S Bel1, A Gaudineau2, L Zorgnotti2, N Sananes2, G Fritz2, B Langer2. 1. Département de gynécologie-obstétrique de l'hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France. Electronic address: sandra.bel@chru-strasbourg.fr. 2. Département de gynécologie-obstétrique de l'hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France.
Abstract
OBJECTIVES: Labor induction is one of the most frequent procedures during pregnancy in France. In most cases, the cervix is unriped. Guidelines regarding cervical ripening are heterogeneous in terms of molecules, administration route, dosage or surveillance. The objective was to describe how international recommendations are applied in French teaching maternities. METHODS: This is a national telephone survey for all 46 obstetrical departments. For each center, the obstetrician in charge was contacted. RESULTS: All of the 46 maternities were accounted for. All of them assessed cervical status clinically, defined as riped for a Bishop score≥7 for 90.2% of the maternities. Ripening evaluation depended on parity for 56.5% of them. Cervical ripening was performed near a surgical unit in case of a cesarean section for 82.6% of the maternities. The most common method used the controlled-released pessary of dinoprostone (89.1%) followed by intra-vaginal dinoprostone (65.2%), the foley catheter (50.0%) and misoprostol (17.4%). DISCUSSION AND CONCLUSION: Numbers of methods of cervical ripening and protocols of administration and surveillance varied widely between obstetrical departments, sometimes even in contradiction to guidelines and review of the litterature. Controlled-released pessary and intra-vaginal gel of dinoprostone were the most common molecules used for cervical ripening. Differences in protocols should be analyzed on their efficiency to establish consensus-based recommendations.
OBJECTIVES: Labor induction is one of the most frequent procedures during pregnancy in France. In most cases, the cervix is unriped. Guidelines regarding cervical ripening are heterogeneous in terms of molecules, administration route, dosage or surveillance. The objective was to describe how international recommendations are applied in French teaching maternities. METHODS: This is a national telephone survey for all 46 obstetrical departments. For each center, the obstetrician in charge was contacted. RESULTS: All of the 46 maternities were accounted for. All of them assessed cervical status clinically, defined as riped for a Bishop score≥7 for 90.2% of the maternities. Ripening evaluation depended on parity for 56.5% of them. Cervical ripening was performed near a surgical unit in case of a cesarean section for 82.6% of the maternities. The most common method used the controlled-released pessary of dinoprostone (89.1%) followed by intra-vaginaldinoprostone (65.2%), the foley catheter (50.0%) and misoprostol (17.4%). DISCUSSION AND CONCLUSION: Numbers of methods of cervical ripening and protocols of administration and surveillance varied widely between obstetrical departments, sometimes even in contradiction to guidelines and review of the litterature. Controlled-released pessary and intra-vaginal gel of dinoprostone were the most common molecules used for cervical ripening. Differences in protocols should be analyzed on their efficiency to establish consensus-based recommendations.