CERVICAL RIPENING PRIOR TO LABOR INDUCTION WITH INTRACERVICAL PROSTAGLANDIN-E(2) GEL IN PATIENTS WITH PREECLAMPSIA - A PLACEBO-CONTROLLED STUDY

Objective: The safety and efficacy of 0.5 mg prostaglandin E(2) gel ad ministered repeatedly intracervically for cervical ripening were asses sed in a placebo-controlled trial in 45 preeclamptic women with unripe cervix at term. Methods: We did a prospective study on 45 women with established preeclampsia and unripe cervix (Bishop scores less than or equal to 5). The cervical ripening for labor induction was started, i n randomized order, either with 0.5 mg intracervical prostaglandin E(2 ) (PGE(2)) gel (n = 24) or with a similar-looking placebo gel (n = 21) . If Bishop scores rose over 5, labor was induced with amniotomy and/o r intravenous oxytocin infusion. Treatment was judged to have failed i f, 12 h after the application of two gels, Bishop scores were still le ss than or equal to 5. Results: Seven of 24 women (29.1%) treated with PGE(2) went into labor without any further induction procedure, and i n 15 of 24 women (62.6%) the cervix ripened so much that labor could b e induced by amniotomy and/or oxytocin infusion. In the placebo group the corresponding figures were 1 (4.8%) (P < 0.05) and 14 (66.7%) (NS) . There were 2 failures in the PGE(2) group and 6 failures in the plac ebo group. The time interval from the first gel to labor induction or augmentation in the PGE(2) group (13.8 +/- 9.4 h) was significantly sh orter (P < 0.05) than that in the placebo group (19.0 +/- 9.3 h), as w as also the rime interval from the first gel to the delivery (23.0 +/- 17.6 vs. 33.6 +/- 23.1 h). There were 3 cesarean sections in the PGE( 2) group in comparison to 10 in the placebo group (P < 0.05). No uteri ne hypertonus or fetal bradycardia ensued. The neonatal outcome was un eventful in both groups. Conclusions: Intracervical PGE(2) gel is an e ffective and safe method for cervical ripening in preeclamptic patient s.