Cervical priming and labor induction with vaginal application of 3 mg Pge₂ in suppositories in term pregnant women with premature rupture of amniotic membranes and unfavorable cervix

Abstract

Sixty-one term pregnant women, 29 nulliparous (Group A) and 32 multiparous (Group B) with unfavorable cervix and premature rupture of the membranes (PROM) were given 3 mg PGE2 in suppository form for cervical ripening and labor induction. Five hours after starting the treatment, 12 women of the 29 in Group A and 21 of the 31 in Group B had a favorable cervix and established labor. The remaining 17 nulliparae and 11 multiparae still had an unfavorable cervix and were then given another PGE2 suppository. Until the next morning, i.e. within 24 h, 19 nulliparous and 22 multiparous women gave birth whereas a further 5 nulliparous women who now had favorable cervix but no uterine contractions were delivered after stimulation with intravenous oxytocin. The remaining undelivered women were given another PGE2 suppository. With or without additional oxytocin stimulation, all but 2 multiparous women could be delivered within a further 12 hours. The total number of instrumental deliveries in Group A was 2 caesarean sections due to disproportion (7%) and 5 ventouses. In Group B, 3 caesarean sections (9%) had to be carried out, one due to fetal distress and 2 due to failed induction. From the results of this study we conclude that vaginal application of 3 mg PGE2 in suppository form can be used to induce labor in patients with PROM and unripe cervix. However, when the results are compared with those obtained in previous studies after application of PGE2 in gel, the latter technique seems preferable.

Oral misoprostol versus intracervical prostaglandin E2 gel for active management of premature rupture of membranes at term

“…Granstrom et al [21] reported an ITD interval of 12.9 hours in a study of 61 women using 3 mg of intravaginal PGE2 gel (67% of women delivered in 24 hours). Similar percentages for delivery within 24 hours are reported by Ekman et al [22] (60% and 70.5% in 2 arms) and Mahmood et al [23] (80%).…”

Labor induction in the patient with preterm premature rupture of membranes

“…27 Since this trial, multiple studies have reported conflicting data that consistently support the use of prostaglandins as safe and effective in the patient with PROM, but differ with regard to prostaglandins superiority to oxytocin. [28][29][30][31][32][33] Butt et al 28 report in their well-designed randomized controlled trial of 108 women with term PROM that although the time spent in active labor as well as maternal and neonatal outcomes were similar, oxytocin conveyed a shorter interval to delivery time by greater than 3 h when compared to prostaglandin. Women in both groups had a mean Bishop score of 6 at the start of induction.…”

Premature Rupture of the Membranes - Intervention or Not

“…A low grade of cervical effacement can in crease the risk of complication especially in nulliparous women [2,3]. Therefore, cervical ripening by prosta glandins could diminish these risks [5,6], Another in teresting approach is the use of prostaglandin infusion which recently has been shown to be very effective from the hypothesis -unripe cervix, unripe uterus for oxytocin [7],…”

“…Oral temperature 37.5 "C or less. (6) No evidence of spontaneous con tractions 4 h after PROM. Permission to perform the study was granted by the Ethical Committee of Uppsala University.…”