Pharmacologic cervical ripening strategies and time-related outcomes: a community hospital cohort study.

BACKGROUND: Pharmacologic cervical ripening is a primary determinant of labor induction efficiency, yet practice-based data from community hospitals remain limited.

OBJECTIVE: To compare time-related outcomes-specifically time to delivery and hospital length of stay-among inductions using misoprostol or dinoprostone, while examining the influence of parity.

STUDY DESIGN: This retrospective cohort study at an urban community hospital (2022-2023) analyzed inductions utilizing only pharmacologic ripening. Exclusion criteria included prolonged antepartum admission, premature rupture of membranes, intrauterine fetal demise, cervical balloon use, or use of both misoprostol and dinoprostone. Patients were categorized by agent: misoprostol (n=188) or dinoprostone (n=477). Primary outcome was time to delivery, with total hospital length of stay also examined. Secondary outcomes included cesarean delivery and neonatal intensive care unit (NICU) admission. Subgroup analyses were performed for nulliparous and multiparous patients.

RESULTS: In the overall cohort, misoprostol was associated with a shorter time to delivery compared with dinoprostone (24.3 vs 28.6 hours; P<.001). Total hospital length of stay in hours with misoprostol was also shorter, though not when measured in whole days. Cesarean delivery was observed less frequently among patients receiving misoprostol (14.9% vs 23.5%; P=.014), while NICU admission rates did not differ significantly (18.1% vs 15.7%; P=.459).Parity distribution differed between exposure groups however, with a higher proportion of multiparous patients receiving misoprostol. Among nulliparous patients, time to delivery was similar between agents (29.2 vs 30.2 hours; P=.363), and differences in cesarean delivery and NICU admission were not statistically significant. Among multiparous patients, misoprostol was associated with a shorter time to delivery compared with dinoprostone (19.7 vs 24.2 hours; P=.001), without meaningful differences in cesarean delivery or NICU admission rates.

CONCLUSION: In this community hospital cohort, misoprostol was associated with shorter induction durations than dinoprostone, with efficiency gains primarily driven by outcomes in multiparous patients. These findings suggest that pharmacologic agent selection for cervical ripening can meaningfully influence obstetric workflow.