Maternal and Fetal Factors Affecting the Effectiveness of Vaginal Dinoprostone in Labor Induction

Maternal and Fetal Factors Affecting the Effectiveness of Vaginal Dinoprostone in Labor Induction | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Maternal and Fetal Factors Affecting the Effectiveness of Vaginal Dinoprostone in Labor Induction Ufuk Atlihan, Onur Yavuz, Can Ata, Huseyin Aytug Avsar This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4979391/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective Induction of labor (IOL) is a common obstetric intervention used to encourage the onset of labor. The aim of study was to evaluate the maternal and fetal factors that play a role in the efficacy of vaginal dinoprostone in labor induction. Materials and Methods Our study included 780 patients who underwent pregnancy follow-up and delivery in our hospital between March 2018 and 2024. All data including body mass index (BMI), age, parity, induction criteria, obstetric history, bishop score, time of delivery, newborn weight and Apgar score were entered by the delivery room physician. Data from 620 patients who had a successful delivery with vaginal dinoprostone application and 120 patients who could not have a vaginal delivery were evaluated retrospectively. Results The BMI value of women in Group 2 at admission to the hospital was found to be significantly higher than that of women in Group 1 (p < 0.001). The Bishop score of women in Group 1 at admission to the hospital was found to be significantly higher than that of women in Group 2 (p < 0.001). The nulliparity rate of women in Group 2 was found to be significantly higher than those in Group 1 (p < 0.001). The uterocervical angle measurement of women in Group 2 was found to be significantly lower than those in Group 1 (p < 0.001). The rate of newborns with 1st and 5th minute Apgar scores ≥ 8 in Group 1 was found to be significantly higher than those in Group 2 (p = 0.006, p = 0.04, respectively). Conclusion It was determined that parity was one of the important determinants in achieving vaginal delivery in pregnancies where dinoprostone vaginal insert was applied. It was determined that multiparous women benefited more from induction with dinoprostone. However, according to the results of our study, more research is needed to evaluate nulliparous pregnancies requiring induction. Dinoprostone Induction of Labor Nulliparity Multiparity Introduction Induction of labor (IOL) is a common obstetric intervention that uses artificial methods to stimulate the onset of labor by artificially initiating the process of cervical effacement, cervical dilation, and uterine contractions ( 1 ). IOL is often considered when prolonged pregnancy poses a risk of death or morbidity for the mother or child or upon the request of pregnant women at term ( 2 ). IOL is considered indicated when outcomes for the fetus, the mother, or both are considered better than expectant management, which means waiting for spontaneous onset of labor ( 3 ). It is an increasingly common practice in modern obstetrics to provide better care for both the fetus and the mother ( 4 ). For example, the rate of induction of labor more than doubled in 2006, reaching 22.5% of all births in the USA ( 4 ). The American College of Obstetricians and Gynecologists (ACOG) has a comprehensive list of recommendations for timing of delivery, including some of the common clinical scenarios listed for this purpose ( 5 ). Also, ACOG recently endorsed elective induction of labor as a “reasonable” option following the publication of results from the ARRIVE (Randomized Trial of Induction Versus Expectant Management) study conducted by the Eunice Kennedy Shriver National Institute ( 6 ). However, the Society for Maternal-Fetal Medicine statement suggested that inducing labor at 39 weeks' gestation in low-risk nulliparous women provides maternal benefits without an increase in adverse neonatal effects ( 7 ). The New England Journal of Medicine published the ARRIVE study, which compared cesarean section (C/S) rates and perinatal outcomes in nulliparous pregnant who underwent elective induction of labor at 39 weeks of gestation with expectant management. The results showed a significantly lower C/S rate in the induction group and no statistically significant lower incidence of adverse perinatal outcomes ( 8 ). Another published study found that the likelihood of a C/S was reduced in nulliparous and multiparous women who were electively induced between 37 and 40 weeks of pregnancy ( 9 ). It also found that women were not at increased risk of third or fourth degree tears or having an operative vaginal delivery, regardless of gestational age ( 9 ). However, a Cochrane systematic review also showed that IOL is beneficial because it is associated with fewer perinatal deaths or to improve birth outcomes in women after delivery ( 10 ). Cervical ripening is an important precursor to successful labor induction, and is accompanied by adequate and strong uterine contractions at regular frequency ( 11 ). There are two main options for cervical ripening, mechanical methods and pharmacological methods ( 12 – 16 ). Oxytocin may be one of the most popular pharmacologic agents for labor induction; however, it has minimal effects on cervical ripening ( 17 ). Prostaglandin analogs, including dinoprostone, a synthetic preparation chemically identical to naturally occurring PGE2, and misoprostol, a synthetic PGE1 analog, not only have an effect on cervical ripening but also have an important role in the induction of labor ( 18 , 19 ). Due to its benefits such as low price and easy storage (no refrigeration required), misoprostol may be the most commonly used pharmacological agent for labor induction worldwide ( 20 ). However, Misoprostol is not licensed for labor induction and has been widely used off-label for labor induction (via oral or vaginal administration) worldwide for many years ( 21 ). In contrast, a slow-release vaginal product used for vaginal dinoprostone administration contains 10 mg of dinoprostone dispersed throughout the matrix of a thin flat polymeric hydrogel drug delivery device designed to provide a controlled and constant release of dinoprostone from the reservoir at 0.3 mg/hr. The efficacy profile is more rapid and more variable in women without membrane rupture than in women with membrane rupture ( 22 ). The main advantage of the dinoprostone slow-release vaginal insert is that it enables rapid retrieval in the event of uterine tachysystole or abnormal fetal heart rate monitoring and has a low side effect profile ( 23 ). Our study aimed to evaluate the maternal and fetal factors that play a role in the effectiveness of vaginal dinoprostone in labor induction. Materials and Methods The present study was designed in a retrospective observational design following the Principles of Helsinki Declaration. Informed voluntary consent forms were obtained from all patients. The study received approval from the our hospital’s Ethics Committee (date: 26/06/2024, number: 2024/308). Our study included 780 patients whose pregnancy follow-ups and deliveries were performed in our hospital between March 2018 and 2024. Data from 620 patients who had a successful delivery with vaginal dinoprostone application and 120 patients who could not have a vaginal delivery were evaluated retrospectively. Inclusion criteria were singleton pregnancy, vertex presentation, > 36 weeks of gestation, bishop score < 7, absence of labor signs and reassuring fetal heart rate. Gestational age was calculated using Naegele's rule and confirmed by early pregnancy ultrasound ( 24 ). Exclusion criteria included abnormal placentation, antepartum bleeding, fetal malformation, history of C/S or uterine surgery, and other contraindications to vaginal delivery. Cervical dilatation, cervical effacement, cervical consistency, cervical position and station of fetal presenting part were evaluated in calculating the bishop score ( 25 ). The American Diabetes Association Criteria were used to diagnose gestational diabetes (GDM) ( 26 ). GDM was diagnosed if fasting blood glucose was above any of the criteria: 92 mg/dL, 1 hour: 180 mg/dL, 2 hours: 153 mg/dL. In pregnant women who have not previously been diagnosed with diabetes mellitus, a 75-g OGTT test is performed at 24–28 weeks, and plasma glucose is measured during fasting, 1st and 2nd hours. It is appropriate to perform OGTT in the morning after an overnight fast of at least 8 hours ( 26 ). The American Diabetes Association Criteria were used to diagnose type-2 diabetes mellitus ( 26 ). Diabetes is diagnosed if HbA1C is greater than or equal to 6.5%, fasting blood glucose is greater than or equal to 126 mg/dl, or two-hour blood glucose is > 200 mg/dl ( 26 ). Pregnancy induced hypertension (PIH) was diagnosed in accordance with the most recent American College of Obstetricians and Gynecologists bulletin ( 27 ). The combination of hypertension and proteinuria is used for the diagnosis of preeclampsia. Hypertension is defined as blood pressure levels of at least 140 mm Hg as systolic or at least 90 mm Hg as diastolic in measurements taken four hours or longer after the 20th week of pregnancy in a woman whose blood pressure values were previously normal. Severe hypertension is considered when blood pressure is at least 160 mm Hg systolic or at least 110 mm Hg diastolic. To diagnose preeclampsia, women with hypertension also require the presence of proteinuria, defined as at least 300 mg in a 24-hour urine collection. PIH is diagnosed in patients who meet hypertension criteria for preeclampsia without proteinuria or serious additional problems ( 27 ).mAmniotic fluid index (AFI) ≤ 5 is considered one of the most important criteria in the ultrasonographic diagnosis of oligohydramnios ( 28 ). Routine fetal heart monitoring was performed for 2 hours before the dinoprostone vaginal slow-release system (Propess®, Ferring, Controlled Therapeutics Ltd, UK) and treatment was started after the fetal heart rate was observed to be normal. Posterior fornix dinoprostone placement was performed and maintained for a maximum of 12 hours in pregnant women without contraindications, according to the manufacturer's instructions. All participants underwent continuous fetal monitoring. According to the modified protocol per the manufacturer's recommendation, dinoprostone was removed in the presence of: uterine tachysystole (defined as more than five contractions in 10 minutes in a 30-minute period), non-reassuring fetal heart rate (NRFS), other nonspecific adverse events (intolerable painful uterine contractions), persistence in the vagina for > 12 hours, and spontaneous rupture of membranes. If regular uterine contractions were not noted 1 hour after removal of dinoprostone, intravenous oxytocin was additionally used to continue induction. All data, including BMI, age, parity, induction criteria, obstetric history, bishop score, reason for vaginal dinoprostone removal, time of delivery, neonatal weight, and Apgar score, were entered by the delivery room physician. The delivery room fetal monitoring monitor provided continuous close observation of fetal heart rate and uterine contraction patterns. Women with successful labor induction were divided into group 1, and women with unsuccessful labor induction were divided into group 2. Statistical Analysis Statistical analysis was performed by SPSS version 22.0 (IBM-Inc.