Abstract
The main objective of our study was to analyze the mean time to delivery following cervical ripening with a 10 mg dinoprostone vaginal insert. We performed a retrospective observational study at the level III maternity ward of Angers university hospital. We included all women who had cervical ripening with dinoprostone between January 1st, 2015 and September 30th, 2016. Overall, 405 patients were included, and 59.3% (240/405) were nulliparous. The mean time to delivery was 20h39 min ± 10h49 min. 21% of deliveries (86/405) occurred between midnight and 6 h a.m., and the cesarean section rate was 33% (132/405). Multiple regression analysis showed that nulliparity, overweight (BMI ≥ 25), a closed cervix on initial examination and the absence of premature rupture of membranes (PRM) all significantly increased the mean time to delivery. We developed a mathematical model integrating the aforementioned factors and their impact to help predict the mean time to delivery following cervical ripening with dinoprostone vaginal insert: Y = 961.188–80.346 × parity + 21.437 × BMI–165.263 × cervical dilation–241.759 × PRM. This equation allows obstetricians to calculate a personalized time to delivery for each patient, allowing a precise scheduling of dinoprostone insert placement, and thus improving the organization in busy maternity wards.
Highlights
Induction of labor (IOL) is nowadays a common obstetrical intervention on maternity wards worldwide, with an estimated yearly rate of 20% in France[1,2]
The Bishop score was originally described to assess the likelihood of vaginal delivery in multiparous women but is nowadays used for assessment of women considered for IOL
Very few studies have assessed the mean time to delivery (TTD) following cervical ripening with dinoprostone vaginal insert
Summary
Induction of labor (IOL) is nowadays a common obstetrical intervention on maternity wards worldwide, with an estimated yearly rate of 20% in France[1,2]. Studies have shown lower satisfaction rates and more unrealistic expectations in women undergoing IOL compared to spontaneous labor[10] It is important for obstetricians and midwives to be able to project the time of delivery, for organization and safety purposes, especially in busy maternity wards. Some deliveries are considered high risk and require the intervention and coordination of several medical and surgical teams, such as cases of placenta praevia/accreta at high risk of postpartum bleeding, or cases requiring immediate neonatal surgery Such deliveries are best scheduled to occur during the day, when the hospital is fully staffed, and all busy level III maternity wards have developed organizational charts, in order to be able to plan and handle these complex cases. Our secondary end points were to determine the factors influencing the time to delivery, and to develop a mathematical model that would allow us to calculate the TTD for each woman, based on these factors
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