Cervical ripening and labor induction with a controlled-release dinoprostone vaginal insert: A meta-analysis

Objective: To systematically review published randomized trials that compar ed efficacy of a 10-mg, controlled-release dinoprostone vaginal insert with other prostaglandins for cervical ripening and labor induction. Data Sources: We supplemented a search of entries in electronic databases w ith references cited in original studies and review articles to identify ra ndomized clinical trials of dinoprostone vaginal inserts for cervical ripen ing and labor induction. Methods of Study Selection: We evaluated, abstracted data, and assessed the quality of randomized clinical trials on the efficacy of dinoprostone vagi nal inserts as cervical ripening and labor induction agents. Only published randomized trials were included in this meta-analysis. Tabulation, Integration, and Results: Seventeen studies were identified, ei ght of which met our criteria for metaanalysis. Those eight trials included 964 subjects, 490 of whom were allocated to dinoprostone vaginal inserts a nd 474 to other prostaglandin (PG) preparations. We calculated an estimate of the odds ratio (OR) and risk difference for dichotomous outcomes, using a random- and fixed-effects model. Continuous outcomes were pooled using a variance-weighted average of within-study difference in means. Compared wit h women who received other PC preparations, those wire received dinoproston e vaginal inserts had lower incidence of vaginal delivery within 12 hours o f PG application (OR 0.55, 95% confidence interval 0.39, 0.79), Vaginal ins erts were associated with longer intervals to vaginal delivery and lower ra tes of active labor. There were no differences in cesarean delivery rates, incidence of hyperstimulation or need for oxytocin augmentation between din oprostone and other PGs. Conclusion: Dinoprostone vaginal insert was less effective than other prost aglandins for cervical ripening and labor induction. (Obstet Gynecol 1999;9 4:878-83. (C) 1999 by The American College of Obstetricians and Gynecologis ts.).