PREINDUCTION CERVICAL RIPENING - A RANDOMIZED COMPARISON OF 2 METHODS

Objectives: To compare two methods of pre-induction cervical ripening in a randomized clinical trial. Methods: A single intracervical prosta glandin E(2) (PGE(2)) gel application was compared with a single inser tion of hygroscopic dilators in 441 women at term with unfavorable cer vical scores. Induction success was defined as entry into active labor within 6 hours of oxytocin infusion. Results: There was no statistica l difference in pre- or post-ripening cervical scores. In the group re ceiving hygroscopic dilators, only 28% entered the active phase of lab or within 6 hours of oxytocin infusion compared with 45% (P < .001) in the PGE(2) group. Thus, in this study, a change in cervical score did not directly predict induction success. There was a higher rate of po stpartum endometritis (24 versus 14%; P = .007) and suspected neonatal infection (10 versus 5%; P = .03) in the dilator group. Conclusions: Pre-induction ripening by hygroscopic dilators and intracervical PGE(2 ) was equivalent as measured by changes in the cervical score. The cha nge in cervical score, however, was not predictive of successful induc tion, and PGE(2) was more frequently associated with induction success . Hygroscopic dilators were associated with a higher incidence of post partum maternal and neonatal infection because of a longer duration of labor. Hospital charges for intracervical PGE(2) gel totaled $522 com pared with $91 for the insertion of three dilators.