Cervical ripening and labor induction with prostaglandin E2 gel: a placebo-controlled study

Abstract

A randomized double-blind, placebo-controlled study was undertaken to evaluate the effect of a single intracervical application of prostaglandin E2 gel on the ripening of the cervix and on the subsequent induction of labor with oxytocin in patients with low Bishop scores (less than or equal to 4). Compared to controls receiving gel only, the group receiving prostaglandin E2 gel had significant increases in their cervical Bishop scores, shorter induction-to-delivery intervals, shorter time requiring use of oxytocin, and more successful labor induction without oxytocin. Systemic side effects were minimal and fetal outcomes were comparable, as were the routes of delivery.

PIP: A randomized double-blind, placebo-controlled study was undertaken to evaluate the effect of a single intracervical application of prostaglandin E2 gel on the ripening of the cervix and on the subsequent induction of labor with oxytocin in patients with low Bishop scores (or =4). Women who presented with medical and/or obstetric indications for the induction of labor were enrolled in the study from the Mount Sinai and Toronto General Hospitals in Canada. 107 women were included in the analysis. Participants had a gestational age of 36 or more weeks and a parity of 3 or under. Compared to controls receiving gel only, the group receiving prostaglandin E2 gel had significant increases in their cervical Bishop scores, shorter induction-to-delivery intervals, shorter time requiring use of oxytocin, and more successful labor induction without oxytocin. Systemic side effects were minimal and fetal outcomes were comparable, as were the routes of delivery. A single low-dose intracervical application of prostaglandin E2 gel proved to be a safe and reliable aid in dealing with indicated but potentially difficult inductions. The product has the advantages of being uniformly prepared, accurate in dosage, stable, easy to apply, and associated with minimal side effects for mother or fetus.