Ripening of the uterine cervix and induction of labour at term with prostaglandin E2 in viscous gel

Abstract

In order to achieve ripening of the uterine cervix or induce labour in patients at term with an unfavourable cervical state, 1 mg of prostaglandin E2 (PGE2), suspended in a viscous gel, was instilled into the cervical canal. In a pilot study, 41 patients received the PGE2-gel. Twenty-three of these, (56%), went into labour, and delivery occurred without further stimulation within 15 hours. In the remaining 18 patients, there was a marked improvement of the cervical state, which changed from an average (modified) Bishop score of 2.5 to 6.1 within 24 hours. In a double-blind study comprising 20 nulliparae, 10 received gel containing PGE2 and 10 gel without prostaglandin. Cervical state did not change significantly (Bishop score 3.6 and 4.0) after 24 hours in patients receiving placebo gel. In those receiving PGE2 gel, 8 went into labour and were delivered without further induction within 13 hours. Two patients showed an increase in Bishop score from 3 to 6 and 7, respectively, after 24 hours. They were then induced by oxytocin and delivery occurred after 8 and 10 hours. The results suggest that administration of PGE2 intracervically can induce ripening of the cervix in patients at term with an unfavourable cervical state, and thus facilitate delivery.

PIP: In order to achieve ripening of the uterine cervix or to induce labor in patients at term with an unfavorable cervical state, 1 mg of prostaglandin E2 (PGE2), suspended in a viscous gel, was instilled into the cervical canal. 61 women were divided into 2 groups, with 41 receiving the PGE2 gel intracervically. In the 2nd group, 10 patients received a gel with 1 mg PGE2 administered intracervically while the other 10 received a gel without the PGE2. Within this 2nd group, the patients were matched for maternal age, gestational age, and mean Bishop score. 23 of the 41 patients (56%) receiving the PGE2 gel went into labor, with delivery occurring without further stimulation, within 15 hours. In the remaining 18 patients, there was a marked improvement of the cervical state, which changed from an average (modified) Bishop score of 2.5 to 6.1 within 24 hours, with all delivering uneventfully. In a double-blind study comprising the remaining 20 nulliparae, the cervical state did not change significantly (Bishop score 3.6 and 4.0) after 24 hours in patients receiving the placebo gel. In those receiving PGE2 gel, 8 went into labor and were delivered without further induction within 13 hours. 2 patients showed an increase in Bishop score from 3 to 7, respectively after 24 hours and were induced by oxytocin, with delivery occurring after 8 and 10 hours. The results confirm that the intracervical administration of PGE2 in a viscous medium can induce ripening of the cervix in those patients at term displaying unfavorable cervical state.