Comparison of the sequential use of mifepristone and dinoprostone vaginal insert with dinoprostone vaginal insert as the only method for induction of labor in very unripe cervix: a secondary analysis of a multicenter real‐word evidence study

Objective Induction of labor is a prevalent obstetric procedure designed to artificially initiate the labor process, which is critical for achieving vaginal delivery. A key factor influencing the success of induction of labor is cervical ripening, assessed using the Bishop score. A low Bishop score (0–3) indicates an unfavorable cervix and is associated with a higher risk of induction failure. This study aims to compare the efficacy of two approaches to labor induction: the sequential use of mifepristone followed by dinoprostone (two‐step approach) versus dinoprostone alone (one‐step approach) in women with a very low Bishop score. Methods A secondary analysis was conducted on data from a multicenter clinical trial involving 503 women with non‐urgent indications for induction of labor. Of these, 296 participants met the inclusion criteria and were analyzed. Results The results demonstrated that pretreatment with mifepristone significantly improved labor outcomes. The vaginal delivery rate was 73.4% in the mifepristone group compared to 51.5% in the dinoprostone‐only group ( P < 0.001). Additionally, the interval from dinoprostone insertion to delivery was shorter in the mifepristone group, and the rate of failed induction was significantly lower (1.0% vs. 6.5%). Conclusion These findings suggest that the sequential use of mifepristone prior to dinoprostone administration enhances the likelihood of successful labor induction in women with a very low Bishop score. The study highlights the importance of optimizing cervical ripening methods to improve labor outcomes.