Cervical ripening and induction of delivery by local administration of prostaglandin E2 gel or vaginal tablets is equally effective

Rix, Per; Ladehoff, P; Møller, Anna Margrethe; Tilma, Karen Andersen; Zdravkovic, Milica Branislava

doi:10.3109/00016349609033282

Cited by 18 publications

(8 citation statements)

References 3 publications

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“…The time intervals, from commencement of cervical priming to induction of labour, and from commencement of cervical priming to eventual delivery, were also significantly shorter for women in the intensive regimen. We believe these results agree with findings of researchers who used prostaglandin ge1 3,4,13,14 . As the median number of pessaries used were not significantly different in either dosing regimens, we believe that the intensive dosing regimen will also improve the cost effectiveness of induction of labour by shortening hospital stays, in agreement with the study of Mackenzie et al 15 who found financial advantages with a two dose prostaglandin regimen compared with a single dose regimen.…”

Section: Discussionsupporting

confidence: 90%

Two dosing regimens for preinduction cervical priming with intravaginal dinoprostone pessary: a randomised clinical trial

Tan

Tay

1999

BJOG

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Objective To compare the efficacy within 24 hours of a three-times-a-day intensive dosing regimen with a standard once daily dosing regimen using dinoprostone vaginal pessary in preinduction cervical priming.Design Randomised controlled trial.Setting Department of Obstetrics and Gynaecology, Singapore General Hospital.Participants One hundred singleton term primigravidae with cephalic presentation with unfavourable cervical scores (Bishop score 1 5 ) requiring induction of labour.Methods Eligible women were randomly assigned the standard regimen (3000 pg dinoprostone [Prostin, Upjohn, Crawley, UK] once daily) or an intensive regimen (3000 pg dinoprostone given sequentially three times daily four hours apart) for cervical priming until successful priming (Bishop score of 2 6) or the onset of active labour occurred.Main outcome measures Number of women whose cervices were ripened successfully or who entered active labour within 24 hours of starting cervical priming, priming to induction interval, and priming to delivery interval.Results Forty-nine women were assigned to the standard regimen and 5 1 to the intensive regimen. The median number (range) of dinoprostone pessaries used was two (one to seven) in the standard regimen and three (one to nine) in the intensive regimen. Forty-two women (82.4%) who underwent the intensive regimen achieved successful cervical ripening or active labour within 24 hours, compared with 21 assigned to standard regimen (OR 6-2, 95% CI 2-3-17.4). This difference was statistically significant. The median intervals from priming to induction, and from priming to delivery, were also statistically significantly shorter in women treated with the intensive regimen. Thirty-five women (68.63%) assigned the intensive regimen experienced pain, compared with 21 (42.86%) in the standard regimen (OR 2-92, 95% CI 1.19-7.21), with two and one women in the respective regimens requiring opiate analgesics. Five women with oligohydramnios had transient cardiotocographic abnormalities during priming with the intensive regimen, none of which required immediate intervention, and the babies were born in good condition. There were no cases of uterine hypertonus and the outcomes of labour were similar for women from both regimens.Conclusions Preinduction cervical priming with the intensive dosing regimen improves the chances of successful ripening within 24 hours for primigravidae with unfavourable cervical scores at full term singleton pregnancies, and shortens the interval from priming to induction, and priming to delivery. This regimen may be more cost effective by shortening the period of hospital stay. The overall incidence of adverse reactions to the mother and fetus during priming was low. However, close fetal surveillance must be maintained, particularly in pregnancies complicated with oligohydramnios.

