Controlled-release dinoprostone vaginal insert for cervical ripening and labor induction

Labor is induced in approximately 20% of pregnancies in Europe and North America. Labor induction in patients with an unfavorable cervix is associated with a higher incidence of prolonged labor and higher rates of operative and cesarean delivery. Prostaglandins used for cervical ripening lead to shorter labor, less use of oxytocin and a greater likelihood of vaginal delivery within 24 h. Dinoprostone (prostaglandin E2) has been used since the 1970's and is recognized as an agent that not only results in cervical ripening but also activates myometrial contractility. A proprietary sustained- and controlled-release dinoprostone vaginal insert releases a continuous dose of dinoprostone for 12 h and has been shown to decrease the time to vaginal delivery compared with placebo. This controlled-release insert has been compared with various prostaglandin agents and provides safe and efficacious cervical ripening in women with an unfavorable cervix.