Intracervical Prostaglandin E₂ Gel for Cervical Ripening and Labor Induction: What Is the Appropriate Dose?

Abstract

In order to evaluate a dose-related response of cervical ripening and labor induction to a prostaglandin E₂ (PGE₂) gel, 110 women with uncomplicated postdate pregnancies and unripe cervices received intracervically 0.5 mg PGE₂ (n = 40), 1.5 mg PGE₂ (n = 35) or 2.5 mg PGE₂ (n = 35). The failure rate in terms of cervical ripening was similar in all groups. Labor characteristics such as the duration of the latent phase as well as the total length of labor, the cesarean-section rate, instrumental deliveries and neonatal outcome were similar in all groups. The number of women who required oxytocin for labor augmentation was negatively correlated to the dose of PGE₂ (p < 0.05). In addition, 3 out of 35 women in the 2.5-mg group presented hypertonic uterine activity. The increase in the dose of PGE₂ gel did not increase the possibility for a vaginal delivery, but reduced the requirement for oxytocin while increasing hypertonic uterine action.

Evaluation of glyceryl trinitrate, misoprostol, and prostaglandin E2 gel for preinduction cervical ripening in term pregnancy

“…4 Intracervical dinoprostone gel was given in a dose of 500 mg according to standard recommendations. 20 High cesarean section rates were observed in our study in all three groups. This might be because of inclusion of primigravida women with unfavorable cervices, a group at high risk of instrumental and operative delivery.…”

“…It has been shown in a recent meta‐analysis that 50 µg misoprostol is associated with shorter duration of labor and no increase in hyperstimulation compared with a 25 µg dose 4 . Intracervical dinoprostone gel was given in a dose of 500 µg according to standard recommendations 20 …”