The influence of pre-induction vaginal prostaglandin E2 gel upon subsequent labour

Abstract

Eight hundred and three patients with singleton viable pregnancies and fetal cephalic presentation were given prostaglandin E2 in viscous gel by intravaginal instillation the evening before planned surgical induction. When the cervix was 'ripe', surgical induction was avoided in 65.9 per cent of primigravidae and 87.5 per cent of multigravidae; the administration of epidural analgesia was less frequent, the rate of spontaneous vaginal delivery greater, the Caesarean section rate lower, and the state of the newborn at delivery better than in those patients who required surgical induction. Side effects attributable to the prostaglandin gel were rare as were complications.

PIP: 803 patients with fetal cephalic presentation who required induction of labor were vaginally administered PGE2 (prostaglandin E2) in viscous gel 14-22 hours prior to surgical induction. The dose of PGE2 was related to the incidence of labor and as the cervical scores increased so did the proportion of patients going into labor. Patients had shorter duration of labor, less need for epidural analgesia, more unassisted vaginal deliveries, fewer cesareans, and fewer Apgar scores less than 5 at 1 minute. Of patients requiring surgical induction, 13.5% required cesarean sections as opposed to 4.7% of the patients who went into labor with PGE2 along. Hypertonus fetal distress occurred once and fetal distress due to suspected placental insufficiency occurred 4 times. Using PGE2, surgical induction was avoided in 65.9% of primigravidae patients and in 87.5% of multigravidae patients with fewer complications and virtually no gastrointestinal side effects.