-Chicago-USA). The normality of the distribution was evaluated with Kolmogorov-Smirnov. Not normally distributed parameters were analyzed with the Mann-Whitney U test. Chi-square test and Fisher precision test were used in the analysis of categorical data. Not normally distributed parameters were presented as median (minimum-maximum). Number and percentage (%) were used to express qualitative data. Results were evaluated at a 95% confidence interval (CI). The p value considered statistically significant was < 0.05. Results In our study, the mean age of the women in group 2 was found to be significantly higher than that of women in group 1 (p = 0.001). Bishop score at admission of women in group 1 was found to be significantly higher than women in group 2 (p < 0.001). BMI score of women in group 2 was found to be significantly higher than women in group 1 (p < 0.001). The nulliparity rate of women in group 2 was found to be significantly higher than that of women in group 1 (p < 0.001). The uterocervical angle measurement of women in group 2 was found to be significantly lower than women in group 1 (p < 0.001). The time to delivery after insertion in group 2 women was found to be significantly higher than in group 1 women (p < 0.001). The time to delivery after retrieval in group 2 women was found to be significantly higher than in group 1 women (p < 0.001). Table 1 Demographic-and clinical-characteristics of the groups Variables Group I n:620 %79.4 Group II n:160 %20.6 p value Maternal age (years) 30 (23–43) 31 (25–40) 0.001 Gestational age (weeks) 40 (38–41) 40 (38–41) 0.9 Bishop score at admission (n) 3 (1–4) 2 (1–4) < 0.001 Body mass index (kg/m2) 28 (25–31) 30 (26–34) < 0.001 Parity Nulliparity Multiparity 357 (57.6%) 263 (42.4%) 151 (94.4%) 9 (5.6%) < 0.001 Indications for induction Elective Oligohydramnios Gestational diabetes mellitus Type 2 diabetes mellitus Pregnancy induced hypertension 480 (77.4%) 24 (3.9%) 49 (7.9%) 9 (1.5%) 58 (9.4%) 113 (70.6%) 5 (3.1%) 15 (9.4%) 5 (3.1%) 22 (13.8%) 0.2 Use of painless anesthesia 515 (83.2%) 141 (88.1%) 0.1 Uterocervical angle ( \(\:^\circ\:\) ) 100 (60–140) 90 (60–130) < 0.001 Time to delivery after insertion (hours) 18 (7–29) 32 (21–45) < 0.001 Time to delivery after retrieval (hours) 11 (4–21) 14.5 (10–29) < 0.001 The rate of women with a 1-minute Apgar score ≥ 8 in group 1 was found to be significantly higher than that of women in group 2 (p = 0.006). The rate of women with a 5-minute Apgar score ≥ 8 in group 1 was found to be significantly higher than that of women in group 2 (p = 0.04). Table 2 Fetal outcomes between the groups Variables Group I n:620 %79.4 Group II n:160 %20.6 p value Fetal weight (grams) 3180 (2340–4310) 3165 (2330–4290) 0.9 Apgar score (1-minute) \(\:\le\:\) 7 \(\:\ge\:\) 8 180 (29%) 440 (71%) 65 (40.6%) 95 (59.4%) 0.006 Apgar score (5-minute) \(\:\le\:\) 7 \(\:\ge\:\) 8 18 (2.9%) 602 (97.1%) 10 (6.3%) 150 (93.8%) 0.04 Discussion The main purpose of the IOL is to ensure timely cervical ripening and successful vaginal birth. In our study, it was found that 79.4% of term pregnancies treated with dinoprostone slow-release vaginal insert for IOL had a successful vaginal delivery rate. This success rate was consistent with many other previous studies with a successful vaginal delivery rate ranging from approximately 70–90% after using a dinoprostone slow-release vaginal insert for the IOL ( 29 – 34 ). In the 2008 report of the Turkey Demographic and Health Survey (TDHS), the C/S rate was found to be 37%, and in the TDHS-2013 report, it was 48% ( 35 – 37 ). These rates are significantly higher than the 15% rate given as an acceptable cesarean delivery rate by the World Health Organization ( 38 ). In light of this information, the successful birth rate data in our study reveal that dinoprostone administration is an effective method for successful initiation of labor. In our study, we demonstrated that parity is one of the most important determinants in achieving successful vaginal delivery in term pregnancies treated with dinoprostone slow-release vaginal insert for IOL. 96.7% of all multiparous women had a successful vaginal delivery, and in the nulliparous group, the rate of successful vaginal delivery after dinoprostone slow-release vaginal insert treatment was determined as 70.2%. However, there are different results in the literature regarding the successful delivery rates of dinoprostone application in multiparous and nulliparous pregnant women ( 39 , 40 ).In a retrospective study by Zhao et al., results revealed that parity was the strongest and most significant predictor of successful vaginal delivery in term pregnancies when comparing the efficacy of dinoprostone slow-release vaginal insert between multiparous and nulliparous women ( 41 ). In the study by Huang et al., parity was proven to be the main factor contributing to the time to vaginal delivery, and a significant decrease in the time to vaginal delivery was observed in multiparous women compared to nulliparous women ( 42 ). In present study, the mean age was found to be significantly higher in the unsuccessful vaginal delivery group. In the study conducted by Pevzner et al., it was revealed that a maternal age of < 35 years significantly supports successful labor induction ( 43 ). Similarly, in the study conducted by Obut et al., it was revealed that increasing maternal age reduces the probability of vaginal delivery ( 44 ). In present study, no statistically significant relationship was found between gestational age, birth weight, IOL indication and use of painless anesthesia parameters and successful vaginal delivery. Possible reasons could be the small sample size, because if the sample size is limited, other less important factors cannot reach the level of statistical significance. Only the most significant and important factor can be repeated in almost all studies. In the literature, labor induction is shown to be more likely to be successful in women with lower BMI ( 45 , 46 ). In our study, similar to the literature, BMI was found to be significantly lower in pregnant women who had successful vaginal births. Higher bishop scores have traditionally been associated with higher vaginal birth success rates ( 47 , 48 ). However, there are studies that question the reliability of bishop scores in predicting final birth outcome ( 49 , 50 ). In our study, bishop scores were found to be significantly higher in patients who had a successful vaginal delivery with vaginal dinoprostone administration, based on the results obtained in most randomized trials and clinical guidelines for labor induction ( 51 , 52 ). In our study, the 1st and 5th minute Apgar scores of patients who had a successful vaginal delivery were found to be significantly higher. In the literature, neonatal outcomes were found to be positive in pregnancies induced with dinoprostone ( 41 , 53 ). In our study, time to delivery after insertion (hours) and time to delivery after retrieval (hours) were found to be significantly lower in patients who had a successful vaginal delivery compared to patients who could not have a vaginal delivery. Similarly, in the literature, the time to delivery after insertion (hours) and time to delivery after retrieval (hours) were found to be lower in patients who had a successful delivery with dinoprostone compared to patients who underwent spontaneous delivery follow-up or underwent C/S due to induction failure. Whether epidural analgesia increases the risk of cesarean delivery and prolongs labor has been intensely debated during the last decade ( 54 ). Unfortunately, good studies are few and most have had small numbers of subjects. In the study conducted by Hasegawa et al., it was stated that epidural analgesia was associated with slow progress of labor, which increased the rate of instrumental delivery. However, in our study, no relationship was found between the use of painless anesthesia and the success of vaginal delivery. In our study, uterocervical angle measurement was found to be significantly higher in patients who had successful vaginal delivery compared to patients who could not have vaginal delivery. However, in the study conducted by İleri et al., no relationship was found between uterocervical angle and delivery success in pregnancies induced with dinoprostone ( 55 ). In the study conducted by Yang et al., it was stated that the use of uterocervical angle measurement and bishop score together could help predict the success of labor induction ( 56 ). In another study in the literature, it was stated that uterocervical angle could be used in addition to cervical length measurement in the risk of premature birth and term pregnancy in predicting delivery success ( 57 ). Our study showed that the success rate of vaginal delivery in nulliparous term pregnancies was only 70.2%, suggesting that other strategies may be considered instead of the dinoprostone slow-release vaginal insert for IOL in nulliparous term pregnancies. In fact, many studies have supported the use of PGE1, and some have suggested the combination