Intracervical prostaglandins are effective compared to placebo, but appear inferior when compared to intravaginal prostaglandins.
Randomized trial of intracervical versus posterior fornix dinoprostone for induction of labor.
To investigate whether intracervical placement of a sustained-release dinoprostone insert decreased the length of time to delivery when compared with placement in the posterior fornix.
                Sixty-three patients were randomized to intracervical (n = 33) or posterior fornix (n = 30) placement of the initial dose. Dinoprostone was placed under direct visualization with a vaginal speculum and packing forceps. The patients and staff were blinded to the site of placement. Multiple end points were examined throughout labor. Student t test, Fisher exact test, Wilcoxon test, Mann-Whitney U test, and chi2 analyses were performed when appropriate. A P value of less than.05 was considered significant.
                Forty-six patients who required only a single dose of dinoprostone had a reduced time to delivery with intracervical (n = 24; 11.70 hours) compared with intravaginal (n = 22; 16.20 hours) placement (P =.025). There was also a reduced time to active labor (intracervical = 8.25 hours, posterior fornix = 11.50 hours; P =.083), ruptured membranes (intracervical = 10.25 hours, posterior fornix = 12.00 hours; P =.047), and request for initial pain medications (intracervical = 5.00 hours, posterior fornix = 11.25 hours; P =.025) with intracervical placement. There was no difference in number of patients managed with artificial rupture of membranes. There was no difference in maternal age, race, parity, maternal height or weight, or indication for induction. There was also no difference in cesarean delivery rate, antepartum fever, hyperstimulation, Apgar scores, birth weight, or umbilical artery pH.
                In patients who respond to a single sustained-release dinoprostone insert, intracervical placement decreases time to delivery without increasing the cesarean delivery rate, infectious morbidity, or other complications of labor.