Intracervical prostaglandin E2 for induction of labor in patients with premature rupture of membranes and an unripe cervix.

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.