Intracervical versus intravaginal PGE2 for induction of labor at term in patients with an unfavorable cervix

Summary In a randomized double-blind study we evaluated the effects on cervical ripening and labor induction of 0.5 mg PGE₂ in gel given intracervically and 2.0 mg PGE₂ given as a vaginal suppository. All patients were at term with unfavorable cervical scores. The indications for induction were toxemia, diabetes mellitus, Rh-immunization, or intrauterine growth retardation. Significantly better results for both cervical priming and labor induction were obtained after intracervical PGE₂-gel application than after treatment with placebo or vaginal suppositories. Eleven out of 19 patients (58%) were delivered within 24 h after intracervical PGE₂-gel compared to two out of 19 patients given placebo (p < 0.01). In patients not delivered 24 h after the start of treatment, the mean cervical score had changed from 3.7 to 6.0 (p < 0.05) after PGE₂-gel application compared to a change from 3.9 to 4.3 after placebo treatment (n.s.). The outcome after treatment with PGE₂ suppositories did not differ significantly from that with placebo treatment.