Clinical utility of multiple-dose administration of prostaglandin E2 gel

Abstract

An open-label study was undertaken to assess the clinical impact of multiple doses of intracervical prostaglandin E2 (0.5 mg) gel administered at 6-hour intervals. Fifty women with low Bishop scores requiring induction of labor were recruited. The prestudy mean Bishop score was 2.3 +/- 1.1 and changed significantly with one (p less than 0.001), two (p less than 0.001), and three (p less than 0.002) doses. The mean gestational age of patients receiving three doses was significantly less than that of patients receiving one dose, (38.5 versus 40.1 weeks, p less than 0.005). Prostaglandin E2 gel induced labor in 56% of patients, but 14% required subsequent oxytocin (Syntocinon) augmentation. Cesarean section was performed in 6% of patients. No deleterious fetal, neonatal, or maternal effects occurred.

PIP: An open-label study was undertaken to assess the clinical impact of multiple doses of intacervical prostaglandin E2 (0.5mg) gel administered at 6-hour intervals. 50 women in Canada with low Bishop scores requiring induction of labor were recruited. The prestudy mean Bishop score was 2.3 +or-1.1 and changed significantly with 1 (p 0.001), 2 (p 0.001), and 3 (p 0.002) doses. The mean gestational age of patients receiving 3 doses was significantly less than that of patients receiving 1 dose, (38.5 versus 40.1 weeks, p 0.005). Prostaglandin E2 gel induced labor in 55% of patients, but 14% required subsequent oxytocin (Syntocinon) augmentation. Cesarean section was performed in 6% of patients. No deleterious fetal, neonatal, or maternal effects occurred. 80% of the study group fell into the categories of postmaturity, pregnancy-induced hypertension, and intrauterine growth retardation. There appeared to be a trend toward a higher mean change in Bishop score from 6 to 12 hours in the primiparous women, but a statistically significant difference was not achieved. Surgical amniotomy was performed in 25 patients after labor was established. 47 of the patients achieved vaginal delivery. 3 Cesarean sections were performed because of cord prolapse, fetal distress, and failure to progress. Postpartum hemorrhage occurred in 3 patients.