Multizentrische Erfahrungen bei intrazervikaler Applikation eines neuen PGE₂-Gels bei Geburtseinleitung

Abstract

With the participation of four Swiss obstetric clinics, medically indicated inductions of birth (with living fetuses) were performed using a new, stable PGE2 gel, and documented according to a uniform protocol. The study was conducted to investigate the efficacy of 0.5 mg of PGE2, in 2.5 ml of a vehicle (Triacetin) not yet commercially available, for local cervical maturation (n = 41). Thirty-nine patients selected by prospective randomization, in whom birth was induced conventionally, served as a control group. The efficiency of the prostaglandin gel alone or respectively with additional administration of oxytocin was evaluated on the basis of the clear changes in the cervical findings observed within 12 or respectively 24 hours, the spontaneous births, or, in the case of cesarean deliveries, according to the pelvic score. Application of PGE2 alone led to impressive changes of the cervix score and, in 34 of the 41 cases, to regular contractions after an average time of 87 minutes. After 12 hours, prior to administration of oxytocin, 43% of the patients were already delivered. The combination of locally applied PGE2 gel with conventional oxytocin induction significantly increases the number of successful inductions. The percentage of unsuccessfully attempted inductions was reduced to 24% in the PGE2 gel group as compared to 44% in the control group.

Intravenous oxytocin alone for cervical ripening and induction of labour

“…Twenty-seven trials compared oxytocin with vaginal PGE2 (Andersen 1990; Atad 1996; Chua 1991; Egarter 1987; Ekman 1986; Ekman-Ordeberg 1985; Griffith-Jones 1990; Hannah 1996; Herabutya 1991; Jagani 1984; Lange 1984; Legarth 1987; Lyndrup 1989; Lyndrup 1990; Macer 1984; Magos 1983; McCaul 1997; McQueen 1990; Olmo 2001; Pollnow 1996; Ray 1992; Roberts 1986; Rymer 1992; Silva-Cruz 1988; Valadan 2005; Van Der Walt 1989; Wilson 1978). Fourteen trials compared oxytocin with intracervical PGE2 (Ashrafunnessa 1997; Bilgin 1996; Bung 1986; Dominguez 1999; Goeschen 1989; Jackson 1994; Magann 1995; Malik 1996; Papageorgiou 1992; Parikh 2001; Puertas 1996; Ulmsten 1979; Wiqvist 1986; Zahradnik 1987). Three trials compared oxytocin with vaginal PGFalpha (Day 1985; MacLennan 1980; Yang 1994).…”

“…Fourteen trials compared oxytocin with intracervical PGE2 (Ashrafunnessa 1997; Bilgin 1996; Bung 1986; Dominguez 1999; Goeschen 1989; Jackson 1994; Magann 1995; Malik 1996; Papageorgiou 1992; Parikh 2001; Puertas 1996; Ulmsten 1979; Wiqvist 1986; Zahradnik 1987).…”

Geburtseinleitung mit einem neuen intrazervikal applizierbaren Prostaglandin E2-Gel

“…Die Gelherstellung ist aufw end ig. die Haltbarkeit beschränkt und eine exakte Dosierungsmöglichk eit ist oft nicht gegeben (1 ). In un serer Unters uchung kon nte ein pharmaz eutisch hergestelltes Prä parat geprüft werden.…”

“…In unserer Unte rs uch ung kam es in 34 der 43 Fälle zu eine r erfolgre iche n Einleitun g. Diese Zahl ist mit eine r kürzli ch veröffentl icht en Multizenterstudie (1) vergleichbar. die ebe nfa lls ein industrie ll gefertigtes Prostaglan din E2-Gel.…”