Introduction There is no guideline advising on the management of women in whom induction of labour with first dinoprostone pessary has failed. Repeat cervical ripening with a second pessary is a commonly used management option.

Aim To assess the safety and efficacy of a second 10 mg dinoprostone (Prostaglandin E2) pessary inserted 24 hours after initial failure of cervical ripening.

Methods A pilot retrospective study of women at a North London teaching hospital, over a 7 month period. Women who failed initial induction were managed using a repeat pessary of prostaglandin E2. Primary outcomes of interest included establishment of active labour, mode of delivery, Bishop score and any adverse events.

Results 34 women having induction of labour were given a second pessary following failed initial induction. Medical records were available for 19 of these. 12 women (63%) achieved active labour following insertion of the 2nd dinoprostone pessary, and 10 of these (83%) delivered vaginally. Two cases of uterine hyperstimulation resolved on removal of the pessary. There was a significant difference in Bishop score pre-pessary insertion between the women who achieved active labour (83.3% had score ≥3) compared to those who failed to labour (0% had score ≥3), (p < 0.05).

Conclusion Successful induction of labour can be achieved safely with second dinoprostone pessary following failed initial induction of labour if the Bishop score prior to insertion is ≥3. A larger study will follow, in order to add power to this data.