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Prostaglandin E₂ Cervical Ripening Without Subsequent Induction of Labor

From the Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio.

Objective: To determine whether outpatient administration of intracervical prostaglandin (PG) gel decreases the E₂ interval to delivery and duration of labor.

Methods: A randomized, double-blind, placebo-controlled trial compared the intracervical placement of 0.5 mg PGE₂ gel with placebo in 61 pregnant women at 38 weeks’ or greater gestation with Bishop scores less than 9. Transvaginal cervical length, fetal fibronectin, and Bishop score were assessed before gel placement. Subjects were then allowed to go into spontaneous labor unless an indication for induction developed.

Results: Thirty women were assigned to PGE₂ and 31 to placebo. There were no significant demographic differences between the groups and there were no differences in cervical length, fetal fibronectin status, or Bishop scores. Fifteen women in the PGE₂ group and five in the placebo group went into labor and delivered within the first 2 days after gel placement (P = .007). The median interval to delivery was significantly shorter in the PGE₂ group, at 2.5 days, compared with placebo, at 7 days (P = .02). Nulliparas in the PGE₂ group had a median interval to delivery of 2 days, compared with 7 days for nulliparas receiving placebo (P = .03). Active phases of labor were significantly shorter in the PGE₂ group and for women with a negative fetal fibronectin test who received PGE₂.

Conclusion: Outpatient administration of intracervical gel shortened intervals to delivery and shortened PGE₂ labor.

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