Citation Information :
Fathima S, Kandasamy V, Britto J, Ramanujam S. A Comparative Study on the Efficacy of Dinoprostone Controlled Release Vaginal Pessary vs Dinoprostone Intracervical Gel for Induction of Labor. J South Asian Feder Obs Gynae 2025; 17 (1):16-20.
Introduction: Induction of labor (IOL) means initiation of uterine contractions after the period of viability by any method for vaginal delivery. Cervical ripening with dinoprostone is theoretically similar to endogenous cervical ripening prior to spontaneous labor. Controlled release vaginal pessary has an advantage over prostaglandin E2 gel in the fact that multiple insertions are not required; it can easily be removed in case of any adverse event; and the occurrence of hyperstimulation is very less. This study aimed to compare the efficacy of dinoprostone controlled release vaginal pessary vs dinoprostone intracervical gel for IOL.
Materials and methods: This was a randomized controlled trial conducted at a tertiary care hospital in Chengalpattu district. Patients were randomly divided into two groups of 25 each, where group A was induced with dinoprostone controlled release vaginal pessary and group B was induced with dinoprostone intracervical gel. Parameters such as cervical ripening, induction to delivery interval, and maternal and fetal outcomes were measured.
Results: The use of the vaginal pessary resulted in more effective cervical ripening, as evidenced by higher Modified Bishop's scores at 12- and 18-hours postinduction compared with that of the gel. The induction-to-delivery interval was notably shorter for those administered the vaginal pessary. As far as maternal outcomes are considered, the use of the vaginal pessary was associated with fewer complications and interventions, such as the need for augmentation with oxytocin, which aligns with the smoother progression of labor.
Conclusion: In conclusion, the dinoprostone controlled release vaginal pessary offers several advantages over the intracervical gel in inducing labor, particularly in terms of efficacy in cervical ripening and reducing the time from induction to delivery. Future research should continue to explore these findings across broader and more diverse populations to generalize the efficacy and safety profiles of these induction methods further.
Cunningham F, Leveno K, Bloom S, et al. Williams obstetrics. New York: McGraw-Hill Education; 2018. pp. 500–512.
Anh ND, Duc TA, Ha N-TT, et al. Dinoprostone vaginal insert for induction of labor in women with low-risk pregnancies: A prospective study. Med Arch 2022;76:39–44. DOI: 10.5455/medarh.2022.76.39-44.
de Vaan MD, ten Eikelder ML, Jozwiak M, et al. Mechanical methods for induction of labor. Cochrane Database Syst Rev 2019;2019:CD001233. DOI: 10.1002/14651858.CD001233.pub3.
Gadziński P, Froelich A, Jadach B, et al. Ionotropic gelation and chemical crosslinking as methods for fabrication of modified-release gellan gum-based drug delivery systems. Pharmaceutics 2022;15:108. DOI: 10.3390/pharmaceutics15010108.
Hiremath CN. Abbreviated profile of drugs (APOD): Modeling drug safety profiles to prioritize investigational COVID-19 treatments. Heliyon 2021;7:e07666. DOI: 10.1016/j.heliyon.2021.e07666.
Onetto AJ, Sharif S. Drug distribution. Treasure Island, FL: StatPearls Publishing; 2024.
Tempe A, Sindher S, Dhiman N, et al. Comparison of dinoprostone controlled release vaginal pessary with dinoprostone intracervical gel for preinduction cervical ripening and induction of labor at term. MAMC J Med Sci 2021;7(1):52−57. DOI: 10.4103/mamcjms.mamcjms_108_20.
Thomas J, Fairclough A, Kavanagh J, et al. Vaginal prostaglandin (PGE2 and PGF2a) for induction of labour at term. Cochrane Database Syst Rev 2014;2014(6):CD003101. DOI: 10.1002/14651858.CD003101.pub3.
Smith GC, Pell JP, Dobbie R. Caesarean section and risk of unexplained stillbirth in subsequent pregnancy. Lancet 2017;366(9501):1779−1784. DOI: 10.1016/s0140-6736(03)14896-9.
