Objective To compare outcomes of induction of labour with dinoprostone gel (Prostin), dinoprostone slow release pessary (Propess) and cervical ripening balloon.
Design Prospective observational study of 78 primiparous and multiparous women induced for various reasons at term (>37 weeks).
Exclusions Spontaneous rupture of membranes, contraindications to induction.
Outcomes Induction to delivery interval, mode of delivery, adverse events.
Results There were more women with a previous Caesarean section in the balloon group and more twin pregnancies thus a slightly lower mean birth weight. Adverse events: prostin – 1 failed IOL, 1 scar dehiscence; propess – 2 cases of uterine hyper-stimulation, 1 precipitate delivery; cervical balloon – 1 cord prolapse at artificial rupture of membranes.
Conclusion Advantages of Propess and the cervical balloon include fewer vaginal examinations, shorter induction to delivery intervals and hospital stays thus significant cost savings. The cervical balloon may carry a lower risk of uterine hyperstimulation but its safety and efficacy are yet to be proven in women with a previous Caesarean section, although there were no cases of scar dehiscence when the cervical ripening balloon was used as opposed to one in the Prostin group.
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