Ripening of the Uterine Cervix and Induction of Labour at Term with Prostaglandin E₂ in Viscous Gel

Abstract

In order to achieve ripening of the uterine cervix or induce labour in patients at term with an unfavourable cervical state, 1 mg of prostaglandin E2 (PGE2), suspended in a viscous gel, was instilled into the cervical canal. In a pilot study, 41 patients received the PGE2-gel. Twenty-three of these, (56%), went into labour, and delivery occurred without further stimulation within 15 hours. In the remaining 18 patients, there was a marked improvement of the cervical state, which changed from an average (modified) Bishop score of 2.5 to 6.1 within 24 hours. In a double-blind study comprising 20 nulliparae, 10 received gel containing PGE2 and 10 gel without prostaglandin. Cervical state did not change significantly (Bishop score 3.6 and 4.0) after 24 hours in patients receiving placebo gel. In those receiving PGE2 gel, 8 went into labour and were delivered without further induction within 13 hours. Two patients showed an increase in Bishop score from 3 to 6 and 7, respectively, after 24 hours. They were then induced by oxytocin and delivery occurred after 8 and 10 hours. The results suggest that administration of PGE2 intracervically can induce ripening of the cervix in patients at term with an unfavourable cervical state, and thus facilitate delivery.

ASPECTS ON RIPENING OF THE CERVIX AND INDUCTION OF LABOR BY INTRACERVICAL APPLICATION OF PGE2 IN VISCOUS GEL

“…Calder et al reported (1977) promising results with this technique both for ripening of the cervix and for induction of labor (9). Similar findings were also reported by Shepherd et al (1976) (22),Thiery et al (1977) (24), and by using a more strictly intracervical application (28,29). Also vaginal deposition of PGE2-gel for ripening of the cervix has been reported (18,19).…”

Prostaglandin dehydrogenase is a target for successful induction of cervical ripening

“…Cervical stromal tissues were obtained from nonpregnant women as described above and from pregnant women undergoing cesarean hysterectomy according to protocols approved by the Institutional Review Board at the University of Texas Southwestern Medical Center. Gestational age and other details were recorded, and cervical ripening was ascertained using a modified Bishop's score in pregnant women (35). In cases that precluded a clinical examination (i.e., placenta previa), cervical length was substituted for effacement (≥4 cm = 0, 2-3 cm = 1, and 0-2 cm = 2), station was presumed to be 0, and dilation of hysterectomy specimen was used to categorize cervical ripening.…”

Plasma prostaglandin F2αand plasma 13,14-dihydro-15-keto-prostaglandin F2αlevels in women during induction of labor with i. v. infusion of prostaglandin F2αin relation to uterine contractions

“…Induction of labor by means of iv PGF 2Q! infusions in high-risk pregnancies does therefore not seem to be better than induction by means of endocervical PGE 2 gel application [7,10,15]. The success rate in induction by means of iv infusions of PGF 2a does therefore not justify the inconvenience and unpleasant side-effects associated with the method, in comparison to the minimal sideeffects associated with local application of PGE 2 followed by low dose of oxytocin if necessary.…”