Senthilvel S, Vijayakrishnan M. Comparative study of dinoprostone vaginal pessary versus PGE2 gel in labour induction: A randomised controlled study. International Journal of Reproduction, Contraception, Obstetrics and Gynecology [Internet]. 2022 Jun 27 [cited 2025 Feb 14];11(7):1979–1983. Available from: https://www.ijrcog.org/index.php/ijrcog/article/view/11827.
Lee B, Khan KS, Allotey J, et al. Effectiveness of strategies incorporating training and support of traditional birth attendants on perinatal and maternal mortality: Meta-analysis. BMJ 2018;343:d7102. DOI: 10.1136/bmj.d7102.
Hansen SL, Clark SL, Foster JC. Active management of the third stage of labour with and without controlled cord traction: A randomised, controlled, non-inferiority trial. Lancet 2016;387(10020):1721−1727. DOI: 10.1016/S0140-6736(12)60206-2.
D RM, Rai P. A comparative study between dinoprostone pessary and dinoprostone gel for induction of labor and neonatal outcome. Indian Journal of Obstetrics and Gynecology Research [Internet]. [cited 2025 Feb 14];11(2):167–171. Available from: https://www.ijogr.org/article-details/21711.
Gaudineau A, Senat MV, Ehlinger V, et al. Induction of labour at term with vaginal misoprostol or a prostaglandin E2 pessary: A non-inferiority randomized controlled trial. Am J Obstet Gynecol 2021;225(5):542.e1−542.e8. DOI: 10.1016/j.ajog.2021.04.226.
Ehlinger V, Senat MV, Gaudineau A, et al. A comparison of prostaglandin E2 and misoprostol pharmacokinetics for labour induction. Obstet Gynecol Sci 2021;64(1):42−49. DOI: 10.5468/ogs.2021.64.1.42.
Rayburn W, Smith CV, Parriott JE, et al. Vaginal prostaglandin E2 for cervical ripening and induction of labour: Comparison of gel and sustained-release pessary. BJOG 2021;128(7):1134−1142. DOI: 10.1111/1471-0528.16654.
Marsdal KE, Sundseth H, Andersson N, et al. Labour induction with randomized comparison of cervical, oral and intravaginal misoprostol. BMC Pregnancy Childbirth 2021;21(1):112. DOI: 10.1186/s12884-021-03640-3.
Kalkat RK, McMillan E, Cooper H, et al. Comparison of Dinoprostone slow release pessary (Propess) with gel (Prostin) for induction of labour at term-a randomised trial. J Obstet Gynaecol. 2008;28(7): 695–699. DOI: 10.1080/01443610802462522.
Tan BP, Kelly AJ. A critical review of prostaglandin E2 for cervical ripening and labour induction. Cochrane Database Syst Rev 2018;6:CD003101. DOI: 10.1002/14651858.CD003101.pub3.
Stubblefield PG, Stetson P, Minkoff HL. Randomized trial of misoprostol and dinoprostone for labour induction: Efficacy and cost considerations. Am J Obstet Gynecol 1994;170(5):1213−1219. DOI: 10.1016/S0002-9378(94)70098-3.
Christensen DD, Garry DJ, Leong FC. A network meta-analysis of prostaglandin E2 versus misoprostol for cervical ripening and labour induction. J Perinat Med 2016;44(6):619−628. DOI: 10.1515/jpm-2015-0356.
Brownfoot FC, Crowther CA, Middleton P. Different routes and formulations of prostaglandins for cervical ripening and labour induction in late pregnancy. Cochrane Database Syst Rev 2019;8:CD009701. DOI: 10.1002/14651858.CD009701.pub3.
A comparison of different methods of induction of labor in patients of previous cesarean section. J South Asian Feder Obst Gynae 2023;15(5):580−584. DOI: 10.5005/jp-journals-10006-2287.
Agarwal R, Garg R, Yadav D, et al. Efficacy and safety of mifepristone followed by vaginal PGE1 vs PGE2 gel alone for induction of labor in late intrauterine fetal demise. J South Asian Feder Obst Gynae 2023;15(4):409–411. DOI: 10.5005/jp-journals-10006-2274.
