Comparison of intravaginal and two intracervical prostaglandin E2 gels in pre-induction of labour.

A randomized study was undertaken to compare the effect of vaginal (1 mg of dinoprostone/2.5 ml gel) and intracervical (0.5 mg of dinoprostone in 2.5 ml of two different vehicles) on induction of labor and perinatal outcome. Sixty women (n = 20/20/20) who presented with an unfavorable cervix and a specific indication for the induction of labor participated in the study. There were no significant differences between the groups with respect to maternal age, weight, parity, gestational length or Bishop scores before prostaglandin E2 preinduction. Labour was induced with prostaglandin gel alone in twenty-two patients and with oxytocin infusion on the following morning after gel application in seven patients; altogether the rate of successful induction was 48.3%. The rate of uterine hyperstimulation was 16.7% with most cases in the groups receiving intracervical prostaglandin E2. Neonatal asphyxia diagnosed with umbilical vein and artery blood gas analysis was seen in eleven neonates who were delivered by labor induced with prostaglandin gel alone (50%). Prostaglandin pre-induction decreases the need for Cesarean sections in complicated pregnancies, but because of the risk of uterine hyperstimulation and neonatal asphyxia prostaglandins should be used only with specific indications.