To compare sequential dinoprostone and oxytocin for induction of labor at term with intact membranes and an unripe cervix to two simultaneous regimens. Our aim was to confirm findings from smaller trials and add to data on fetal safety.

This study is a non-blinded, three arm randomized trial at 3 sites. Entry criteria were: >36 weeks' singleton, cephalic gestation with intact membranes and an unripe cervix (Bishop's score <6). Study arms were: 1) dinoprostone vaginal insert (Cervidil) for 12 hours followed by oxytocin, 2) dinoprostone vaginal insert (Cervidil) for 12 hours with simultaneous oxytocin, and 3) intracervical dinoprostone gel (Prepidil)(one dose) followed by immediate oxytocin. Primary outcome measure was the rate of vaginal delivery <24 hours. Secondary outcomes were randomization to delivery interval, rate of cesarean delivery (CD) for non reassuring fetal status (NRFS) and rate of uterine hyperstimulation.

Inclusion Criteria:

• > or = to 36 weeks of gestation
• Singleton fetus
• Cephalic presentation
• Intact membranes and an unripe cervix (Bishop score <6)

Exclusion Criteria:

• Multifetal gestation
• Rupture of membranes
• Ripe cervix (Bishop score >6)
• Active labor
• Contraindication to vaginal delivery
• Previous uterine surgery
• Non-cephalic presentation
• Fetal macrosomia