

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Keywords : Cervical ripening, Prolonged pregnancy, Failed induction of labor, Vaginal prostaglandins, Nulliparous, Unfavorable cervix

Abbreviations : BMI, FHR, AFHR, MAR, PPH

Plan

Introduction

Materials and methods

Results

Discussion

Strengths/limitations

Comparison with the literature

Perspectives

Conclusion

	Échec de déclenchement chez les nullipares à terme à col défavorable: comparaison de la maturation entre deux prostaglandines vaginales de galéniques différentes: tampon à libération prolongée versus gel vaginal.
	Mots clés: maturation cervicale, grossesse prolongée, échec de déclenchement, prostaglandines vaginales, nullipares, col défavorable