Dinoprostone Versus Balloon Catheter for Cervical Ripening in Multiparous Women Undergoing Induction of Labor: A Retrospective Cohort Study
Raneen Abu Shqara, Ruba Maklade, Lilian Haj, Nadir Ganem, Lior Lowenstein, Maya Frank WolfABSTRACT
Aim
To compare maternal and neonatal outcomes of induction strategies initiated with slow‐release vaginal dinoprostone (10 mg) or balloon catheter in multiparous women undergoing term induction of labor with an unfavorable cervix.
Methods
This retrospective cohort study included 802 multiparous women with singleton pregnancies at ≥ 37 weeks' gestation, Bishop score < 8, and a medical indication for induction of labor at a tertiary university‐affiliated center (2020–2025). Women underwent cervical ripening with either a balloon catheter ( n = 522) or a slow‐release vaginal dinoprostone insert ( n = 280). The co‐primary outcomes were the cervical ripening‐to‐delivery interval and delivery within 24 h. Multivariable analyses identified independent predictors of delivery interval and cesarean birth.
Results
Compared with balloon catheter, dinoprostone was associated with a shorter cervical ripening‐to‐delivery interval (11.6 vs. 19.4 h; p < 0.001). Delivery within 12 h was more frequent with dinoprostone (51.4% vs. 26.1%; p < 0.001), whereas delivery within 24 h did not differ significantly between groups (75.7% vs. 71.1%; p = 0.183). Dinoprostone was also associated with a higher spontaneous vaginal delivery rate (95.0% vs. 90.0%; p = 0.015) and a lower cesarean delivery rate (3.2% vs. 8.2%; p = 0.006). Intrapartum fever occurred less frequently with dinoprostone (1.4% vs. 4.2%; p = 0.036), while no statistically significant differences were observed in measured neonatal outcomes, including NICU admission.
Conclusions
Among multiparous women undergoing term induction of labor, dinoprostone was associated with a shorter cervical ripening‐to‐delivery interval, higher spontaneous vaginal delivery rates, and lower cesarean rates than balloon catheter. Delivery within 24 h was similar between groups, with no significant differences in measured neonatal outcomes.