PGE2 GEL AND PGE2 INTRAVAGINAL TABLETS TO INDUCE DELIVERY AT TERM - APROSPECTIVE RANDOMIZED STUDY

In a prospective randomised study, the effects of an intracervical gel containing 0.5 mg PgE2 and an intravaginal tablet containing 3 mg PgE 2 were compared in their efficiency to induce delivery at term. When o nly gel was used, induction failed in 45 % of the cases, especially wi th an initially immature cervix score. However, these patients did sho w significant improvement of the Bishop score. The vaginal tablet was more effective with regard to the induction of delivery. When using th e vaginal tablet alone, induction failed in only 5 % of cases (p < 0.0 01). Best results, however, were obtained with a combination of both a pplication forms. In this group there were no failures. Tablet applica tion induced delivery within 24 hours in 56 % of the cases, gel applic ation in only 27 % (p < 0.001). There were no significant differences observed in these groups during the course of labour. The length of th e latency period was identical, whether a tablet or a gel was used in initiating labour. In 29 % of the cases, beta-sympathicomimetics had t o be used because of tetanic contractions or polysystolia. No signific ant differences in the occurrence of these contractions were seen in e ither the gel or the tablet group. Even in a high-risk collective with 25 % pathological Doppler-flow findings, no higher rate of operative deliveries or fetal acidoses was observed after prostaglandin inductio n, if careful surveillance of the patients and early use of tocolytics in experienced hands were administered. Our results further confirm t he concept of a differential induction of labour with prostaglandins. In case of an immature cervix score, the use of an intracervical gel c an induce ripening of the cervix. The vaginal tablet can be used for t he induction of delivery with a mature cervix score.