of mechanical methods and pharmacological methods or the use of mechanical or pharmacological agents alone, compared with PGE2 ( 58 ). A randomized controlled trial by Edwards et al. compared the combined use of a dinoprostone slow-release vaginal insert and a foley catheter with the use of a foley catheter alone for cervical ripening and labor induction. This study supported the combined use of a dinoprostone slow-release vaginal insert and a foley catheter for cervical ripening over the use of a foley catheter alone for IOL in nulliparous term pregnant women. The results showed that the combination strategy could shorten the time to vaginal delivery in nulliparous women but not in multiparous women ( 59 ). Conclusion Since multiparous women benefit the most from IOL using the dinoprostone slow-release vaginal insert, the two combinations mentioned above may be considered. Our current study did not provide any recommendations on this issue due to its single-arm nature. The limitation of study is that it is retrospective in nature and a single-arm study. However, based on the results of the current study, further research is needed to evaluate nulliparous term pregnancies requiring IOL. Declarations Ethical approval: Ethical approval for this study was obtained from the ‘Buca Seyfi Demirsoy Training and Research Hospital’ on June 26, 2024, with the protocol number 2024/308. Consent for publication: Not applicable Consent to participate: All participiants were consented with informed consents approved by local ethical board. Availability of data and materials: The datasets used and/or analyzed in relation to the current study are available from the corresponding author upon reasonable request. Funding: The authors received no funding for this work. Compliance with ethical standards Acknowledgements: Not applicable Competing interests: The authors declare that they have no competing interests. Author contributions: Data analysis; UA, Project development: CA, Data Collection: OY, HAA, Manuscript writing; UA All authors reviewed and approved the final version, and no other person made a substantial contribution to the paper. References Tsakiridis I, Mamopoulos A, Athanasiadis A, Dagklis T. Induction of Labor: An Overview of Guidelines. Obstet Gynecol Surv. 2020 Jan;75(1):61-72. de Vaan, Marieke DT, et al. "Mechanical methods for induction of labour." Cochrane Database of Systematic Reviews 10 (2019). Marconi AM. Recent advances in the induction of labor. F1000Res. 2019;8. Connolly, Katherine A., et al. "A randomized trial of Foley balloon induction of labor trial in nulliparas (FIAT-N)." American Journal of Obstetrics and Gynecology 215.3 (2016): 392-e1. ACOG committee opinion no. 560: Medically indicated late-preterm and early-term deliveries. Obstet Gynecol. 2013 Apr;121(4):908-910. Migliorelli F, De Oliveira SS, Martinez de Tejada B. The ARRIVE trial: towards auniversal recommendation of induction of labor at 39 weeks? Eur J Obstet Gynecol Reprod Biol 2020;244:192e5. Society for Maternal-Fetal Medicine. "SMFM statement on elective induction of labor in low-risk nulliparous women at term: the ARRIVE trial." Am J Obstet Gynecol 221.1 (2019): B2-B4. Grobman WA, Rice MM, Reddy UM, Tita ATN, Silver RM, Mallett et al. Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network. Labor Induction versus Expectant Management in Low-Risk Nulliparous Women. N Engl J Med. 2018 Aug 09;379(6):513-523. Darney BG, Snowden JM, Cheng YW, Jacob L, Nicholson JM, Kaimal A, et al. Elective induction of labor at term compared with expectant management: maternal and neonatal outcomes. Obstet Gynecol. 2013 Oct;122(4):761-769. Middleton P, Shepherd E, Crowther CA. Induction of labour for improving birth outcomes for women at or beyond term. Cochrane Database Syst Rev 2018;5:CD004945 Yang MT, Yu MH, Yeh CC, Tseng WC. Labor pain-induced chordae tendineae rupture. Taiwan J Obstet Gynecol 2020;59:342e3 ACOG Practice Bulletin No. 107: Induction of labor. Obstet Gynecol. 2009 Aug;114(2 Pt 1):386-397. Gu N, Ru T, Wang Z, Dai Y, Zheng M, Xu B, Hu Y. Foley Catheter for Induction of Labor at Term: An Open-Label, Randomized Controlled Trial. PLoS One. 2015;10(8):e0136856. ACOG Practice Bulletin No. 135: Second-trimester abortion. Obstet Gynecol. 2013 Jun;121(6):1394-1406. Manly E, Hiersch L, Moloney A, Berndl A, Mei-Dan E, Zaltz A, et al. Comparing Foley catheter to prostaglandins for cervical ripening in multiparous women. J Obstet Gynaecol Can 2020;42:853e60. Ellis JA, Brown CM, Barger B, Carlson NS. Influence of maternal obesity on labor induction: a systematic review and meta-analysis. J Midwifery Wom Health 2019;64:55e67 Oglak SC, Bademkıran MH, Obut M. Predictor variables in the success of slow release dinoprostone used for cervical ripening in intrauterine growth restriction pregnancies. J Gynecol Obstet Hum Reprod 2020;49:101739 le Roux PA, Olarogun JO, Penny J, Anthony J. Oral and vaginal misoprostol compared with dinoprostone for induction of labor: a randomized controlled trial. Obstet Gynecol 2002; 99:201–5. Chioss G, Costantine MM, Bytautiene E, Betancourt A, Hankins GD, Saade GR, Longo M (2012) In vitro myometrial contractility profiles of different pharmacological agents used for induction of labor. Am J Perinatol 29(9):699–704. https://doi.org/10.1055/s-0032-1314891. Mundle S, Bracken H, Khedikar V, Mulik J, Faragher B, Easterling T, et al. Foley catheterisation versus oral misoprostol for induction of labour in hypertensive women in India (INFORM): a multicentre, open-label, randomised controlled trial. Lancet 2017;390:669e80. Chatsis V, Frey N. Misoprostol for cervical ripening and induction of labour: a review of clinical effectiveness, cost-effectiveness and guidelines [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2018 Nov 23. PMID 30907996 Shirley M. Dinoprostone vaginal insert: a review in cervical ripening. Drugs 2018;78:1615e24 Ayaz A, Shaukat S, Farooq MU, Mehmood K, Ahmad I, Ali Bahoo ML. Induction of labor: a comparative study of intravaginal misoprostol and dinoprostone. Taiwan J Obstet Gynecol. 2010 Jun;49(2):151-5. doi: 10.1016/S1028-4559(10)60032-0. PMID: 20708519. Edwards KI, Itzhak P. Estimated Date of Delivery. [Updated 2022 Oct 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK536986/ Laughon, S. Katherine MD, MS; Zhang, Jun PhD, MD; Troendle, James PhD; Sun, Liping MD, MS; Reddy, Uma M. MD, MPH. Using a Simplified Bishop Score to Predict Vaginal Delivery. Obstetrics & Gynecology 117(4):p 805-811, April 2011. | DOI: 10.1097/AOG.0b013e3182114ad2 American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2020. Diabetes Care. 2020;43(Suppl 1):S14-S31. ACOG Practice Bulletin No. 202: Gestational Hypertension and Preeclampsia. Obstet Gynecol. 2019;133(1):1. Locatelli, A., Vergani, P., Toso, L. et al. Perinatal outcome associated with oligohydramnios in uncomplicated term pregnancies. Arch Gynecol Obstet 269, 130–133 (2004). https://doi.org/10.1007/s00404-003-0525-6 Witter FR, Rocco LE, Johnson TR. A randomized trial of prostaglandin E2 in a controlled-release vaginal pessary for cervical ripening at term. Am J Obstet Gynecol 1992;166:830e4. Cundiff GW, Simpson ML, Koenig N, Lee T. Observational study of neonatal safety for outpatient labour induction priming with dinoprostone vaginal insert. J Obstet Gynaecol Can 2017;39:354e60. Pez V, Deruelle P, Kyheng M, Boyon C, Clouqueur E, Garabedian C. Cervical ripening and labor induction: evaluation of single balloon catheter compared to double balloon catheter and dinoprostone insert. Gynecol Obstet Fertil Senol 2018;46:570e4. Abdelaziz A, Mahmoud AA, Ellaithy MI, Abees SH. Pre-induction cervical ripening using two different dinoprostone vaginal preparations: a random ized clinical trial of tablets and slow release retrievable insert. Taiwan J Obstet Gynecol 2018;57:560e6. Duro-Gomez J, Garrido-Oyarzún MF, Rodríguez-Marín AB, de la Torre Gonzalez AJ, Arjona-Berral JE, Castelo-Branco C. What can we do to reduce the associated costs in induction of labour of intrauterine growth restriction foetuses at term? A cost-analysis study. Arch Gynecol Obstet 2017;296:483e8. Daykan Y, Biron-Shental T, Navve D, Miller N, Bustan M, Sukenik-Halevy R. Prediction of the efficacy of dinoprostone slow release vaginal insert (Propess) for cervical ripening: a prospective cohort study. J Obstet Gynaecol Res 2018;44:1739e46. Hacettepe Universitiy Institute of Population Studies. Turkey Demographic and Health Survey Main Report. 2008. [Internet] Avaliable from: http:/www.hipshacettepe. edu.tr . World Health Organization. The World Health Statistics report 2010; 2011. [Internet] Avaliable from: http: //www.who.int/whosis/whostat/2010/en/ [Google Scholar] Hacettepe Universitiy Institute of Population Studies. Turkey Demographic and Health Survey Main Report; 2008. [Internet] Avaliable from: http:/www.hipshacettepe. edu.tr/tnsa2013/data/TNSA-2013-ana-Rapor-tr.pdf . [Google Scholar] No authors listed. Appropriate technology for birth. Lancet. 1985;2:436–7. [PubMed] [Google Scholar] Ting NS, Ding DC, Wei YC. Comparison of the Dinoprostone Vaginal Insert and Dinoprostone Tablet for the Induction of Labor in Primipara: A Retrospective Cohort Study. J Clin Med. 2022 Jun 19;11(12):3519. doi: 10.3390/jcm11123519. PMID: 35743589; PMCID: PMC9225524. Yokoyama N, Suzuki S. Comparison of Obstetric Outcomes Between Controlled-Release Dinoprostone Vaginal Delivery System (PROPESS) and Administration of Oral Dinoprostone for Labor Induction in Multiparous Women at Term. Cureus. 