Maternal satisfaction with induction of labour by dinoprostone vaginal insert or cervical ripening balloon associated with oral misoprostol: an observational study

Objectives: Induction of labour (IoL) for women with unfavourable cervix is performed with different methods, with the association of cervical ripening balloons (CRB) with misoprostol considered as the most effective; however, poor evidence is available about maternal satisfaction with such strategy. The aim of this study was to compare subjective outcomes of IoL between women undergoing cervical ripening by either vaginal dinoprostone or CRB with misoprostol. Methods: This was an observational study comparing two cohorts of women with unfavourable cervix undergoing IoL by either dinoprostone-releasing vaginal insert (N = 50) or a double-balloon CRB with concurrent administration of oral misoprostol (N = 51). Primary outcome was maternal satisfaction assessed by the score at the Birth Satisfaction Scale - Revised (BSS-R) questionnaire; secondary outcomes included a survey on other subjective aspects relating to IoL experience, evaluation of obstetric outcomes, and analysis of maternal satisfaction after adjustment for important influencing factors. Results: At BSS-R questionnaire, vaginal dinoprostone and CRB-misoprostol association resulted in similar scores (24.1 ± 7.6 vs 24.5 ± 7.4, p 0.68); mean difference between the two groups was -0.4 with a 95% CI [-3.4; 2.5]. Other subjective outcomes were similar, except for a greater discomfort experienced at CRB insertion, with scores 2.3 ± 1.3 vs 1.6 ± 1.3 reported at the corresponding item of the survey (p 0.008), and for its permanence in situ, scoring 2.7 ± 1.1 vs 1.7 ± 1.2 in the two groups (p 0.001). After adjustement for obstetric factors, mode of delivery resulted independently associated with maternal satisfaction (p < 0.001) CONCLUSIONS: IoL with dinoprostone vaginal insert or CRB with oral misoprostol resulted in a similar subjective satisfaction among women needing cervical ripening.