Abstract

Induction of labour by using different prostaglandin preparations is generally preferred to avoid complications of prolonged pregnancy. Dinoprostone vaginal gel or insert are commonly used for this purpose. The present study compares the different indications of induction of labour, feto-maternal outcome and cost effectiveness analysis between the two groups. Materials & methods: This prospective randomized comparative study was carried out in 200 pregnant mothers (100 mothers receiving dinoprostone vaginal gel and 100 mothers receiving dinoprostone vaginal insert) undergone labour induction with unfavorable Bishop score. Then the different indications of induction of labour, feto-maternal outcome and cost effectiveness analysis between the two groups were compared. Statistical analysis was done by IBM SPSS Ver.25 statistical software. Results: The most common indication for induction was Post dated pregnancy ( 32% in gel & 41% in insert group) followed by premature rupture of membrane ( 21% vs 18%) and hypertensive disorders in pregnancy (20% vs 15%) among the studied groups. The rate of caesarean section was 41% in gel group & 25% in Insert group. No cases or episodes of uterine hyperstimulation was seen in either groups. Average duration of hospital stay following delivery was less those who received vaginal insert compared to gel, which was statistically significant ( p <0.001). Regarding fetal and neonatal outcome, statistically significant difference was found in incidence of meconium stained liquor (22% vs 17%, p < 0.011), APGAR score at 1 and 5 minutes (p< 0.001) between the two groups. But no statistically significant difference was found between the two groups regarding neonatal birth weight, fetal deceleration, delayed crying after birth or NICU admission rate. Conclusion: Dinoprostone vaginal insert for cervical ripening demonstrate a high degree of efficacy and safety for both mother and fetus in terms of decrease chance of caesarean section, shorter hospital stay after delivery, lesser incidence of meconium stained liquor & less incidence of fetal distress. Also patient acceptability is better as single application is sufficient to achieve cervical ripening in majority of patients

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