PREINDUCTION CERVICAL RIPENING WITH COMMERCIALLY AVAILABLE PROSTAGLANDIN E(2) GEL - A RANDOMIZED, DOUBLE-BLIND COMPARISON WITH A HOSPITAL-COMPOUNDED PREPARATION

OBJECTIVE: Our purpose was to compare the efficacy, safety, and cost o f commercially available dinoprostone cervical gel 0.5 mg with a hospi tal-compounded formulation. STUDY DESIGN: One hundred thirty-four pati ents undergoing labor induction were randomly assigned to one of two c ervical ripening groups. Commercially available dinoprostone gel 0.5 m g or a compounded formulation of 0.5 mg of prostaglandin E(2) gel was administered endocervically. On the basis of cervical scores, gel was reapplied at 6-hour intervals for a maximum of three doses. Physicians managing labor were blinded as to treatment group allocation. RESULTS : Among 134 patients evaluated, 70 were allocated to the commercially available gel and 54 to the compounded gel. No statistically significa nt differences were noted between the treatment groups with respect to start-to-delivery interval, number of doses, amount of oxytocin, or n eonatal adverse outcomes. However, cesarean delivery was performed les s frequently in patients in the group receiving the commercially avail able gel (12.9%) than in the grouup receiving the compounded gel (28.1 %) (p = 0.03). Because of the higher cesarean delivery rate in the com pounded group, use of this formulation was not associated with cost sa vings. CONCLUSIONS: The two prostaglandin E(2) formulations appeared e quivalent with respect to efficacy. An unexplained higher cesarean sec tion rate, however, was associated with the use of the compounded prep aration.