RANDOMIZED COMPARISON OF THE EFFECTS OF ENDOCERVICAL AND VAGINAL PROSTAGLANDIN E(2) GEL IN WOMEN WITH VARIOUS DEGREES OF CERVICAL RIPENESS

OBJECTIVE: The trial was conducted to obtain an unbiased comparison of the relative merits of endocervical and vaginal prostaglandin E(2) ge l in a weighted case mix of parous and nulliparous women with favorabl e and unfavorable cervical features. STUDY DESIGN: Multicenter ranodmi zed trial with 285 participants, (three exclusions) was performed with sealed envelopes stratified for parity and Bishop score. RESULTS: Out comes of labor and delivery were clearly related to the cervical score at trial entry, especially in nulliparous women. Endocervical prostag landin E(2) had a more marked effect on cervical ripeness than did vag inal prostaglandin E(2), but this did not result in any differences in more substantive outcomes. Frequencies of delivery within 12 (50%) an d 24 hours (77.7%), cesarean section (7.3%), instrumental vaginal deli very (11.7%), and poor infant outcomes were similar with both preparat ions. CONCLUSION: Because differences in effectiveness between endocer vical and vaginal prostaglandin E(2) in triacetin gel are marginal, pr eferences of women and clinicians can determine the choice between the m.