Is induction of labor with continuous release dinoprostone vaginal pessary a viable option in patients with preeclampsia?

Abstract

Objective: To evaluate the role of dinoprostone vaginal pessary (DVP) for induction of labor in preeclampsia. Methods: This is a prospective review of 94 patients with preeclampsia, who delivered from July 1995 to December 1996 at a university center. Of these, 25 received DVP, 22 oxytocin, 11 intracervical prostaglandin E 2, and 36 received no pharmacologic agents. Patients receiving DVP and oxytocin induction were compared for outcome of pregnancy and cesarean section rate. Statistical analysis was carried out by Student t test, χ 2 test with Yates correction. Results: The two groups were comparable with respect to parity and 5-minute Apgar scores. n DVP (25) Oxytocin (22) P Value Gestational age (wk) 36.6 ± 3.2 38.3 ± 2.7 <.05 Birth weight (g) 2482 ± 757 2993 ± 788 <.05 Bishop score 1.6 ± 1.6 5.4 ± 2.8 <.005 Labor duration (h) 21.3 ± 11.9 12.5 ± 8.2 <.01 Cesarean section (%) 40 36 NS Three patients in the DVP group developed complications—one episode of seizure, one atonic postpartum hemorrhage, and one cervical laceration. One patient in the oxytocin group developed HELLP syndrome. Conclusion: DVP is at least as effective as oxytocin in achieving vaginal delivery in preeclampsia, despite lower Bishop scores. Future larger studies are needed to better assess DVP in patients with preeclampsia.