A prospective randomized study comparing vaginal dinoprostone plus oxytocin versus oxytocin alone for labor induction in nulliparous women with unripe cervix

Aims: To compare the effectiveness and outcomes of two medications (oxytocin and dinoprostone) used for cervical ripening and labor induction. Methods: Term nulliparous pregnant women with Bishop score <4 who received labor induction indication were divided into two groups. The first group received vaginal dinoprostone followed by oxytocin. The second group received only oxytocin only. Labor onset times, delivery duration, Bishop scores, contraction frequencies every 10 minutes, cesarean rates, and Apgar scores of newborns were compared between the two groups. Results: Although there was no statistically significant difference in terms of active labor onset time between the dinoprostone and oxytocin groups, a significant difference was observed regarding the time to delivery. (dinoprostone: 873.5±219.12 minutes; oxytocin: 637.4±339.3 minutes; p=0.0001). A significant difference was also found between the two groups in terms of mean Bishop scores at 2, 4, 6, 8, and 10 hours. (p=0.0001, p=0.0001, p=0.008, p=0.033, respectively). Similarly, there was a significant difference between the two groups regarding contraction frequency per 10 minutes in the first 2 hours of induction. (dinoprostone: 0.22±0.42/10 minutes; oxytocin: 0.72±0.88/10 minutes; p=0.0001) No statistically significant difference was found between the two groups in terms of cesarean rates. However, it was determined that the oxytocin group had a 2.06 times higher probability of undergoing cesarean section compared to the other group. OR:2.06 (0.83-5.10, 95% CI). The mean 1st minute Apgar score of babies in the dinoprostone group was 6.49±0.19 and the 5th minute Apgar score mean was 9.10±0.11. The mean 1st minute Apgar score of babies in the oxytocin group was 6.80±0.17 and the 5th minute Apgar score mean was 8.80±0.15, with no statistical significance detected between the two groups (p>0.05). Conclusion: Dinoprostone can be preferred as a method to reduce cesarean rates; however, oxytocin may be preferred in clinics with high patient density due to its faster effect and quicker completion of delivery.