LOCAL-ADMINISTRATION OF PROSTAGLANDIN E(2) FOR CERVICAL RIPENING AND LABOR INDUCTION - THE APPROPRIATE ROUTE AND DOSE

Background. Although there are many comparative studies concerning the local administration of prostaglandin Ea gel for cervical ripening an d labor induction, the safety, efficacy and the appropriate route and dose of the gel are still debated. Patients and Methods. One hundred a nd ten women with high-risk pregnancy and unripe cervix received prost aglandin E(2) gel 1 mg intravaginally (n=35), 2 mg intravaginally (n=3 6) and 0.5 mg intracervically (n=39), maximally three times at 6-hour intervals for cervical ripening prior to labor induction. The safety, efficacy and optimal dose were assessed. Results. The 2 mg intravagina l gel and the 0.5 mg intracervical gel were equally effective and more effective than the 1 mg intravaginal gel in labor characteristics suc h as ripening time and cesarean section rate, but not in labor time. H owever, the failure rate (labor could not be induced) was highest in t he intracervical group (10.3%) compared to the intravaginal groups (2. 9% and 2.8%), although the differences were not statistically signific ant. In the two intravaginal groups three and five patients received t he third gel application and one patient in both groups could not be i nduced, In the intracervical group the ripening of the cervix failed i n all patients, who received the third gel. The neonatal outcome was u neventful in all groups. There were two cases of uterine hypertonus as sociated with fetal bradycardia, one in the intracervical and one in t he 2 mg intravaginal group. Thus careful fetal monitoring is necessary . Furthermore, the vaginal route has the advantage of an easier techni que of administration and obviously lower risk for inadvertent extraam nial instillation. Conclusion. We recommend the use of multiple applic ations of 2 mg intravaginal prostaglandin E(2) gel as a safe, effectiv e and easy method for preinduction cervical ripening in high-risk preg nancies. More than three gel applications hardly increase the efficacy .