Labor induction in PROM with dinoprostone administered vaginally

Premature rupture of membranes (PROM) in term pregnancies without subsequent uterine contractions presents significant risks for boththe mother and fetus, and later for the neonate. When amniotic fluid outflow is prolonged, labor induction is typically recommended. This is particularly challenging when cervical ripening is poor – indicated by a Bishop score <6. 

A recent study analyzed 81 PROM cases, focusing on term pregnancies with a Bishop score below 6 –where labor was induced using dinoprostone insert administered vaginally. The patients had no other significant complications or health issues. The mean birth weight of the neonates was 3,293 grams, with 98% having an Apgar score of 8 or higher (only one neonate had an Apgar score 6). 

Labor induction resulted in vaginal births in 65%, while 8% of the patients required vacuum extraction-assisted vaginal delivery. However, cesarean section was necessary in 26% of the cases, primarily due to unsuccessful labor induction or the risk of intrauterine infection. 

From the results, it was concluded that dinoprostone insert administered vaginally is a safe and effective method for managing term pregnancies complicated by PROM with a low Bishop score.

Source:Zwoliński J, Śladowska-Zwolińska A, Siergiej M, et al. European Journal of Obstetrics and Gynecology and Reproductive Biology. 2024 Feb 1;293:110.