Cervical Ripening Prior to Labor Induction with Intracervical Prostaglandin E₂ Gel in Patients with Preeclampsia–A Placebo-Controlled Study

Abstract

Objective: The safety and efficacy of 0.5 mg prostaglandin E, gel administered repeatedly intracervically for cervical ripening were assessed 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 <S 5). The cervical ripening for labor induction was started, in randomized order, either with 0.5 mg intracervi-cal prostaglandin E₂ (PGE₂) gel (n = 24) or with a similar-looking placebo gel (n = 21). If Bishop scores rose over 5, labor was induced with amniotomy and/ or intravenous oxytocin infusion. Treatment was judged to have failed if, 12 h after the application of two gels. Bishop scores were still <5.

Results: Seven of 24 women (29.1%) treated with PGE went into labor without any further induction procedure, and in 15 of 24 women (62.6%) the cervix ripened so much that labor could be 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, group and 6 failures in the placebo group. The time interval from the first gel to labor induction or augmentation in the PGE, group (13.8 ± 9.4 h) was significantly shorter (P < 0.05) than that in the placebo group (19.0 ± 9.3 h). as was also the time interval from the first gel to the delivery (23.0 ± 17.6 vs. 33.6 ± 23.1 h). There were 4 cesarean sections in the PGE, group in comparison to 10 in the placebo group (P < 0.05). No uterine hypertonus or fetal bradycardia ensued. The neonatal outcome was uneventful in both groups.

Conclusions: Intracervical PGE, gel is an effective and safe method for cervical ripening in preeclamptic patients.

Key Words:

• Cervical ripening
• Preeclampsia
• Prostaglandin