Factors predicting unsuccessful labor induction with dinoprostone in post-term pregnancy with unfavorable cervix

Objective. - To identify predictive factors for unsuccessful induction of labor within 24 hours after dinoprostone insertion in post-term pregnancy with unfavorable cervix. Material and methods. - We retrospectively reviewed 325 singleton pregnancies with a diagnosis of post-term pregnancy and unfavorable cervix (Bishop score < 6) during the period January 2012-Decembre 2012. Patients were classified into 2 groups: successful labor, defined as cervical ripening, within 24 hours after dinoprostone insertion (Group R; n=248; 76.3%) or failure group (Group E; n=77; 23.7%). Antepartum and perpartum characteristics of women were compared. Results. - Nulliparity (74.0 versus 56.0%; OR= 2.23; 95% CI: 1.27-4.00; P=0.005), gestational age <= 41 SA + 4 (53.2 versus 33.9%; OR = 2.22; 95% CI: 1.32-3.74; P=0.003) and history of dilatation and curettage (27.3 versus 10.5%; OR= 3.19; 95% CI: 1.66-6.11; P=0.0005) were significantly associated with unsuccessful induction of labor. Bishop score was significantly higher in Group R (3.6 versus 1.9; P=0.001). Also, consistency (74.0 versus 44.4%; OR= 3.57; 95% CI: 2.04-6.40; P < 10(-5)) and absence of dilatation of the cervix (59.7 versus 23.0%; OR = 4.97; 95% CI: 2.89-8.56; P < 10(-6)) were identified as significant predictive factors for unsuccessful induction of labor. Conclusion. - Nulliparity, gestational age <= 41 SA + 4, history of dilatation and curettage and Bishop score, in particular consistency and dilatation, are correlated with failure of cervical ripening in post-term pregnancy with unfavorable cervix. (C) 2013 Elsevier Masson SAS. All rights reserved.