Predictor Factors in the Success of Slow-Release Dinoprostone Used for Cervical Ripening in Pregnancies with Premature Rupture of Membranes

Objective: The study aimed to evaluate the factors affecting successful vaginal delivery in induction with slow-release dinoprostone at term pregnancy with premature rupture of membranes. Materials and Methods: Pregnancies between 37(0/7) and 41(6/7) gestation weeks with premature rupture of membranes in which slow-release dinoprostone was used for cervical ripening were sought for inclusion in the study. Pregnancies with previous uterine surgery, multiple fetal gestations, chorioamnionitis, non-cephalic presentation, fetal distress at the time of admission, HIV positivity, and estimated fetal weight >4500 on ultrasonographic evaluation were excluded. The primary outcome of measures were factors affecting the success of vaginal delivery including maternal age, gestational weeks at delivery, initial Bishop score, parity, induction time, and induction–delivery time interval. To reduce the risk of overfitting in the study, penalized maximum likelihood estimation was performed instead of traditional logistic regression in the statistical analysis. Results: A total of 1266 participants who met the study criteria were included in the study. Among the parameters evaluated for the prediction of successful vaginal delivery in cases with premature rupture of membranes, maternal age (P < .001), Bishop score (P < .001), parity (P = .01), induction time (P < .001), and induction–delivery time interval (P < .001) had an impact on success. The mean gestational week of the participants who had cesarean deliveries was lower than in those who had vaginal deliveries (P = .03); however, this was not a predictor factor of penalized maximum likelihood estimation (P = .70). Conclusion: Basic parameters such as maternal age, induction time, parity, and Bishop score can be used to predict successful vaginal birth following dinoprostone slow-release vaginal insert administration.