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Abstract
Objective : To evaluate the efficacy of sequential use of Prepidil ® (prostaglandin E 2 gel) and extra-amniotic saline infusion for the induction of labor in nulliparous women with very low Bishop scores. Study design : Nulliparous women with singleton gestations, intact membranes and a cervical Bishop score of h 2 who received Prepidil gel and extra-amniotic saline infusion sequentially for the induction of labor between July 1996 and July 1998 were studied. Results : Thirty-one women met the inclusion criteria. Indications for induction included post-dates (six of 31), pre-eclampsia (ten of 31), diabetes (three of 31), oligohydramnios (three of 31), intrauterine growth restriction (two of 31) and non-reactive non-stress test (NST) (seven of 31). The average time from onset of induction to delivery was 38.1 - 13.5 h. Vaginal delivery was achieved in 80.6%. Women requiring >2 doses of Prepidil had a higher risk of delivering abdominally (OR = 3.5). Three of seven (42.9%) women with labor induced for non-reactive NST but only three of 24 (12.5%) with labor induced for other indications had a Cesarean section delivery ( p < 0.001). Conclusions : Nulliparous women with very unfavorable cervices can be counselled that they have an 80% chance of vaginal delivery using sequential Prepidil and extra-amniotic saline infusion as an induction method, with 90% delivering within the first 48 h.