Vaginal prostaglandins for the ripe cervix

Abstract

The use of vaginal PGE2 tablets for induction of labor with a ripe cervix is associated with a shorter first stage of labor and with reduced requirements for oxytocin, analgesia and instrumental delivery.

Effect of high parity on occurrence of some fetal growth indices: a cohort study

“…These results are in line with previous studies reporting that high parity is associated with a decreased risk of LBW and an increased risk of macrosomia 3,13–15. For example, a prospective cohort study of 1098 pregnancies in Finland found a steady increase in average birth weight in correlation with higher parity 12…”

In vivo controlled release of PGE2 from a vaginal insert (0.8 mm, 10 mg) during induction of labour

“…It is difficult to distinguish uterine hyperactivity from the normal onset of labour with certainty and, consequently, the definition of uterine hyperstimulation varies widely in the literature. This is also reflected in the published hyperstimulation rates of between 0 and 16% reported in clinical trials with prostaglandins 1,6,12 . In our study a tachysystolic uterine contraction pattern (uterine hyperactivity or hypertonus) was recorded in five women (7.4%), while frequent uterine contractions together with an abnormal fetal heart rate recording (uterine hyperstimulation) was seen in one woman (1.5%).…”

“…During the last two decades there has been a concerted effort in many research labouratories to elucidate the role of prostaglandins in parturition 1 . Prostaglandin E 2 (PGE 2 ) is recognised as a successful agent not only for cervical ripening, but also for activation of myometrial contractility 2–6 . PGE 2 , for local administration, is available in a variety of formulations, including vaginal tablets, endocervical gels and vaginal gels 1 , and it is administered using various dosing regimens.…”

Outpatient management of the uncomplicated postdate pregnancy with intravaginal prostaglandin E2 gel and membrane stripping

“…These factors include cervical ripeness and parity. Intravaginal PGE 2 has been shown to induce labor in patients with any degree of cervical ripeness, with dosages of 1 mg needed to accomplish active labor in the multiparous patient with a Bishop score of 8-9, compared to dosages of 3 mg in the nulliparous patient with a Bishop score of 5-6 [6]. In the nulliparous patient with a relatively ripe cervix, 2 mg intravaginal PGE 2 results in fewer side effects such as uterine hypertonus, uterine hyperstimulation, and fetal bradycardia, than a 3-mg dosage, 2.3% vs. 8.7%, respectively [5].…”

“…Paramount amongst these less conventional techniques are 1) use of intravaginal prostaglandin E 2 (PGE 2 ) for labor induction with an unfavorable cervix, rather than preinduction cervical ripening [3,4]; 2) use of intravaginal PGE 2 for labor induction with a favorable cervix [5][6][7], rather than oxytocin and amniotomy; 3) outpatient, rather than inhospital, administration of intravaginal PGE 2 to ripen the cervix and induce labor [8][9][10], while simultaneously performing antenatal fetal testing; and 4) use of membrane stripping, after intravaginal PGE 2 tablet administration, to enhance labor induction [6].…”