Beneficial effects of controlled-release dinoprostone vaginal insert for elective induction of labor before due date

Evidence suggests that the inducing labour before the due date has been shown to lower the rate of caesarean sections and is not linked to an increased risk of unfavourable perinatal outcomes in comparison to expectant management. Recently, controlled-release dinoprostone (PGE2) vaginal insert has been approved for use in developed nation like Japan. However, there is scarcity of data establishing its efficacy in cervical ripening and labor induction before due date. 

The present retrospective cohort study was conducted to compare the therapeutic potential of PGE2 vaginal inserts and mechanical dilation for labor induction before due date. It included 206 mothers at 37, 38, and 39 weeks' gestation who delivered between January 2021 and October 2022. The researchers compared perinatal outcomes, particularly the success rate of vaginal delivery, between two groups: those using PGE2 (n=46) and those using mechanical methods (n=160). Success was defined as the proportion of women who had a vaginal delivery within 48 hours after initiating oxytocin.

The findings of the study demonstrated:

• Success rate of vaginal delivery was significantly higher in the PGE2 group, with 80.4% (37 out of 49) achieving vaginal delivery, compared to 66.2% (106 out of 177) in the non-PGE2 group. 
• Additionally, there were no emergency cesarean sections due to non-reassuring fetal status in the PGE2 group, while the non-PGE2 group had eight such cases (5.0%).

To summarize, the use of PGE2 vaginal inserts for elective labor induction between 37 and 39 weeks significantly increased the likelihood of successful vaginal delivery. This establishes the therapeutic potential of PGE2 for labor induction, potentially reducing the need for cesarean sections and improving perinatal outcomes. 

Source: Tamai J, Ikenoue S, Akita K, Fukuma Y, Tanaka Y, Hasegawa K, Otani T, Kasuga Y, Tanaka M. Efficacy of controlled-release dinoprostone vaginal insert for elective induction of labor before due date. J Obstet Gynaecol Res. 2024 Oct 13. doi: 10.1111/jog.16123. Epub ahead of print. PMID: 39400965.