A comparison of four methods of ripening the unfavourable cervix

Abstract

A comparison was made between four methods of ripening the unfavourable cervix (extra-amniotic prostaglandin E2 gel, oral prostaglandin E2, intravaginal prostaglandin E2 and intravenous oxytocin) in a clinical trial involving 60 primigravidae. In all groups there was an improvement in cervical status. This was significantly greater in those patients who received extra-amniotic prostaglandin gel and they also showed significant decreases in the mean induction-delivery interval and in the incidence of Caesarean section.

PIP: 4 methods of ripening the unfavorable cervix (extra-amniotic prostaglandin (PG) gel; oral prostaglandin tablets; intravaginal prostaglandin tablets; and intravenous oxytocin) were compared in this study. 60 primigravida with a modified Bishop score of 4 or less and who had obstetric indications for induction of labor were randomly assigned into 4 groups: 1) extra-amniotic PG gel; 2) intravenous oxytocin; 3) intravaginal PG tablets; and 4) oral PG. Results are summarized in Table 2, while Table 3 presents the indications for Cesarian section in the various groups. Although improvement in cervical status was observed in all 4 groups, the single extra-amniotic application of PGE2 in viscous gel (group 1) provided the most satisfactory method of ripening the unfavorable cervix. All patients in group 1 had good labor and had significant decreases in the mean induction delivery interval and in the incidence of Cesarian section. Nevertheless, reliable criteria need to be developed to predict the effect of the ripening procedure and the optimal dose of PG to be instilled.