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The following is a summary of “Dinoprostone vaginal insert compared to cervical ripening balloon as second line of cervical ripening after first dinoprostone insert,” published in the August 2024 issue of Obstetrics and Gynecology by Pradeau et al.

The objective of this retrospective cohort study was to compare the efficacy of dinoprostone vaginal insert (PG) and cervical ripening balloon (CRB) as second-line interventions for cervical ripening in women at term who exhibited a persistent unfavorable cervix after initial PG treatment. This study included women with singleton pregnancies in cephalic presentation requiring additional cervical ripening at ≥37 weeks’ gestation due to maternal or fetal indications. Those with a persistent unfavorable cervix, defined as a Bishop score <6, 24 hours following the first PG application, were subjected to either a second PG or CRB. 

The primary outcome was the rate of vaginal delivery. In contrast, secondary outcomes included achieving a favorable cervix (Bishop score ≥6) or labor within 24 hours after the second intervention, postpartum hemorrhage (PPH), and neonatal morbidity. The cohort consisted of 180 women, 127 receiving repeated PG (70.6%) and 53 receiving CRB after the first PG (29.4%). Following the second device application, 93.3% of women either achieved a favorable cervix or went into labor within 24 hours, with CRB showing a significantly higher success rate than repeated PG (98.1% vs. 91.3%, p=0.048). The rates of vaginal delivery were comparable between the two groups (62.2% after repeated PG vs. 54.7% after CRB, p=0.36). PPH occurred in 22.2% of the women, with no significant difference between the groups (21.3% vs. 21.4%, p=0.63). 

Neonatal morbidity rates were also similar across both groups (13.4% vs. 9.4%, p=0.48). In conclusion, while the vaginal delivery rates and neonatal morbidity were similar for PG and CRB as second-line treatments, CRB demonstrated superior efficacy in achieving cervical ripening compared to repeated PG in women with a persistent unfavorable cervix.

Source: sciencedirect.com/science/article/abs/pii/S0301211524004779