Randomized trial of administration of prostaglandin E-2 gel for induction of labor in the morning or the evening

Objective: To compare the outcome of induction of labor and patient's prefe rences using a protocol with the first dose of prostaglandin E-2 endocervic al gel in the evening versus a protocol with the first dose in the morning. Design: We performed a randomized trial comparing administration of prostag landin E-2 endocervical gel in the morning with administration of prostagla ndin Pr gel in the evening, followed if necessary by a second dose being gi ven after six hours if labor had not started or the cervix was still unripe . Formal induction of labor by amniotomy and oxytocin infusion was performe d the morning after the initial prostaglandin E-2 dose. Patients' preferenc es were assessed using a questionnaire that was completed after delivery. Setting: Tertiary care hospital in the Netherlands with 1,600 deliveries pe r year. PARTICIPANTS: One-hundred and twenty-six women with viable singleton pregna ncies at term who had induction of labor with prostaglandins. Main outcome measures: Time of delivery (daytime, evening or night) and pat ient's satisfaction. Results: Fifty-eight women were allocated for administration of gel in the morning, whereas 68 had their gel in the evening. Administration of gel in the evening did not significantly reduce delivery between 23.00 hours and 0 8.00 hours, although there was a reduction in delivery between 23.00 hours and 08.00 hours in nulliparae. None of the multiparous women delivered betw een 18.00 hours and 23.00 hours after induction of labor in the evening. Th e relative risk for delivery by vacuum or forceps was increased after alloc ation of gel in the evening (4.2; 95 % confidence limits 1.4 to 13). Patien ts' preferences favored administration of gel in the morning. Conclusions: There was no benefit in starting induction of labor with prost aglandin E-2 in the evening, compared with starting in the morning.