Cervical Ripening with Prostaglandin E₁: How an Ambulatory Method Decreases the Hospital Stay in Abortus with Intrauterine Fetal Demise

Abstract

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.