Premature Rupture of Membranes Near Term: Induction of Labor with Endocervical Prostaglandin E₂ Gel or Intravenous Oxytocin

ABSTRACT

We have studied the influence of endocervical application of 0.4 mg prostaglandin E₂ (PGE₂) in gel on the clinical outcome of pregnancies of at least 36 weeks' duration complicated with premature rupture of the membranes (PROM) and unripe cervix, (modified Bishop score of 7 or less). There were 579 women in the study. The PGE₂ gel was applied within the first 12 hours after PROM. The first 60 women were randomly divided into controls given oxytocin infusions and experimental subjects given PGE₂ gel. All others were given PGE₂ gel, and the results were compared with those obtained in patients with similar criteria who were treated with oxytocin infusions during the preceding year. The clinical outcome was significantly better in the PGE₂-treated patients than oxytocin-infused patients. PROM to delivery interval and the incidence of operative deliveries were significantly reduced. No adverse effects on the neonates were observed and the incidence of neonatal infection declined. It is concluded that cervical ripening with PGE₂ gel in patients with PROM and unripe cervix near term significantly improves the outcome for both mother and child.