Cervical ripening and induction of labor by intracervical and extra-amniotic prostaglandin gel application in cases of intrauterine fetal death

Abstract

In 42 patients with intrauterine fetal death between the 29th and 43rd week of gestation, a standard, 2-step procedure was employed to deliver the dead fetus. After priming with an intracervical application of PGF2 alpha- or PGE2-gel, labor was induced by extra-amniotic prostaglandin (PG) gel or oxytocin infusion while under epidural anesthesia. Intracervical PG application led to a significant improvement in the modified Bishop score from 1.3 to 7.6 after a mean of 8 h. In 20 patients labor and progressive dilatation of the cervix occurred after intracervical PG gel application alone. The average total therapy time was 18.1 h in patients treated with PGF2 alpha and 13.7 h in the PGE2-treated group. The average induction of labor to delivery intervals were 8.8 h in the PGF2 alpha- and 7.1 h in the PGE2-group. Gastrointestinal side effects were observed in only 5 patients. The combination of cervical ripening with intracervical PG gel application and induction of labor by extra-amniotic PG gel under epidural anesthesia is an efficient and safe method for treatment of intrauterine fetal death.

Study of Single Dose Carboprost in Terminating Pregnancy

“…This value is slightly higher than the dilatation seen in Rath W, Kuhn W study and is lower compared to Ulmsten U, Ekman G study. 6,7 Group-II: In study group, intracervical instillation of PGE2 gel was done under aseptic precautions and in control group Laminaria tent inserted under aseptic precaution 12 hours after instillation of PGE2 gel/Laminaria tent insertion carboprost (250 μg) was given intramuscularly at third hourly interval until the patient aborts up to a maximum of 5 injections. Patients who do not abort within 15 hours of starting the carboprost injection, treatment was declared as failure and managed by alternative methods.…”