2023 Jun 24;15(6):e40907. doi: 10.7759/cureus.40907. PMID: 37366476; PMCID: PMC10290566. Zhao L, Lin Y, Jiang TT, Wang L, Li M, Wang Y, et al. Vaginal delivery among women who underwent labor induction with vaginal dinoprostone (PGE2) insert: a retrospective study of 1656 women in China. J Matern Fetal Neonatal Med 2019;32:1721e7 Huang F, Chen H, Wu X, Li J, Guo J, Zhang X, Qiao Y. A model to predict delivery time following induction of labor at term with a dinoprostone vaginal insert: a retrospective study. Ir J Med Sci. 2024 Jun;193(3):1343-1350. doi: 10.1007/s11845-023-03568-3. Epub 2023 Nov 10. PMID: 37947994; PMCID: PMC11128390. Pevzner, Leo MD1; Rayburn, William F. MD2; Rumney, Pamela RNC1; Wing, Deborah A. MD1. Factors Predicting Successful Labor Induction With Dinoprostone and Misoprostol Vaginal Inserts. Obstetrics & Gynecology 114(2 Part 1):p 261-267, August 2009. | DOI: 10.1097/AOG.0b013e3181ad9377 Obut M, Aynaoğlu Yıldız G, Bademkıran MH, Oğlak SC, Yücel Çelik Ö, Ölmez F. Predictor Factors in the Success of Slow-Release Dinoprostone Used for Cervical Ripening in Pregnancies with Premature Rupture of Membranes. Eurasian J Med. 2022 Feb;54(1):72-76. doi: 10.5152/eurasianjmed.2022.21237. PMID: 35307633; PMCID: PMC9634876. Roos N, Sahlin L, Ekman-Ordeberg G, et al. Maternal risk factors for postterm pregnancy and cesarean delivery following labor induction. Acta Obstet Gynecol Scand 2010; 89: 1003–1010. Liu, W., Guo, L., Feng, L., Wang, J., Zhang, M., & Fan, X. (2024). Predictive Factors for the Success of Vaginal Dinoprostone for the Induction of Labour. International Journal of Women’s Health, 16, 1093–1101. https://doi.org/10.2147/IJWH.S461094 Wormer KC, Bauer A, Williford AE. Bishop Score. [Updated 2023 Sep 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470368/ Teixeira C, Lunet N, Rodrigues T, Barros H. The Bishop Score as a determinant of labour induction success: a systematic review and meta-analysis. Arch Gynecol Obstet. 286(3), 739–753. https://doi.org/10.1007/s00404-012-2341-3. (2012). Kolkman DG, Verhoeven CJ, Brinkhorst SJ, van der Post JA, Pajkrt E, Opmeer BC, Mol BW. The Bishop score as a predictor of labor induction success: a systematic review. Am J Perinatol. 30(8):625–630. https://doi.org/10.1055/s-0032-1331024. (2013). Hou L, Zhu Y, Ma X, Li J, Zhang W. Clinical parameters for prediction of successful labor induction after application of intravaginal dinoprostone in nulliparous Chinese women. Med Sci Monit. 2012 Aug;18(8):CR518-522. doi: 10.12659/msm.883273. PMID: 22847202; PMCID: PMC3560701. Intrapartum fetal heart rate monitoring: nomenclature, interpretation and general management principles. ACOG practice bulletin No 106. American College of Obstetricians and Gynecologists Obstet Gynecol 114, 192–202. (2009). Leduc, D., Biringer, A., Lee, L., Dy, J. Clinical Practice Obstetrics Committee; Special Contributors. Induction of labour. J Obstet Gynaecol Can. 35(9), 840–857. https://doi.org/10.1016/S1701-2163(15)30842-2. (2013). Anh ND, Duc TA, Ha NT, Giang DT, Dat DT, Thuong PH, Toan NK, Duc NT, Duc NM. Dinoprostone Vaginal Insert for Induction of Labor in Women with Low-Risk Pregnancies: A Prospective Study. Med Arch. 2022 Feb;76(1):39-44. doi: 10.5455/medarh.2022.76.39-44. PMID: 35422562; PMCID: PMC8976886. Zhang, Jun, Mark A. Klebanoff, and Rebecca DerSimonian. "Epidural analgesia in association with duration of labor and mode of delivery: a quantitative review." American journal of obstetrics and gynecology 180.4 (1999): 970-977. İleri, A., Yıldırım Karaca, S., Gölbaşı, H. et al. Diagnostic accuracy of pre-induction cervical elastography, volume, length, and uterocervical angle for the prediction of successful induction of labor with dinoprostone. Arch Gynecol Obstet 308, 1301–1311 (2023). https://doi.org/10.1007/s00404-023-07076-8 Yang, S.-W.; Kim, S.-Y.; Hwang, H.-S.; Kim, H.-S.; Sohn, I.-S.; Kwon, H.-S. The Uterocervical Angle Combined with Bishop Score as a Predictor for Successful Induction of Labor in Term Vaginal Delivery. J. Clin. Med. 2021, 10, 2033. https://doi.org/10.3390/jcm10092033 Atlıhan, Ufuk, and Umit Derundere. "THE ROLE OF UTEROCERVICAL ANGLE IN DETERMINING THE THREAT OF PRETERM BIRTH." Measurement 16: 17. Kansu-Celik H, Gun-Eryılmaz O, Dogan NU, Haktankaçmaz S, Cinar M, Yilmaz SS, Gülerman C. Prostaglandin E2 induction of labor and cervical ripening for term isolated oligohydramnios in pregnant women with Bishop score ≤ 5. J Chin Med Assoc. 2017 Mar;80(3):169-172. doi: 10.1016/j.jcma.2016.07.004. Epub 2016 Oct 10. PMID: 27745800. Edwards RK, Norris ML, West MD, Zornes C, Loeffler KA, Peck JD. Controlled Release Dinoprostone Insert and Foley Compared to Foley Alone: A Randomized Pilot Trial. Am J Perinatol. 2021 Aug;38(S 01):e57-e63. doi: 10.1055/s-0040-1705113. Epub 2020 Mar 2. PMID: 32120419; PMCID: PMC8049622. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4979391","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":359740782,"identity":"fc1ba59e-404b-4e95-82c3-ca96c4f2f274","order_by":0,"name":"Ufuk Atlihan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyUlEQVRIiWNgGAWjYDAC5sMNDAw2DAb8IE5CATFa2BKBWtIYDCQbQFoMSNFicADEI0YLfxtjAzNPwmFj4/OrEz88MGCQ5xc7gF+LxDGIFjOzG283SwAdZjhzdgJ+LQbyjQ3MvD8O25jdOLsBpCXB4DYhLWwQW2yMZ5zd/IMkLWYG/L3biLMF5JeDcxLSjSVu8G6zSDCQIOwX/jbmgw/eJFgb9vef3XzzR4WNPL80AS0gcABiH1ilBGHlSPYdIEX1KBgFo2AUjCQAAKPUQVo5TgZUAAAAAElFTkSuQmCC","orcid":"","institution":"Private Karatas Hospital","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Ufuk","middleName":"","lastName":"Atlihan","suffix":""},{"id":359740783,"identity":"15491962-9c73-41de-84d1-605b630a744f","order_by":1,"name":"Onur Yavuz","email":"","orcid":"","institution":"Dokuz Eylul University School of Medicine","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Onur","middleName":"","lastName":"Yavuz","suffix":""},{"id":359740784,"identity":"f07a28b2-0b90-4ff5-b4f3-2f19cfbcbacd","order_by":2,"name":"Can Ata","email":"","orcid":"","institution":"Izmir Democracy University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Can","middleName":"","lastName":"Ata","suffix":""},{"id":359740785,"identity":"7d474eb3-3989-42d4-9570-ed48c1362665","order_by":3,"name":"Huseyin Aytug Avsar","email":"","orcid":"","institution":"Izmir University Tınaztepe Galen Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Huseyin","middleName":"Aytug","lastName":"Avsar","suffix":""}],"badges":[],"createdAt":"2024-08-26 16:42:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4979391/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4979391/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":71641964,"identity":"e6c723b7-d5e7-403d-ae80-b3f05f563219","added_by":"auto","created_at":"2024-12-17 10:54:42","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":497638,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4979391/v1/7418a89e-6615-414f-b0c7-179f190def7d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Maternal and Fetal Factors Affecting the Effectiveness of Vaginal Dinoprostone in Labor Induction","fulltext":[{"header":"Introduction","content":"\u003cp\u003eInduction of labor (IOL) is a common obstetric intervention that uses artificial methods to stimulate the onset of labor by artificially initiating the process of cervical effacement, cervical dilation, and uterine contractions (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). IOL is often considered when prolonged pregnancy poses a risk of death or morbidity for the mother or child or upon the request of pregnant women at term (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). IOL is considered indicated when outcomes for the fetus, the mother, or both are considered better than expectant management, which means waiting for spontaneous onset of labor (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). It is an increasingly common practice in modern obstetrics to provide better care for both the fetus and the mother (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). For example, the rate of induction of labor more than doubled in 2006, reaching 22.5% of all births in the USA (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). The American College of Obstetricians and Gynecologists (ACOG) has a comprehensive list of recommendations for timing of delivery, including some of the common clinical scenarios listed for this purpose (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Also, ACOG recently endorsed elective induction of labor as a \u0026ldquo;reasonable\u0026rdquo; option following the publication of results from the ARRIVE (Randomized Trial of Induction Versus Expectant Management) study conducted by the Eunice Kennedy Shriver National Institute (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). However, the Society for Maternal-Fetal Medicine statement suggested that inducing labor at 39 weeks' gestation in low-risk nulliparous women provides maternal benefits without an increase in adverse neonatal effects (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). The New England Journal of Medicine published the ARRIVE study, which compared cesarean section (C/S) rates and perinatal outcomes in nulliparous pregnant who underwent elective induction of labor at 39 weeks of gestation with expectant management. The results showed a significantly lower C/S rate in the induction group and no statistically significant lower incidence of adverse perinatal outcomes (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Another published study found that the likelihood of a C/S was reduced in nulliparous and multiparous women who were electively induced between 37 and 40 weeks of pregnancy (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). It also found that women were not at increased risk of third or fourth degree tears or having an operative vaginal delivery, regardless of gestational age (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). However, a Cochrane systematic review also showed that IOL is beneficial because it is associated with fewer perinatal deaths or to improve birth outcomes in women after delivery (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Cervical ripening is an important precursor to successful labor induction, and is accompanied by adequate and strong uterine contractions at regular frequency (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). There are two main options for cervical ripening, mechanical methods and pharmacological methods (\u003cspan additionalcitationids=\"CR13 CR14 CR15\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Oxytocin may be one of the most popular pharmacologic agents for labor induction; however, it has minimal effects on cervical ripening (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Prostaglandin analogs, including dinoprostone, a synthetic preparation chemically identical to naturally occurring PGE2, and misoprostol, a synthetic PGE1 analog, not only have an effect on cervical ripening but also have an important role in the induction of labor (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Due to its benefits such as low price and easy storage (no refrigeration required), misoprostol may be the most commonly used pharmacological agent for labor induction worldwide (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). However, Misoprostol is not licensed for labor induction and has been widely used off-label for labor induction (via oral or vaginal administration) worldwide for many years (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). In contrast, a slow-release vaginal product used for vaginal dinoprostone administration contains 10 mg of dinoprostone dispersed throughout the matrix of a thin flat polymeric hydrogel drug delivery device designed to provide a controlled and constant release of dinoprostone from the reservoir at 0.3 mg/hr. The efficacy profile is more rapid and more variable in women without membrane rupture than in women with membrane rupture (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). The main advantage of the dinoprostone slow-release vaginal insert is that it enables rapid retrieval in the event of uterine tachysystole or abnormal fetal heart rate monitoring and has a low side effect profile (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Our study aimed to evaluate the maternal and fetal factors that play a role in the effectiveness of vaginal dinoprostone in labor induction.