Patient-administered outpatient intravaginal prostaglandin E2 suppositories in post-date pregnancies: a double-blind, randomized, placebo-controlled study.
OBJECTIVE
To shorten post-date pregnancies in a safe, effective manner by outpatient acceleration of cervical ripening.


METHODS
Eighty patients with uncomplicated pregnancies at or beyond 41 weeks' gestation and a cervical Bishop score less than 9 were randomized to daily self-administered, 2-mg intravaginal prostaglandin E2 (PGE2) or placebo suppositories. Each followed a standard post-date antepartum surveillance protocol. Patients were admitted for spontaneous labor or for induction if the Bishop score reached 9, antepartum testing was nonreassuring, exclusion criteria were fulfilled, or if the gestational age reached 44 weeks.


RESULTS
Fewer suppositories were used in the PGE2 group (four versus seven; P = .006), resulting in earlier gestational age on admission (295 versus 297 days; P = .021) and lower antepartum testing charges ($476.97 versus $647.29; P = .001). Labor and delivery time was significantly decreased in nulliparas (10.7 +/- 5.1 versus 15.3 +/- 7.6 hours; P = .035).


CONCLUSIONS
Daily low-dose, patient-administered PGE2 vaginal suppositories can decrease the gestational length and cost of uncomplicated post-date pregnancies by reducing the time to achieve a favorable cervix, the need for antepartum testing, and, potentially, post-date-related complications.
Sawai
S K
SK
Department of Obstetrics and Gynecology, University of South Florida College of Medicine, Tampa.
O'Brien
W F
WF
Mastrogiannis
D S
DS
Krammer
J
J
Mastry
M G
MG
Porter
G W
GW
D000282:Administration, Intravaginal; D002584:Cervix Uteri / Q000187:drug effects; D015232:Dinoprostone / Q000008:administration & dosage* / Q000009:adverse effects; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007751:Labor, Induced; D007743:Labor, Obstetric / Q000187:drug effects; D011247:Pregnancy; D011256:Pregnancy Outcome; D011273:Pregnancy, Prolonged; D011446:Prospective Studies; D012646:Self Administration; D013488:Suppositories
D013488:Suppositories; D015232:Dinoprostone