# Effects and Pain Levels in Nulliparous Pregnant Women Undergoing Cervical Ripening With the Controlled-Release Dinoprostone Vaginal Delivery System (PROPESS) Compared With Mechanical Methods

## TL;DR

This study compares the effectiveness and pain levels of a drug-based cervical ripening system (PROPESS) versus mechanical methods in first-time pregnant women.

## Contribution

The study provides new evidence that PROPESS is as effective as mechanical methods for cervical ripening with potentially less pain.

## Key findings

- PROPESS and mechanical methods had similar rates of unsuccessful cervical ripening.
- Pain levels during PROPESS insertion were significantly lower than with mechanical methods.

## Abstract

Objective

We compared the effects of controlled-release dinoprostone vaginal delivery system (PROPESS; Ferring Pharmaceuticals, Saint-Prex, Switzerland) use on cervical ripening and on pain levels, compared with mechanical methods.

Methods

The criteria for inclusion in this study were as follows: nulliparity, singleton pregnancy, cephalic presentation, gestational age of 41 weeks, and a Bishop score at the start of induction equal to or less than 4. During the study period, 25 women used PROPESS, and 25 women used mechanical methods for cervical ripening at 41 weeks of gestation. After the selected insertion methods were completed, the patients were asked about their pain levels during the insertion, with the pain scored on a 10-point numerical pain-rating scale (Numeric Rating Scale, NRS). Successful cervical ripening was defined as a Bishop score >6 at removal, or if the patient delivered vaginally by the next day following insertion of PROPESS only or mechanical cervical dilation only.

Results

There were no significant differences in the rate of unsuccessful cervical ripening cases between the two groups; however, the average NRS score at PROPESS insertion was significantly lower than that during mechanical methods.

Conclusions

The cervical ripening effect of PROPESS was not significantly different from that of mechanical methods in women requiring cervical ripening. PROPESS also had the potential benefit of being pain-free during cervical ripening.