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\begin{document}

\title{Risk factors and ramifications of failure to achieve cervical ripening
with prostaglandins -- Retrospective Cohort Study}



\author[1]{Alexandra Berezowsky}%
\author[2]{Gil Zeevi}%
\author[3]{Eran Hadar}%
\author[4]{Eyal Krispin}%
\affil[1]{University of Toronto}%
\affil[2]{Tel Aviv University}%
\affil[3]{Rabin Medical Center}%
\affil[4]{Rabin medical center}%


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  \date{May 27, 2024}


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\begin{abstract}
Objective: To assess the characteristics and evaluate the outcomes of
women who failed to respond to cervical ripening with prostaglandins.
Methods: A retrospective cohort analysis (2012-2018) of all women with
singleton gestation who underwent induction of labor, due to post-date
pregnancy, with a slow-release prostaglandin-E2 vaginal insert for
cervical ripening. Overall, 1285 women were divided into 2 groups: a)
responders - 1,202 (93.54\%) - achieved ripening within 24 hours ; b)
non-responders- 83 (6.46\%) -- did not achieve cervical ripening within
24 hours. Characteristics and outcomes were compared between the groups.
Primary outcome was defined as vaginal delivery rate following ripening
process. Secondary outcomes were defined as composite adverse maternal
and adverse neonatal outcomes. A model combining maternal
characteristics and response rates to ripening was constructed as well.
Results: In comparison to non-responders, responders achieved higher
rates of vaginal delivery (96.51\% vs. 66.27\%, p\textless{}0.001). They
also had lower rates of adverse maternal outcomes (12.81\% vs. 24.10\%,
p=0.031) and of neonatal respiratory adverse outcomes (1.33\% vs.
6.02\%, p=0.009). The responders were also younger (30.03 vs 31.73,
p=0.005), and less nulliparous (76.92\% vs 50.99\%, p\textless{}0.001).
A multivariate analysis showed that failure to achieve a cervical
ripening is an independent risk factor for intrapartum cesarean delivery
due to failure to progress in labor (aOR 11.90, 95\% CI 6.13-23.25).
Conclusion: Women who achieve cervical ripening with PROPESS are
younger, and more often multiparous. This group is associated with lower
rates of intrapartum cesarean delivery and adverse outcomes.%
\end{abstract}%



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