title: Improved intravaginal controlled-release prostaglandin E2 insert for cervical ripening at term. The Prostaglandin E2 insert Study Group.
abstract: The purpose of this study was to determine if prostaglandin E2 (PGE2) in a controlled-release vaginal insert with retrieval system can produce cervical ripening at term. This was a multicenter, double blind, randomized, placebo-controlled study involving 206 patients with 102 receiving active agent. A successful outcome was defined as a change in Bishop score of > or = 3, or a Bishop score of > or = 6 at 12 h or delivery within 12 h of the insert placement. Analysis was by Fisher's exact test, Wilcoxon's two-sample rank-sum test, and Student's t-test where appropriate. One hundred ninety-three women completed the protocol. Initial Bishop scores were 2.6 +/- 1.2 and 2.5 +/- 1.4 in the PGE2 and placebo groups, respectively. The incidence of cesarean delivery was identical in the two groups. Uterine hyperstimulation lasted 2-13 min in 5 PGE2 patients (4.9%) with 1 patient requiring tocolysis. More patients in the PGE2 group had a change in Bishop score of > or = 3 (62% vs. 40%; P = 0.002), a Bishop score > or = 6 after 12 h (46% vs. 34%; P = 0.11), and vaginal delivery within 12 h (6.5% vs. 1%; P = 0.055). Sixty-five percent of PGE2 group patients had a successful outcome vs. 44% of control patients (P = 0.001). In conclusion, when administered in a controlled-release vaginal insert with a retrieval system, PGE2 is effective in promoting cervical ripening at term.
authors.affiliation: Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: F R
authors.initials: FR
authors.lastname: Witter
authors.forename: B M
authors.initials: BM
authors.lastname: Mercer
mesh_terms: D000328:Adult; D002584:Cervix Uteri / Q000187:drug effects / Q000502:physiology; D002585:Cesarean Section / Q000706:statistics & numerical data; D003692:Delayed-Action Preparations; D015232:Dinoprostone / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007751:Labor, Induced; D010120:Oxytocics / Q000008:administration & dosage / Q000627:therapeutic use*; D018579:Patient Selection; D010919:Placebos; D011247:Pregnancy; D018709:Statistics, Nonparametric; D015145:Tocolysis; D014621:Vagina
chemical_list: D003692:Delayed-Action Preparations; D010120:Oxytocics; D010919:Placebos; D015232:Dinoprostone