SERIAL INTRAVAGINAL PROSTAGLANDIN-E2 GEL CERVICAL RIPENING IN PRETERMPREGNANCIES

Objective: To determine if prostaglandin (PG) E(2) cervical ripening i s safe and effective in high-risk preterm pregnant women who do not ha ve an indication for immediate delivery. Methods: This was a retrospec tive case-control study of preterm pregnant woman treated with sequent ial PGE(2) gel between 3/1/92 and 3/1/95. Study subjects were between 24 and 36 weeks gestation, had intact membranes, and complications req uiring inpatient monitoring but not immediate delivery. PGE(2) gel was inserted serially until either maternal or fetal deterioration requir ed intervention, fetal maturity was achieved, a Bishop greater than or equal to 7 was reached, or the patient improved and was discharged. C ontrol subjects were matched for inclusion criteria and diagnoses on a dmission. Results: A total of 22 study and 22 control patients were ev aluated. The gestational age at admission was 32.3 +/- 2.8 versus 31.8 +/- 2.9 weeks. The mean number of PGE(2) gel applications was 11.6 ov er a mean of 5.0 days. Intervention during ripening was required in 11 (50%). A Bishop score greater than or equal to 7 without labor was ac hieved in 11 (50%), and labor during the ripening process occurred in 2 (9%). The mean time from Bishop greater than or equal to 7 to delive ry was 2.6 days. The total cesarean delivery rate was 10 (45%) versus 15 (68%), in the control group (P = NS). Neonatal outcomes were simila r. Conclusions: Sequential PGE, gel cervical ripening when used in pre term pregnant women improves the Bishop score, and has a low incidence of spontaneous preterm labor.