Preinduction Cervical Priming with PGE₂ Intracervical Gel

ABSTRACT

A prospective, randomized, controlled clinical trial was conducted to evaluate the safety and efficacy of a single, 0.5-mg dose of prostaglandin E₂ gel in a shelf-stable triacetin base administered intracervically in patients with an unfavorable cervix (Bishop score ≤ 4) 12 hours prior to oxytocin-induction of labor. Forty-eight evaluable patients were enrolled, 25 in the PGE₂ group and 23 in the control group. PGE₂ gel treatment resulted in a significant improvement in the mean Bishop score compared to control (3.14 versus 0.70, P < .00005). Sixty-four percent of the patients treated with PGE₂ had regular uterine contractions during the 12-hour preinduction period beginning 2.18 ± 2.0 hours after gel insertion, compared to 9% in the control group, P = .0001. Moreover, 12% (3/25) of the patients receiving PGE₂ progressed into active labor and delivered during the preinduction period. The duration of oxytocin infusion required for the induction or augmentation of labor was significantly shorter for patients who received intracervical PGE₂ gel compared to the control group (13.1 ± 8.1 versus 19.0 ± 8.7, P < .05). However, there was no significant difference in the incidence of cesarean section between the two study groups (40 and 22% in the PGE₂ and control groups, respectively). No episodes of uterine hypertonus or hyperstimulation or gastrointestinal side effects occurred as a result of PGE₂ gel treatment. The authors conclude that a single intracervical 0.5-mg dose of PGE₂ in a stable triacetin base for patients with Bishop scores ≤ 4 was a safe and effective cervical priming agent that significantly decreased the required duration of oxytocin infusion for labor induction; however, PGE₂ gel priming did not decrease the incidence of cesarean birth.