Comparative study of single versus double time application of dinoprostone E2 gel on the induction of labor in term pregnancy and it’s fetomaternal outcomes

Santosh Khajotia, Manoj Gupta, Mool Chand Khichar, Madhuri Sharma, Kavita Choudhary


Background: Labor is defined as a cascade of effective uterine contractions leading to progressive effacement and dilatation of cervix resulting in the expulsion of the fetus, placenta and the membranes. The aim of the study was to evaluate the effect of single time and double time application of dinoprostone E2 gel and to compare fetomaternal outcomes after single and double application of dinoprostone E2 gel and its complications.

Methods: This was a prospective observational study conducted on 200 pregnant females with a period of gestation ≥37 completed weeks between 1st January 2020 to 31st January 2021. Group A included females undergoing single time application of PGE2 gel and in group B, second dose applied after 6 hrs of first dose if there was no improvement in Bishop score. If necessary, oxytocin for augmentation of labor was started only 6 hrs after the last dose.

Results: Mean age in group A was 24.38±4.37 years and in group B was 24.02±3.76 years and this difference was not found statistically significant (p>0.05). Majority of cases had vaginal delivery. In group A, 28% cases had LSCS delivery while in group B, 17% cases had LSCS delivery (p>0.05). There was significant increase in mean Bishop score after second dose of PGE2 gel in double application group by 3.24 assessed at 12 hours after induction. Double times application of gel resulted in a smaller number of failed inductions i.e.; 23 out of 100 cases in single application group and 7 out of 100 cases in double application group. Main maternal complication was nausea and vomiting which was 5% cases in group A and 11% cases in group B.

Conclusions: Double times application of dinoprostone gel resulted in improved Bishop score, facilitates the process of induction, increased number of successful inductions, shortened application delivery interval and decreased cesarean section rate compared to single application. There was slight increase in maternal and fetal complications with double times application.


Dinoprostone, Induction of labour, Augmentation

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