Use of PGE2 intracervical gel in pre-induction cervical ripening

Abstract

Objetives and Methods: Prostaglandins have been widely used for preinduction cervical ripening. In order to assess its effectiveness and safety in our facility, we conducted a blind placebo controlled trial which consisted of 112 patients with unripe cervix who were randomized to receive either I mg of intracervical PGE2 gel or placebo before labor induction.

Results: There were signifficant differences in the Bishop score variation, which was greater in the experimental group (P<O.OOOI the time elapsed from the application to the vaginal delivery, which was shorter in the PGE2 group (P<O.OOOI); the need for oxytocin inductions, which prevailed more among the controls (P<O.OOOI); and the hospital stay, which was shorter in the experimental group We did not find signifficant differences between the Apgar scores or the cesarean rates, although there was a higher percentage of cesarean sections indicated for acute fetal distress among the experimental group, while the most frequent indication among the controls was three failed inductions. A signifficant higher incidence of complications was found in the experimental group if these are taken as a whole, but if compared individually, the ocurrence of acute fetal dostress, tachysystole, uterine atonoy/postpartum bleeding or precipitate labor was not statistically different between beth groups.

Conclusion: The PGE2 gel is effective to ripen the cervix and shorten the time interval required for vaginal delivery, but it should be used with caution and under appropriate medical supervision.