Outpatient use of prostaglandin gel for ripening of the cervix and induction of labor.

This case series reports the experience in a family practice center with the outpatient use of prostaglandin E2 (PGE2) gel in patients with a medical or obstetric indication for induction. A retrospective medical record review of a 15-month period was completed for 45 women receiving intravaginal PGE2 gel for cervical ripening before the induction of labor. A change in Bishop score was seen following application of the first gel in 21 women (54%). Six women (13%) had labor onset 1 to 16 hours after the initial gel placement, and an additional 19 women (42%) had labor onset within 48 hours of the final gel placement. Twenty-one women (47%) gave birth without the use of oxytocin, and only 11 women (24%) required oxytocin induction of labor. No significant differences were seen in type of delivery, delivery complications, or newborn outcome between categories of labor onset (spontaneous, PGE2 gel, oxytocin). Two complications followed gel insertions, one case of uterine hyperstimulation and one case of a brief episode of fetal bradycardia. Both women were identified within the monitoring period and subsequently were delivered of healthy term infants. This case series demonstrates the usefulness and lack of adverse effects of outpatient PGE2 gel as an adjunct in labor induction.