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e The present study was designed in a retrospective observational design following the Principles of Helsinki Declaration. Informed voluntary consent forms were obtained from all patients. The study received approval from the our hospital\u0026rsquo;s Ethics Committee (date: 26/06/2024, number: 2024/308). Our study included 780 patients whose pregnancy follow-ups and deliveries were performed in our hospital between March 2018 and 2024. Data from 620 patients who had a successful delivery with vaginal dinoprostone application and 120 patients who could not have a vaginal delivery were evaluated retrospectively. Inclusion criteria were singleton pregnancy, vertex presentation, \u0026gt;\u0026thinsp;36 weeks of gestation, bishop score\u0026thinsp;\u0026lt;\u0026thinsp;7, absence of labor signs and reassuring fetal heart rate. Gestational age was calculated using Naegele's rule and confirmed by early pregnancy ultrasound (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Exclusion criteria included abnormal placentation, antepartum bleeding, fetal malformation, history of C/S or uterine surgery, and other contraindications to vaginal delivery. Cervical dilatation, cervical effacement, cervical consistency, cervical position and station of fetal presenting part were evaluated in calculating the bishop score (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). The American Diabetes Association Criteria were used to diagnose gestational diabetes (GDM) (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). GDM was diagnosed if fasting blood glucose was above any of the criteria: 92 mg/dL, 1 hour: 180 mg/dL, 2 hours: 153 mg/dL. In pregnant women who have not previously been diagnosed with diabetes mellitus, a 75-g OGTT test is performed at 24\u0026ndash;28 weeks, and plasma glucose is measured during fasting, 1st and 2nd hours. It is appropriate to perform OGTT in the morning after an overnight fast of at least 8 hours (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). The American Diabetes Association Criteria were used to diagnose type-2 diabetes mellitus (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Diabetes is diagnosed if HbA1C is greater than or equal to 6.5%, fasting blood glucose is greater than or equal to 126 mg/dl, or two-hour blood glucose is \u0026gt;\u0026thinsp;200 mg/dl (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Pregnancy induced hypertension (PIH) was diagnosed in accordance with the most recent American College of Obstetricians and Gynecologists bulletin (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). The combination of hypertension and proteinuria is used for the diagnosis of preeclampsia. Hypertension is defined as blood pressure levels of at least 140 mm Hg as systolic or at least 90 mm Hg as diastolic in measurements taken four hours or longer after the 20th week of pregnancy in a woman whose blood pressure values were previously normal. Severe hypertension is considered when blood pressure is at least 160 mm Hg systolic or at least 110 mm Hg diastolic. To diagnose preeclampsia, women with hypertension also require the presence of proteinuria, defined as at least 300 mg in a 24-hour urine collection. PIH is diagnosed in patients who meet hypertension criteria for preeclampsia without proteinuria or serious additional problems (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).mAmniotic fluid index (AFI)\u0026thinsp;\u0026le;\u0026thinsp;5 is considered one of the most important criteria in the ultrasonographic diagnosis of oligohydramnios (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Routine fetal heart monitoring was performed for 2 hours before the dinoprostone vaginal slow-release system (Propess\u0026reg;, Ferring, Controlled Therapeutics Ltd, UK) and treatment was started after the fetal heart rate was observed to be normal. Posterior fornix dinoprostone placement was performed and maintained for a maximum of 12 hours in pregnant women without contraindications, according to the manufacturer's instructions. All participants underwent continuous fetal monitoring. According to the modified protocol per the manufacturer's recommendation, dinoprostone was removed in the presence of: uterine tachysystole (defined as more than five contractions in 10 minutes in a 30-minute period), non-reassuring fetal heart rate (NRFS), other nonspecific adverse events (intolerable painful uterine contractions), persistence in the vagina for \u0026gt;\u0026thinsp;12 hours, and spontaneous rupture of membranes. If regular uterine contractions were not noted 1 hour after removal of dinoprostone, intravenous oxytocin was additionally used to continue induction. All data, including BMI, age, parity, induction criteria, obstetric history, bishop score, reason for vaginal dinoprostone removal, time of delivery, neonatal weight, and Apgar score, were entered by the delivery room physician. The delivery room fetal monitoring monitor provided continuous close observation of fetal heart rate and uterine contraction patterns. Women with successful labor induction were divided into group 1, and women with unsuccessful labor induction were divided into group 2.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eStatistical analysis was performed by SPSS version 22.0 (IBM-Inc.-Chicago-USA). The normality of the distribution was evaluated with Kolmogorov-Smirnov. Not normally distributed parameters were analyzed with the Mann-Whitney U test. Chi-square test and Fisher precision test were used in the analysis of categorical data. Not normally distributed parameters were presented as median (minimum-maximum). Number and percentage (%) were used to express qualitative data. Results were evaluated at a 95% confidence interval (CI). The p value considered statistically significant was \u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eIn our study, the mean age of the women in group 2 was found to be significantly higher than that of women in group 1 (p\u0026thinsp;=\u0026thinsp;0.001). Bishop score at admission of women in group 1 was found to be significantly higher than women in group 2 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). BMI score of women in group 2 was found to be significantly higher than women in group 1 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The nulliparity rate of women in group 2 was found to be significantly higher than that of women in group 1 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The uterocervical angle measurement of women in group 2 was found to be significantly lower than women in group 1 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The time to delivery after insertion in group 2 women was found to be significantly higher than in group 1 women (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The time to delivery after retrieval in group 2 women was found to be significantly higher than in group 1 women (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic-and clinical-characteristics of the groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup I\u003c/p\u003e \u003cp\u003en:620\u003c/p\u003e \u003cp\u003e%79.4\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup II\u003c/p\u003e \u003cp\u003en:160\u003c/p\u003e \u003cp\u003e%20.6\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMaternal age (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (23\u0026ndash;43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31 (25\u0026ndash;40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGestational age (weeks)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40 (38\u0026ndash;41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40 (38\u0026ndash;41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBishop score at admission (n)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (1\u0026ndash;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (1\u0026ndash;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBody mass index (kg/m2)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28 (25\u0026ndash;31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30 (26\u0026ndash;34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eParity\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eNulliparity\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eMultiparity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e357 (57.6%)\u003c/p\u003e \u003cp\u003e263 (42.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e151 (94.4%)\u003c/p\u003e \u003cp\u003e9 (5.