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Section: Discussionsupporting

confidence: 90%

Two dosing regimens for preinduction cervical priming with intravaginal dinoprostone pessary: a randomised clinical trial

Tan

Tay

1999

BJOG

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“…The definition of unfavorable cervix is controversial. Several studies have defined it as a Bishop score of at least 2 (28), 3 (13), 4 (21, 29), 5 (30,31), or even 6 (14,32). Our results are consistent with a previous report that pre-induction cervical ripening is more likely than placebo to improve the cervical score and result in delivery within 24 hours (12).…”

Section: Discussionsupporting

confidence: 91%

Do practice guidelines guide practice? A prospective audit of induction of labor – three years experience

Mousa¹,

Mahmood²

2000

Acta Obstet Gynecol Scand

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“…Results similar to those with a single application have been achieved, suggesting that the time required for cervical ripening is fixed, based on the required remodeling process of the cervix [3,9,19]. For this reason, one dose of PG was used every 12 h but it has never been evaluated in ambulatory methods and overall in pregnancies with first-trimester fetal death.…”

Section: Discussionmentioning

confidence: 99%

“…A small clinical study has compared 2-mg doses of gel prepared against a 3-mg tablet intravaginally and intracervically at a dose of 0.5 mg in primigravid women whose cervices were unfavorable for induction; the difference in both groups did not reach statistical significance [9,10]. Recently, misoprostol, a prostaglandin E 1 (PGE 1 ) analogue, was given vaginally for the induction of labor at term.…”

Section: Introductionmentioning

confidence: 99%

Cervical Ripening with Prostaglandin E<sub>1</sub>: How an Ambulatory Method Decreases the Hospital Stay in Abortus with Intrauterine Fetal Demise

Hernández-Valencia¹

2003

Fetal Diagn Ther

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Objective: This study was designed to determine whether use of prostaglandin E₁(PGE₁) is justified to improve the known clinical outcome of prostaglandin E₂ (PGE₂) gel, because PGE₂ gel preparations are more costly than PGE₁ tablets in most countries, and data to support the use of the gel in clinical practice is not conclusive. The aim was to compare the safety and efficacy of PGE₁ gel when applied in both an in-hospital or ambulatory setting to oxytocin infusion in those women with unfavorable cervical conditions prior to surgical abortion for either medical or obstetrical indications with intrauterine fetal demise. Surgical dilatation of the unripe cervix may result in cervical injury of uterine perforation which could prolong the hospital stay. Methods: We used PGE₁ gel prepared from tablets and administered in the ambulatory form (group 1), the same PGE₁ gel administered in the labor room (group 2) and intravenously administered oxytocin in the labor room (group 3) for the induction of abortus in women complicated with intrauterine fetus death and missed abortion. Patients requesting abortion were eligible for inclusion, with >8 and <13 weeks of gestation. Eighty-nine women with unfavorable cervices (Bishop score ≤4) were included in this study. Comparisons between the three groups for such variables were done by ANOVA. Results: The statistical test did reveal significant differences in the cervical changes, doses of PGE₁ used and maternal labor stay between the three groups. The difference in effect on cervical ripening was seen following PGE₁ application in both of these groups, but no difference was seen with the oxytocin use. Cervical score changed in 100% of both groups with the PGE₁ gel and 89.6% of the group with oxytocin use, within 6 days in the latter group. The mean number of days of maternal labor stay were 1.5, 4.6 and 6.2 respectively. There was no difference regarding the effect on clinical characteristics of the women on the final Bishop score. The number, initial and final Bishop score, vaginal bleeding and other complications were not different. Conclusions: Duration of hospital stay may be decreased by applying PGE₁ gel in an ambulatory setting when compared to in-hospital PGE₁ gel applications or intravenous oxytocin infusion for cervical ripening. Further research is necessary to determine the safety of PGE₁ gel application for preabortion cervical ripening prior to surgical abortion.

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Cervical ripening and induction of delivery by local administration of prostaglandin E2 gel or vaginal tablets is equally effective

Abstract: Cervical ripening and induction of delivery by local administration of prostaglandin E2 gel or vaginal tablets in cases presenting with an unfavorable cervical state is equally effective.

Cited by 18 publications

References 3 publications

Two dosing regimens for preinduction cervical priming with intravaginal dinoprostone pessary: a randomised clinical trial

Two dosing regimens for preinduction cervical priming with intravaginal dinoprostone pessary: a randomised clinical trial

Do practice guidelines guide practice? A prospective audit of induction of labor – three years experience

Cervical Ripening with Prostaglandin E<sub>1</sub>: How an Ambulatory Method Decreases the Hospital Stay in Abortus with Intrauterine Fetal Demise

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