CERVICAL RIPENING AND INDUCTION OF DELIVERY BY LOCAL-ADMINISTRATION OF PROSTAGLANDIN E(2) GEL OR VAGINAL TABLETS IS EQUALLY EFFECTIVE

Background. Prostaglandin E(2) for local application has been widely u sed for preinduction cervical ripening in cases presenting with an unf avorable cervical state. The optimal way of administering prostaglandi n E(2), however, remains unclear. The aim oflhis study was to compare the effect of multiple application of 0.5 mg Minprostin(R) intracervic al Gel to the effect of 3 mg Minprostin(R) vaginal tablets in priming the uterine cervix and inducing labor in an open, prospective, randomi sed study. Methods. PGE(2) was applied up to three times a day for two days until ripening was obtained or labor induced. In case no progres s took place amniotomy was performed and i.v. oxytocin stimulation one hour later if necessary. A total of 208 pregnant women, consecutively admitted for induction of delivery, with Bishop Scores 0-5, were incl uded. Results. Minprostin(R) gel (group I) and Minprostin(R) tablets ( group II) were equally effective in ripening the cervix. Delivery with in 48 hours was achieved in 59% and 63% respectively. The mean number of applications was 2.6 (s.d. 1.6) and 2.7 (s.d. 1.3) respectively. In case more than four doses were required no further effect was seen on delivery rates. Rates of cesarean section (performed in 15% and 18% r espectively), labor induction (3%/1%), drop outs (14%/12%) and failed inductions (10%/5%) were comparable. Patients in group I had a signifi cantly lower demand for analgesia. A significantly shorter induction-d elivery interval in group II was seen in patients with preinduction Bi shop scores 3-5 compared to patients with Bishop scores 0-2. Side effe cts were few Both procedures appear safe. Conclusions. Cervical ripeni ng and induction of delivery by local administration of prostaglandin E(2) gel or vaginal tablets in cases presenting with an unfavorable ce rvical state is equally effective.