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIndications for induction\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eElective\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eOligohydramnios\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eGestational diabetes mellitus\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eType 2 diabetes mellitus\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003ePregnancy induced hypertension\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e480 (77.4%)\u003c/p\u003e \u003cp\u003e24 (3.9%)\u003c/p\u003e \u003cp\u003e49 (7.9%)\u003c/p\u003e \u003cp\u003e9 (1.5%)\u003c/p\u003e \u003cp\u003e58 (9.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e113 (70.6%)\u003c/p\u003e \u003cp\u003e5 (3.1%)\u003c/p\u003e \u003cp\u003e15 (9.4%)\u003c/p\u003e \u003cp\u003e5 (3.1%)\u003c/p\u003e \u003cp\u003e22 (13.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eUse of painless anesthesia\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e515 (83.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e141 (88.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eUterocervical angle (\u003c/b\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:^\\circ\\:\\)\u003c/span\u003e\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e100 (60\u0026ndash;140)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90 (60\u0026ndash;130)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTime to delivery after insertion (hours)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (7\u0026ndash;29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32 (21\u0026ndash;45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTime to delivery after retrieval (hours)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (4\u0026ndash;21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.5 (10\u0026ndash;29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe rate of women with a 1-minute Apgar score\u0026thinsp;\u0026ge;\u0026thinsp;8 in group 1 was found to be significantly higher than that of women in group 2 (p\u0026thinsp;=\u0026thinsp;0.006). The rate of women with a 5-minute Apgar score\u0026thinsp;\u0026ge;\u0026thinsp;8 in group 1 was found to be significantly higher than that of women in group 2 (p\u0026thinsp;=\u0026thinsp;0.04).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFetal outcomes between the groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup I\u003c/p\u003e \u003cp\u003en:620\u003c/p\u003e \u003cp\u003e%79.4\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup II\u003c/p\u003e \u003cp\u003en:160\u003c/p\u003e \u003cp\u003e%20.6\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFetal weight (grams)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3180\u003c/p\u003e \u003cp\u003e(2340\u0026ndash;4310)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3165\u003c/p\u003e \u003cp\u003e(2330\u0026ndash;4290)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eApgar score (1-minute)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\le\\:\\)\u003c/span\u003e\u003c/span\u003e\u003cb\u003e7\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\ge\\:\\)\u003c/span\u003e\u003c/span\u003e\u003cb\u003e8\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e180 (29%)\u003c/p\u003e \u003cp\u003e440 (71%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65 (40.6%)\u003c/p\u003e \u003cp\u003e95 (59.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eApgar score (5-minute)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\le\\:\\)\u003c/span\u003e\u003c/span\u003e\u003cb\u003e7\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\ge\\:\\)\u003c/span\u003e\u003c/span\u003e\u003cb\u003e8\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (2.9%)\u003c/p\u003e \u003cp\u003e602 (97.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (6.3%)\u003c/p\u003e \u003cp\u003e150 (93.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe main purpose of the IOL is to ensure timely cervical ripening and successful vaginal birth. In our study, it was found that 79.4% of term pregnancies treated with dinoprostone slow-release vaginal insert for IOL had a successful vaginal delivery rate. This success rate was consistent with many other previous studies with a successful vaginal delivery rate ranging from approximately 70\u0026ndash;90% after using a dinoprostone slow-release vaginal insert for the IOL (\u003cspan additionalcitationids=\"CR30 CR31 CR32 CR33\" citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). In the 2008 report of the Turkey Demographic and Health Survey (TDHS), the C/S rate was found to be 37%, and in the TDHS-2013 report, it was 48% (\u003cspan additionalcitationids=\"CR36\" citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). These rates are significantly higher than the 15% rate given as an acceptable cesarean delivery rate by the World Health Organization (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). In light of this information, the successful birth rate data in our study reveal that dinoprostone administration is an effective method for successful initiation of labor. In our study, we demonstrated that parity is one of the most important determinants in achieving successful vaginal delivery in term pregnancies treated with dinoprostone slow-release vaginal insert for IOL. 96.7% of all multiparous women had a successful vaginal delivery, and in the nulliparous group, the rate of successful vaginal delivery after dinoprostone slow-release vaginal insert treatment was determined as 70.2%. However, there are different results in the literature regarding the successful delivery rates of dinoprostone application in multiparous and nulliparous pregnant women (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e).In a retrospective study by Zhao et al., results revealed that parity was the strongest and most significant predictor of successful vaginal delivery in term pregnancies when comparing the efficacy of dinoprostone slow-release vaginal insert between multiparous and nulliparous women (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). In the study by Huang et al., parity was proven to be the main factor contributing to the time to vaginal delivery, and a significant decrease in the time to vaginal delivery was observed in multiparous women compared to nulliparous women (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). In present study, the mean age was found to be significantly higher in the unsuccessful vaginal delivery group. In the study conducted by Pevzner et al., it was revealed that a maternal age of \u0026lt;\u0026thinsp;35 years significantly supports successful labor induction (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e). Similarly, in the study conducted by Obut et al., it was revealed that increasing maternal age reduces the probability of vaginal delivery (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e). In present study, no statistically significant relationship was found between gestational age, birth weight, IOL indication and use of painless anesthesia parameters and successful vaginal delivery. Possible reasons could be the small sample size, because if the sample size is limited, other less important factors cannot reach the level of statistical significance. Only the most significant and important factor can be repeated in almost all studies. In the literature, labor induction is shown to be more likely to be successful in women with lower BMI (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e). In our study, similar to the literature, BMI was found to be significantly lower in pregnant women who had successful vaginal births. Higher bishop scores have traditionally been associated with higher vaginal birth success rates (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e). However, there are studies that question the reliability of bishop scores in predicting final birth outcome (\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e). In our study, bishop scores were found to be significantly higher in patients who had a successful vaginal delivery with vaginal dinoprostone administration, based on the results obtained in most randomized trials and clinical guidelines for labor induction (\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e). In our study, the 1st and 5th minute Apgar scores of patients who had a successful vaginal delivery were found to be significantly higher. In the literature, neonatal outcomes were found to be positive in pregnancies induced with dinoprostone (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e). In our study, time to delivery after insertion (hours) and time to delivery after retrieval (hours) were found to be significantly lower in patients who had a successful vaginal delivery compared to patients who could not have a vaginal delivery. Similarly, in the literature, the time to delivery after insertion (hours) and time to delivery after retrieval (hours) were found to be lower in patients who had a successful delivery with dinoprostone compared to patients who underwent spontaneous delivery follow-up or underwent C/S due to induction failure. Whether epidural analgesia increases the risk of cesarean delivery and prolongs labor has been intensely debated during the last decade (\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e). Unfortunately, good studies are few and most have had small numbers of subjects. In the study conducted by Hasegawa et al., it was stated that epidural analgesia was associated with slow progress of labor, which increased the rate of instrumental delivery. However, in our study, no relationship was found between the use of painless anesthesia and the success of vaginal delivery. In our study, uterocervical angle measurement was found to be significantly higher in patients who had successful vaginal delivery compared to patients who could not have vaginal delivery. However, in the study conducted by İleri et al., no relationship was found between uterocervical angle and delivery success in pregnancies induced with dinoprostone (\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e). In the study conducted by Yang et al., it was stated that the use of uterocervical angle measurement and bishop score together could help predict the success of labor induction (\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e). In another study in the literature, it was stated that uterocervical angle could be used in addition to cervical length measurement in the risk of premature birth and term pregnancy in predicting delivery success (\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e). Our study showed that the success rate of vaginal delivery in nulliparous term pregnancies was only 70.2%, suggesting that other strategies may be considered instead of the dinoprostone slow-release vaginal insert for IOL in nulliparous term pregnancies. In fact, many studies have supported the use of PGE1, and some have suggested the combination of mechanical methods and pharmacological methods or the use of mechanical or pharmacological agents alone, compared with PGE2 (\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e). A randomized controlled trial by Edwards et al. compared the combined use of a dinoprostone slow-release vaginal insert and a foley catheter with the use of a foley catheter alone for cervical ripening and labor induction. This study supported the combined use of a dinoprostone slow-release vaginal insert and a foley catheter for cervical ripening over the use of a foley catheter alone for IOL in nulliparous term pregnant women. The results showed that the combination strategy could shorten the time to vaginal delivery in nulliparous women but not in multiparous women (\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e).