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Effect of epidural analgesia on cervical ripening using dinoprostone vaginal inserts

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Abstract

Objective

To clarify whether the duration from cervical ripening induction to labor onset is prolonged when epidural analgesia is administered following application of dinoprostone vaginal inserts vs. cervical ripening balloon.

Methods

This retrospective study included mothers with singleton deliveries at a single center between 2020–2021. Nulliparous women who underwent labor induction and requested epidural analgesia during labor after 37 weeks of gestation were included. The duration from cervical ripening induction to labor onset was compared between women using a dinoprostone vaginal insert and those using a cervical ripening balloon and between women who received epidural analgesia before and after labor onset.

Results

In the dinoprostone vaginal insert group, the duration was significantly shorter in the subgroup that received epidural analgesia after labor onset (estimated median, 545 [95% confidence interval: 229–861 min]) than the subgroup that received it before labor onset (estimated median, 1,570 [95% confidence interval: 1,226–1,914] min, p = 0.004). However, in the cervical ripening balloon group, the difference between subgroups was not significant. The length of labor among the groups was also not significantly different.

Conclusion

Epidural analgesia as labor relaxant adversely affected the progression of uterine cervical ripening when dinoprostone vaginal inserts were used, whereas it did not affect cervical ripening when a mechanical cervical dilatation balloon was used. The present results are significant for choosing the appropriate ripening method.

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Data availability

Data sharing not applicable – no new data generated.

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Acknowledgements

All authors agree with the content of the manuscript.

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Authors and Affiliations

  1. Department of Perinatal Developmental Pathophysiology, St. Marianna University Graduate School of Medicine, Kawasaki, Japan

    Junichi Hasegawa

  2. Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki, Japan

    Chika Homma, Shota Saji & Natsumi Furuya

  3. Department of Anesthesiology, St. Marianna University School of Medicine, Kawasaki, Japan

    Miki Sakamoto

Authors
  1. Junichi Hasegawa
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  2. Chika Homma
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  3. Shota Saji
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  4. Natsumi Furuya
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  5. Miki Sakamoto
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Contributions

JH and CH conceived the study, wrote the initial protocol, and analyzed the data. JH wrote the first draft of the manuscript. JH, CH, SS and NF collected and analyzed the data. JH and CH coordinated the study and created the database. JH performed the statistical analyses. All authors contributed to the writing of the manuscript. JH and MS is the guarantor for the study. All authors had full access to all data in the study and take responsibility for the integrity of the data and accuracy of the data analysis.. All the authors contributed significantly to this work.

Corresponding author

Correspondence to Junichi Hasegawa.

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The authors declare no competing interests in association with the present study.

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Hasegawa, J., Homma, C., Saji, S. et al. Effect of epidural analgesia on cervical ripening using dinoprostone vaginal inserts. J Anesth 38, 215–221 (2024). https://doi.org/10.1007/s00540-023-03307-z

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  • DOI: https://doi.org/10.1007/s00540-023-03307-z

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