Propess versus Prostin E2 for cervical ripening and induction of labour

Abstract

Objectives: To compare the efficacy and safety of Propess and Prostin E2 for induction of labour (IOL) in women with an unfavourable cervix.

Methods: Medical records of women who had a singleton pregnancy at ≥37 weeks’ gestation with cephalic presentation and had undergone IOL using Prostin E2 (between January and December 2017) or Propess (between April 2018 and March 2019) were retrospectively reviewed. The primary outcome was the duration from IOL to delivery. Secondary outcomes included delivery within 24 hours of IOL, mode of delivery, additional use of Prostin E2 or Propess, oxytocin use, failed IOL, maternal complications, and neonatal well-being.

Results: In total, 471 women who received Prostin E2 (n=245) or Propess (n=226) were included in the analysis. Compared with the Prostin E2 group, the Propess group had a shorter IOL-to-delivery duration (1686 vs 2073 minutes, p=0.02), particularly among multiparous women (1078 vs 1568 minutes, p=0.009). Additionally, the Propess group had a higher rate of delivery within 24 hours of IOL overall (51.3% vs 37.6%, p=0.003) and in both nulliparous (42.0% vs 29.7%, p=0.017) and multiparous (77.2% vs 56.2%, p<0.001) women. However, the Propess group had a higher rate of failed IOL overall (11.1% vs 5.7%, p=0.035), particularly among nulliparous women (14.2% vs 7.0%, p=0.003). Notably, the rate of failed IOL among multiparous women was lower in the Propess group (1.8% vs 2.7%, p<0.001‎). The Propess group had a higher rate of uterine hyperstimulation overall (23.5% vs 7.8%, p<0.001) and in both nulliparous (23.7% vs 5.8%, p<0.001) and multiparous (22.8% vs 12.3%, p<0.001) women. However, there was no significant increase in the incidence of non-reassuring fetal heart rate requiring caesarean delivery. The Propess group even had lower rates of caesarean section among multiparous women (7.0% vs 13.7%, p<0.001) and neonatal intensive care unit admission (0.9% vs 4.9%, p=0.01).

Conclusion: Propess appears to be a safe and effective alternative to Prostin E2 for IOL in women with an unfavourable cervix and intact membranes. Propess use was associated with a shorter IOL-to-delivery duration and a higher rate of vaginal delivery within 24 hours of IOL. Although Propess was associated with a higher incidence of uterine hyperstimulation, there was no significant increase in the incidence of non-reassuring fetal heart rate requiring caesarean delivery or neonatal morbidity.