\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eSince multiparous women benefit the most from IOL using the dinoprostone slow-release vaginal insert, the two combinations mentioned above may be considered. Our current study did not provide any recommendations on this issue due to its single-arm nature. The limitation of study is that it is retrospective in nature and a single-arm study. However, based on the results of the current study, further research is needed to evaluate nulliparous term pregnancies requiring IOL.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval:\u003c/strong\u003e Ethical approval for this study was obtained from the \u0026lsquo;Buca Seyfi Demirsoy Training and Research Hospital\u0026rsquo; on June 26, 2024, with the protocol number 2024/308.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate:\u0026nbsp;\u003c/strong\u003eAll participiants were consented with informed consents approved by local ethical board. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eThe datasets used and/or analyzed in relation to the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e The authors received no funding for this work. Compliance with ethical standards\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e The authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions:\u003c/strong\u003e Data analysis; UA, Project development: CA, Data Collection: OY, HAA, Manuscript writing; UA\u003c/p\u003e\n\u003cp\u003eAll authors reviewed and approved the final version, and no other person made a substantial contribution to the paper.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eTsakiridis I, Mamopoulos A, Athanasiadis A, Dagklis T. Induction of Labor: An Overview of Guidelines. Obstet Gynecol Surv. 2020 Jan;75(1):61-72. \u003c/li\u003e\n\u003cli\u003ede Vaan, Marieke DT, et al. \u0026quot;Mechanical methods for induction of labour.\u0026quot; Cochrane Database of Systematic Reviews 10 (2019).\u003c/li\u003e\n\u003cli\u003eMarconi AM. Recent advances in the induction of labor. F1000Res. 2019;8.\u003c/li\u003e\n\u003cli\u003eConnolly, Katherine A., et al. \u0026quot;A randomized trial of Foley balloon induction of labor trial in nulliparas (FIAT-N).\u0026quot; American Journal of Obstetrics and Gynecology 215.3 (2016): 392-e1.\u003c/li\u003e\n\u003cli\u003eACOG committee opinion no. 560: Medically indicated late-preterm and early-term deliveries. Obstet Gynecol. 2013 Apr;121(4):908-910.\u003c/li\u003e\n\u003cli\u003eMigliorelli F, De Oliveira SS, Martinez de Tejada B. The ARRIVE trial: towards auniversal recommendation of induction of labor at 39 weeks? Eur J Obstet Gynecol Reprod Biol 2020;244:192e5.\u003c/li\u003e\n\u003cli\u003eSociety for Maternal-Fetal Medicine. \u0026quot;SMFM statement on elective induction of labor in low-risk nulliparous women at term: the ARRIVE trial.\u0026quot; Am J Obstet Gynecol 221.1 (2019): B2-B4.\u003c/li\u003e\n\u003cli\u003eGrobman WA, Rice MM, Reddy UM, Tita ATN, Silver RM, Mallett et al. Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal\u0026ndash;Fetal Medicine Units Network. Labor Induction versus Expectant Management in Low-Risk Nulliparous Women. N Engl J Med. 2018 Aug 09;379(6):513-523.\u003c/li\u003e\n\u003cli\u003eDarney BG, Snowden JM, Cheng YW, Jacob L, Nicholson JM, Kaimal A, et al. Elective induction of labor at term compared with expectant management: maternal and neonatal outcomes. Obstet Gynecol. 2013 Oct;122(4):761-769.\u003c/li\u003e\n\u003cli\u003eMiddleton P, Shepherd E, Crowther CA. Induction of labour for improving birth outcomes for women at or beyond term. Cochrane Database Syst Rev 2018;5:CD004945\u003c/li\u003e\n\u003cli\u003eYang MT, Yu MH, Yeh CC, Tseng WC. Labor pain-induced chordae tendineae rupture. Taiwan J Obstet Gynecol 2020;59:342e3\u003c/li\u003e\n\u003cli\u003eACOG Practice Bulletin No. 107: Induction of labor. Obstet Gynecol. 2009 Aug;114(2 Pt 1):386-397.\u003c/li\u003e\n\u003cli\u003eGu N, Ru T, Wang Z, Dai Y, Zheng M, Xu B, Hu Y. Foley Catheter for Induction of Labor at Term: An Open-Label, Randomized Controlled Trial. PLoS One. 2015;10(8):e0136856.\u003c/li\u003e\n\u003cli\u003eACOG Practice Bulletin No. 135: Second-trimester abortion. Obstet Gynecol. 2013 Jun;121(6):1394-1406.\u003c/li\u003e\n\u003cli\u003eManly E, Hiersch L, Moloney A, Berndl A, Mei-Dan E, Zaltz A, et al. Comparing Foley catheter to prostaglandins for cervical ripening in multiparous women. J Obstet Gynaecol Can 2020;42:853e60.\u003c/li\u003e\n\u003cli\u003eEllis JA, Brown CM, Barger B, Carlson NS. Influence of maternal obesity on labor induction: a systematic review and meta-analysis. J Midwifery Wom Health 2019;64:55e67\u003c/li\u003e\n\u003cli\u003eOglak SC, Bademkıran MH, Obut M. Predictor variables in the success of slow release dinoprostone used for cervical ripening in intrauterine growth restriction pregnancies. J Gynecol Obstet Hum Reprod 2020;49:101739\u003c/li\u003e\n\u003cli\u003ele Roux PA, Olarogun JO, Penny J, Anthony J. Oral and vaginal misoprostol compared with dinoprostone for induction of labor: a randomized controlled trial. Obstet Gynecol 2002; 99:201\u0026ndash;5.\u003c/li\u003e\n\u003cli\u003eChioss G, Costantine MM, Bytautiene E, Betancourt A, Hankins GD, Saade GR, Longo M (2012) In vitro myometrial contractility profiles of different pharmacological agents used for induction of labor. Am J Perinatol 29(9):699\u0026ndash;704. https://doi.org/10.1055/s-0032-1314891.\u003c/li\u003e\n\u003cli\u003eMundle S, Bracken H, Khedikar V, Mulik J, Faragher B, Easterling T, et al. Foley catheterisation versus oral misoprostol for induction of labour in hypertensive women in India (INFORM): a multicentre, open-label, randomised controlled trial. Lancet 2017;390:669e80.\u003c/li\u003e\n\u003cli\u003eChatsis V, Frey N. Misoprostol for cervical ripening and induction of labour: a review of clinical effectiveness, cost-effectiveness and guidelines [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2018 Nov 23. PMID 30907996\u003c/li\u003e\n\u003cli\u003eShirley M. Dinoprostone vaginal insert: a review in cervical ripening. Drugs 2018;78:1615e24\u003c/li\u003e\n\u003cli\u003eAyaz A, Shaukat S, Farooq MU, Mehmood K, Ahmad I, Ali Bahoo ML. Induction of labor: a comparative study of intravaginal misoprostol and dinoprostone. Taiwan J Obstet Gynecol. 2010 Jun;49(2):151-5. doi: 10.1016/S1028-4559(10)60032-0. PMID: 20708519.\u003c/li\u003e\n\u003cli\u003eEdwards KI, Itzhak P. Estimated Date of Delivery. [Updated 2022 Oct 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK536986/\u003c/li\u003e\n\u003cli\u003eLaughon, S. Katherine MD, MS; Zhang, Jun PhD, MD; Troendle, James PhD; Sun, Liping MD, MS; Reddy, Uma M. MD, MPH. Using a Simplified Bishop Score to Predict Vaginal Delivery. Obstetrics \u0026amp; Gynecology 117(4):p 805-811, April 2011. | DOI: 10.1097/AOG.0b013e3182114ad2\u003c/li\u003e\n\u003cli\u003eAmerican Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2020. Diabetes Care. 2020;43(Suppl 1):S14-S31.\u003c/li\u003e\n\u003cli\u003eACOG Practice Bulletin No. 202: Gestational Hypertension and Preeclampsia. Obstet Gynecol. 2019;133(1):1.\u003c/li\u003e\n\u003cli\u003eLocatelli, A., Vergani, P., Toso, L. et al. Perinatal outcome associated with oligohydramnios in uncomplicated term pregnancies. Arch Gynecol Obstet 269, 130\u0026ndash;133 (2004). https://doi.org/10.1007/s00404-003-0525-6\u003c/li\u003e\n\u003cli\u003eWitter FR, Rocco LE, Johnson TR. A randomized trial of prostaglandin E2 in a controlled-release vaginal pessary for cervical ripening at term. Am J Obstet Gynecol 1992;166:830e4.\u003c/li\u003e\n\u003cli\u003eCundiff GW, Simpson ML, Koenig N, Lee T. Observational study of neonatal safety for outpatient labour induction priming with dinoprostone vaginal insert. J Obstet Gynaecol Can 2017;39:354e60.\u003c/li\u003e\n\u003cli\u003ePez V, Deruelle P, Kyheng M, Boyon C, Clouqueur E, Garabedian C. Cervical ripening and labor induction: evaluation of single balloon catheter compared to double balloon catheter and dinoprostone insert. Gynecol Obstet Fertil Senol 2018;46:570e4. \u003c/li\u003e\n\u003cli\u003eAbdelaziz A, Mahmoud AA, Ellaithy MI, Abees SH. Pre-induction cervical ripening using two different dinoprostone vaginal preparations: a random ized clinical trial of tablets and slow release retrievable insert. Taiwan J Obstet Gynecol 2018;57:560e6.\u003c/li\u003e\n\u003cli\u003eDuro-Gomez J, Garrido-Oyarz\u0026uacute;n MF, Rodr\u0026iacute;guez-Mar\u0026iacute;n AB, de la Torre Gonzalez AJ, Arjona-Berral JE, Castelo-Branco C. What can we do to reduce the associated costs in induction of labour of intrauterine growth restriction foetuses at term? A cost-analysis study. Arch Gynecol Obstet 2017;296:483e8.\u003c/li\u003e\n\u003cli\u003eDaykan Y, Biron-Shental T, Navve D, Miller N, Bustan M, Sukenik-Halevy R. Prediction of the efficacy of dinoprostone slow release vaginal insert (Propess) for cervical ripening: a prospective cohort study. J Obstet Gynaecol Res 2018;44:1739e46.