Intracervical Prostaglandin E₂ for Induction of Labor in Patients with Premature Rupture of Membranes and an Unripe Cervix

ABSTRACT

The efficacy and safety of intracervical prostaglandin E₂ (PGE₂) gel for induction of labor in patients with premature rupture of the membranes (PROM) at term and with an unripe cervix were evaluated. Fifty-two patients who did not start labor 6 to 12 hours after PROM and who had an unripe cervix were randomized to one of two management protocols. Patients randomized to PGE₂ received a single intracervical application of 0.5 mg PGE₂. Patients randomized to the conservative protocol were managed expectantly for 24 hours. If labor was not established 6 hours after randomization in patients receiving PGE₂ or 24 hours after PROM in patients managed expectantly, labor was induced with intravenous oxytocin. Of the patients receiving PGE₂, 93% began labor after a single application, and the mean interval between prostaglandin application and delivery was 6.6 hours. In the conservative group, only 57% began labor within 24 hours, and more than half of them required augmentation with oxytocin. The mean latency between PROM and delivery was 15 hours in patients managed with PGE₂ and 30 hours in patients managed conservatively (P <0.01). There were no complications and pregnancy outcome was similar in the two groups. Intracervical PGE₂ is safe and effective for inducing labor in patients with PROM and an unfavorable cervix.

Keywords

Premature rupture of the membranes - prostaglandin E₂ - unripe cervix