Maternal and Neonatal Morbidity Following Dinoprostone Alone Versus Dinoprostone Combined With Laminaria for Cervical Ripening In Women with Poor Bishop Score: A Randomized Controlled Trial

Abstract

Objective: To compare the maternal and neonatal morbidity following cervical ripening with dinoprostone alone and dinoprostone in combination with laminaria in women undergoing induction of labor with poor Bishop scores.

Study Design: Randomized controlled trial.

Place and Duration of Study: MCH Unit-II, Pakistan Institute of Medical Sciences, Islamabad. From February 2024 to August 2024.

Methodology: A total of 146 women at term with singleton pregnancies and unfavorable cervix (Bishop score ≤4) undergoing induction of labor were included in this study. Participants were randomized into two equal groups, where Group A received dinoprostone alone, whereas Group B received dinoprostone combined with laminaria for cervical ripening. The two groups were compared for cervical ripening outcomes, and maternal and maternal and neonatal morbidity. 

Results: Women in Group B demonstrated significantly better cervical ripening than those in Group A, with higher post-ripening Bishop score (8.23±1.24 vs. 6.78±1.57; p<0.001), and shorter induction-to-active labor interval (8.47±2.74 vs. 10.56±2.59 hours; p<0.001) and induction-to-delivery interval (13.55±3.96 vs. 17.11±6.17 hours; p<0.001). Similarly, vaginal delivery was more frequent (84.9% vs. 69.9%; p=0.030), while cesarean section (15.1% vs. 30.1%; p=0.030) and failed induction (6.9% vs. 17.8%; p=0.044) were significantly lower in Group B compared to Group A. A comparable maternal and neonatal morbidity outcomes were observed between the groups (p>0.05, for all).

Conclusion: The addition of laminaria to dinoprostone improve cervical ripening, shorten labor duration, and reduce cesarean section and failed induction rates without increasing the maternal or neonatal morbidity.