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A Randomized Trial Comparing Vaginal and Cervical Prostaglandin Gel for Cervical Ripening and Labor Induction

Obstetrics & Gynecology: January 1998
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Objective To compare the effectiveness of intravaginal and intracervical prostaglandin E2 (PGE2) gel for cervical ripening, defined as an increase of 3 or greater in the Bishop score, and for induction of labor.

Methods Women with Bishop score 4 or less were assigned randomly to receive either 2 mg PGE2 intravaginally (n = 125) or 0.5 mg intracervically (n = 122). If the Bishop score was 4 or less, another dose of PGE2 was given after 6 hours, and up to two additional doses were given 6 hours apart on the second day. An oxytocin infusion was begun when the Bishop score was 5 or greater in absence of spontaneous labor, or if labor had not begun on the third day.

Results Baseline characteristics of the two groups were similar. Survival analysis showed that time from PGE2 application, to obtain an increase of 3 or greater in the Bishop score, to vaginal delivery was significantly shorter with intravaginal PGE2 (logrank test: P = .003 and < .001 after stratification for parity, respectively). Thirty-one percent of women in the intravaginal gel group required oxytocin for labor induction compared with 63% in the intracervical group (P < .001). There were no significant differences in relation to cesarean delivery rate, Apgar scores at 5 minutes, and arterial umbilical cord pH, although the power of our study was limited to detect differences in proportions of adverse outcomes.

Conclusion Vaginal PGE2 gel is more effective than intracervical gel for cervical ripening and labor induction.

Address reprint requests to: Olivier Irion, MD, Unité de Développement en Obstétrique, Hôpitaux Universitaires de Genève, 30, Boulevard de la Cluse, CH-1212 Geneva 14, Switzerland. E-mail:

© 1998 The American College of Obstetricians and Gynecologists

Intravaginal prostaglandin E2 gel (2 mg) is more effective than intracervical protaglandin E2 gel (0.5 mg) for cervical ripening and labor induction.