\u003c/li\u003e\n\u003cli\u003eHacettepe Universitiy Institute of Population Studies. Turkey Demographic and Health Survey Main Report. 2008. [Internet] Avaliable from: http:/www.hipshacettepe. edu.tr .\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. The World Health Statistics report 2010; 2011. [Internet] Avaliable from: http: //www.who.int/whosis/whostat/2010/en/ [Google Scholar]\u003c/li\u003e\n\u003cli\u003eHacettepe Universitiy Institute of Population Studies. Turkey Demographic and Health Survey Main Report; 2008. [Internet] Avaliable from: http:/www.hipshacettepe. edu.tr/tnsa2013/data/TNSA-2013-ana-Rapor-tr.pdf . [Google Scholar]\u003c/li\u003e\n\u003cli\u003eNo authors listed. Appropriate technology for birth. Lancet. 1985;2:436\u0026ndash;7. [PubMed] [Google Scholar]\u003c/li\u003e\n\u003cli\u003eTing NS, Ding DC, Wei YC. Comparison of the Dinoprostone Vaginal Insert and Dinoprostone Tablet for the Induction of Labor in Primipara: A Retrospective Cohort Study. J Clin Med. 2022 Jun 19;11(12):3519. doi: 10.3390/jcm11123519. PMID: 35743589; PMCID: PMC9225524.\u003c/li\u003e\n\u003cli\u003eYokoyama N, Suzuki S. Comparison of Obstetric Outcomes Between Controlled-Release Dinoprostone Vaginal Delivery System (PROPESS) and Administration of Oral Dinoprostone for Labor Induction in Multiparous Women at Term. Cureus. 2023 Jun 24;15(6):e40907. doi: 10.7759/cureus.40907. PMID: 37366476; PMCID: PMC10290566.\u003c/li\u003e\n\u003cli\u003eZhao L, Lin Y, Jiang TT, Wang L, Li M, Wang Y, et al. Vaginal delivery among women who underwent labor induction with vaginal dinoprostone (PGE2) insert: a retrospective study of 1656 women in China. J Matern Fetal Neonatal Med 2019;32:1721e7\u003c/li\u003e\n\u003cli\u003eHuang F, Chen H, Wu X, Li J, Guo J, Zhang X, Qiao Y. A model to predict delivery time following induction of labor at term with a dinoprostone vaginal insert: a retrospective study. Ir J Med Sci. 2024 Jun;193(3):1343-1350. doi: 10.1007/s11845-023-03568-3. Epub 2023 Nov 10. PMID: 37947994; PMCID: PMC11128390.\u003c/li\u003e\n\u003cli\u003ePevzner, Leo MD1; Rayburn, William F. MD2; Rumney, Pamela RNC1; Wing, Deborah A. MD1. Factors Predicting Successful Labor Induction With Dinoprostone and Misoprostol Vaginal Inserts. Obstetrics \u0026amp; Gynecology 114(2 Part 1):p 261-267, August 2009. | DOI: 10.1097/AOG.0b013e3181ad9377\u003c/li\u003e\n\u003cli\u003eObut M, Aynaoğlu Yıldız G, Bademkıran MH, Oğlak SC, Y\u0026uuml;cel \u0026Ccedil;elik \u0026Ouml;, \u0026Ouml;lmez F. Predictor Factors in the Success of Slow-Release Dinoprostone Used for Cervical Ripening in Pregnancies with Premature Rupture of Membranes. Eurasian J Med. 2022 Feb;54(1):72-76. doi: 10.5152/eurasianjmed.2022.21237. PMID: 35307633; PMCID: PMC9634876.\u003c/li\u003e\n\u003cli\u003eRoos N, Sahlin L, Ekman-Ordeberg G, et al. Maternal risk factors for postterm pregnancy and cesarean delivery following labor induction. Acta Obstet Gynecol Scand 2010; 89: 1003\u0026ndash;1010.\u003c/li\u003e\n\u003cli\u003eLiu, W., Guo, L., Feng, L., Wang, J., Zhang, M., \u0026amp; Fan, X. (2024). Predictive Factors for the Success of Vaginal Dinoprostone for the Induction of Labour. International Journal of Women\u0026rsquo;s Health, 16, 1093\u0026ndash;1101. https://doi.org/10.2147/IJWH.S461094\u003c/li\u003e\n\u003cli\u003eWormer KC, Bauer A, Williford AE. Bishop Score. [Updated 2023 Sep 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470368/\u003c/li\u003e\n\u003cli\u003eTeixeira C, Lunet N, Rodrigues T, Barros H. The Bishop Score as a determinant of labour induction success: a systematic review and meta-analysis. Arch Gynecol Obstet. 286(3), 739\u0026ndash;753. https://doi.org/10.1007/s00404-012-2341-3. (2012).\u003c/li\u003e\n\u003cli\u003eKolkman DG, Verhoeven CJ, Brinkhorst SJ, van der Post JA, Pajkrt E, Opmeer BC, Mol BW. The Bishop score as a predictor of labor induction success: a systematic review. Am J Perinatol. 30(8):625\u0026ndash;630. https://doi.org/10.1055/s-0032-1331024. (2013).\u003c/li\u003e\n\u003cli\u003eHou L, Zhu Y, Ma X, Li J, Zhang W. Clinical parameters for prediction of successful labor induction after application of intravaginal dinoprostone in nulliparous Chinese women. Med Sci Monit. 2012 Aug;18(8):CR518-522. doi: 10.12659/msm.883273. PMID: 22847202; PMCID: PMC3560701.\u003c/li\u003e\n\u003cli\u003eIntrapartum fetal heart rate monitoring: nomenclature, interpretation and general management principles. ACOG practice bulletin No 106. American College of Obstetricians and Gynecologists Obstet Gynecol 114, 192\u0026ndash;202. (2009).\u003c/li\u003e\n\u003cli\u003eLeduc, D., Biringer, A., Lee, L., Dy, J. Clinical Practice Obstetrics Committee; Special Contributors. Induction of labour. J Obstet Gynaecol Can. 35(9), 840\u0026ndash;857. https://doi.org/10.1016/S1701-2163(15)30842-2. (2013).\u003c/li\u003e\n\u003cli\u003eAnh ND, Duc TA, Ha NT, Giang DT, Dat DT, Thuong PH, Toan NK, Duc NT, Duc NM. Dinoprostone Vaginal Insert for Induction of Labor in Women with Low-Risk Pregnancies: A Prospective Study. Med Arch. 2022 Feb;76(1):39-44. doi: 10.5455/medarh.2022.76.39-44. PMID: 35422562; PMCID: PMC8976886.\u003c/li\u003e\n\u003cli\u003eZhang, Jun, Mark A. Klebanoff, and Rebecca DerSimonian. \u0026quot;Epidural analgesia in association with duration of labor and mode of delivery: a quantitative review.\u0026quot; American journal of obstetrics and gynecology 180.4 (1999): 970-977.\u003c/li\u003e\n\u003cli\u003eİleri, A., Yıldırım Karaca, S., G\u0026ouml;lbaşı, H. et al. Diagnostic accuracy of pre-induction cervical elastography, volume, length, and uterocervical angle for the prediction of successful induction of labor with dinoprostone. Arch Gynecol Obstet 308, 1301\u0026ndash;1311 (2023). https://doi.org/10.1007/s00404-023-07076-8\u003c/li\u003e\n\u003cli\u003eYang, S.-W.; Kim, S.-Y.; Hwang, H.-S.; Kim, H.-S.; Sohn, I.-S.; Kwon, H.-S. The Uterocervical Angle Combined with Bishop Score as a Predictor for Successful Induction of Labor in Term Vaginal Delivery. J. Clin. Med. 2021, 10, 2033. https://doi.org/10.3390/jcm10092033\u003c/li\u003e\n\u003cli\u003eAtlıhan, Ufuk, and Umit Derundere. \u0026quot;THE ROLE OF UTEROCERVICAL ANGLE IN DETERMINING THE THREAT OF PRETERM BIRTH.\u0026quot; Measurement 16: 17.\u003c/li\u003e\n\u003cli\u003eKansu-Celik H, Gun-Eryılmaz O, Dogan NU, Haktanka\u0026ccedil;maz S, Cinar M, Yilmaz SS, G\u0026uuml;lerman C. Prostaglandin E2 induction of labor and cervical ripening for term isolated oligohydramnios in pregnant women with Bishop score \u0026le; 5. J Chin Med Assoc. 2017 Mar;80(3):169-172. doi: 10.1016/j.jcma.2016.07.004. Epub 2016 Oct 10. PMID: 27745800.\u003c/li\u003e\n\u003cli\u003eEdwards RK, Norris ML, West MD, Zornes C, Loeffler KA, Peck JD. Controlled Release Dinoprostone Insert and Foley Compared to Foley Alone: A Randomized Pilot Trial. Am J Perinatol. 2021 Aug;38(S 01):e57-e63. doi: 10.1055/s-0040-1705113. Epub 2020 Mar 2. PMID: 32120419; PMCID: PMC8049622.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Dinoprostone, Induction of Labor, Nulliparity, Multiparity","lastPublishedDoi":"10.21203/rs.3.rs-4979391/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4979391/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eInduction of labor (IOL) is a common obstetric intervention used to encourage the onset of labor. The aim of study was to evaluate the maternal and fetal factors that play a role in the efficacy of vaginal dinoprostone in labor induction.\u003c/p\u003e\u003ch2\u003eMaterials and Methods\u003c/h2\u003e \u003cp\u003eOur study included 780 patients who underwent pregnancy follow-up and delivery in our hospital between March 2018 and 2024. All data including body mass index (BMI), age, parity, induction criteria, obstetric history, bishop score, time of delivery, newborn weight and Apgar score were entered by the delivery room physician. Data from 620 patients who had a successful delivery with vaginal dinoprostone application and 120 patients who could not have a vaginal delivery were evaluated retrospectively.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe BMI value of women in Group 2 at admission to the hospital was found to be significantly higher than that of women in Group 1 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The Bishop score of women in Group 1 at admission to the hospital was found to be significantly higher than that of women in Group 2 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The nulliparity rate of women in Group 2 was found to be significantly higher than those in Group 1 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The uterocervical angle measurement of women in Group 2 was found to be significantly lower than those in Group 1 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The rate of newborns with 1st and 5th minute Apgar scores\u0026thinsp;\u0026ge;\u0026thinsp;8 in Group 1 was found to be significantly higher than those in Group 2 (p\u0026thinsp;=\u0026thinsp;0.006, p\u0026thinsp;=\u0026thinsp;0.04, respectively).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eIt was determined that parity was one of the important determinants in achieving vaginal delivery in pregnancies where dinoprostone vaginal insert was applied. It was determined that multiparous women benefited more from induction with dinoprostone. However, according to the results of our study, more research is needed to evaluate nulliparous pregnancies requiring induction.\u003c/p\u003e","manuscriptTitle":"Maternal and Fetal Factors Affecting the Effectiveness of Vaginal Dinoprostone in Labor Induction","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-09-30 17:47:24","doi":"10.21203/rs.3.rs-4979391/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f24eaa63-c257-4ce1-9842-ee8a3f05746c","owner":[],"postedDate":"September 30th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-12-17T10:53:55+00:00","versionOfRecord":[],"versionCreatedAt":"2024-09-30 17:47:24","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4979391","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4979391","identity":"rs-4979391","version":["v1"]},"buildId":"zQwnuV7TCBrMSSSToR1PI","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}