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

Abstract

To achieve ripening of the uterine cervix or induce labor in patients at term with an unfavorable 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. Of these, 23 (56%), went into labor and delivery occurred without further stimulation within 15 h. In the remaining 18 patients, there was a marked improvment of the cervical state, which changed from an average (modified) Bishop score of 2.5-6.1 within 24 h. In a double-blind study comprising 20 nulliparae, 10 received gel containing PGE2 and 10 gel without PG. Cervical state did not change significantly (Bishop score 3.6 and 4.0) after 24 h in patients receiving placebo gel. In those receiving PGE2 gel, 8 went into labor and were delivered without further induction within 13 h. Two patients showed an increase in Bishop score from 3 to 6 and 7, respectively, after 24 h. They were then induced by oxytocin and delivery occurred after 8 and 10 h. Administration of PGE2 intracervically apparently can induce ripening of the cervix in patients at term with an unfavorable cervical state and thus facilitate delivery.