# The Effect of Introducing Dinoprostone Vaginal Inserts (DVI) in Cases of Term Prelabor Rupture of Membranes With Unfavorable Cervix

## TL;DR

This study compares the use of dinoprostone vaginal inserts versus oxytocin for inducing labor in women with ruptured membranes and an unfavorable cervix, finding similar success rates but less oxytocin use.

## Contribution

The study introduces dinoprostone vaginal inserts as a viable alternative to oxytocin for labor induction in term prelabor rupture of membranes with an unfavorable cervix.

## Key findings

- Vaginal delivery rates were similar between dinoprostone and oxytocin groups.
- Dinoprostone use significantly reduced the need for oxytocin.
- No significant differences in adverse outcomes like chorioamnionitis or neonatal morbidity were observed.

## Abstract

Aim: To evaluate the efficacy and safety of dinoprostone vaginal inserts (DVI) for labor induction in women with term prelabor rupture of membranes (PROM) and an unfavorable cervix.

Methods: This retrospective, single-center observational study included singleton, cephalic pregnancies at ≥37 weeks’ gestation admitted for PROM (August 2017-December 2024). Exclusion criteria were spontaneous labor onset, cesarean delivery without induction, or a Simplified Bishop score (SBS) ≥6. Prior to DVI availability (2017-2020), intravenous oxytocin administration was performed in all cases; after 2020, DVI was administered when SBS ≤5, followed by oxytocin as needed. Sixty matched cases per group were analyzed following propensity score matching for maternal age, height, weight at delivery, and SBS. Primary outcomes included vaginal delivery rate, labor duration, and oxytocin use; secondary outcomes included chorioamnionitis, postpartum hemorrhage, and neonatal morbidity.

Results: Vaginal delivery rates were comparable (DVI 78.3% vs. oxytocin 73.3%, p = 0.52). Median time from PROM to delivery was similar (DVI 47.0 h vs. oxytocin 51.9 h). Oxytocin use was significantly lower in the DVI group (46.7% vs. 100%, p < 0.0001). No significant differences were observed in chorioamnionitis or neonatal outcomes. Among vaginal deliveries, more women in the DVI group delivered within 24 or 48 hours, although this difference was not statistically significant.

Conclusion: In PROM with an unfavorable cervix, DVI use did not increase adverse outcomes and was associated with reduced oxytocin use. While differences in delivery timing were not statistically significant, DVI may provide clinical benefits, supporting the need for further prospective studies.