Optimising daytime deliveries when inducing labour using prostaglandin vaginal inserts

Abstract

Objective: To determine induction start time(s) that would maximise daytime deliveries when using prostaglandin vaginal inserts.

Methods: Women enrolled into the Phase III trial, EXPEDITE (clinical trial registration: NCT01127581), had labour induced with either a misoprostol or dinoprostone vaginal insert (MVI or DVI). A secondary analysis was conducted to determine the optimal start times for induction by identifying the 12-h period with the highest proportion of deliveries by parity and treatment.

Results: Optimal start times for achieving daytime deliveries when using MVI appear to be 19:00 in nulliparae and 23:00 in multiparae. Applying these start times, the median time of onset of active labour would be approximately 08:30 for both parities and the median time of delivery would be the following day at approximately 16:30 for nulliparae and 12:00 (midday) for multiparae. Optimal start times when using DVI appear to be 07:00 for nulliparae and 23:00 for multiparae. Using these start times, the median time of onset of active labour would be the following day at approximately 04:00 and 11:50, and the median time of delivery would be approximately 13:40 and 16:10, respectively.

Conclusions: When optimising daytime deliveries, different times to initiate induction of labour may be appropriate depending on parity and the type of retrievable prostaglandin vaginal insert used.

Keywords:

• Daytime deliveries
• dinoprostone
• induction of labour
• misoprostol
• retrievable prostaglandin vaginal delivery systems

Declaration of interest

The study was fully funded by Ferring Pharmaceuticals. Medical writing and editorial assistance for manuscript development was provided by C. J. Parkyn, PhD, and was funded by Ferring Pharmaceuticals. H. M. has received research and travel support from Ferring Pharmaceuticals, Inc., and has attended an advisory board as a panel member and consultant; L. G. has received research support from Ferring Pharmaceuticals, Inc., and has attended an advisory board as a panel member and consultant. D. W. has been a consultant for Ferring Pharmaceuticals, Inc.; prior to that she received research support for the conduct of this trial. She has attended an advisory board as a panel member and received support for travel to a FDA meeting on behalf of the sponsor; B. P. is a former employee of and current consultant to Ferring International; O. R. is an employee of Ferring Pharmaceuticals.

Supplementary material available online

Supplementary Table S1.