M. Nuutila et P. Kajanoja, CERVICAL RIPENING PRIOR TO LABOR INDUCTION WITH INTRACERVICAL PROSTAGLANDIN-E(2) GEL IN PATIENTS WITH PREECLAMPSIA - A PLACEBO-CONTROLLED STUDY, Hypertension in pregnancy, 14(3), 1995, pp. 313-317
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.