Serial intravaginal prostaglandin E2 gel cervical ripening in preterm pregnancies.
OBJECTIVE
To determine if prostaglandin (PG) E2 cervical ripening is safe and effective in high-risk preterm pregnant women who do not have an indication for immediate delivery.


METHODS
This was a retrospective case-control study of preterm pregnant women treated with sequential PGE2 gel between 3/1/92 and 3/1/95. Study subjects were between 24 and 36 weeks gestation, had intact membranes, and complications requiring inpatient monitoring but not immediate delivery. PGE2 gel was inserted serially until either maternal or fetal deterioration required intervention, fetal maturity was achieved, a Bishop > or = 7 was reached, or the patient improved and was discharged. Control subjects were matched for inclusion criteria and diagnoses on admission.


RESULTS
A total of 22 study and 22 control patients were evaluated. The gestational age at admission was 32.3 +/- 2.8 versus 31.8 +/- 2.9 weeks. The mean number of PGE2 gel applications was 11.6 over a mean of 5.0 days. Intervention during ripening was required in 11 (50%). A Bishop score > or = 7 without labor was achieved in 11 (50%), and labor during the ripening process occurred in 2 (9%). The mean time from Bishop > or = 7 to delivery was 2.6 days. The total cesarean delivery rate was 10 (45%) versus 15 (68%), in the control group (P = NS). Neonatal outcomes were similar.


CONCLUSIONS
Sequential PGE2 gel cervical ripening when used in preterm pregnant women improves the Bishop score, and has a low incidence of spontaneous preterm labor.
Department of Obstetrics and Gynecology, Arnold Palmer Hospital for Children and Women, Division of Orlando Regional Healthcare System, Florida 32806, USA.
S J
SJ
Carlan
W F
WF
O'Brien
S
S
Logan
D000282:Administration, Intravaginal; D000328:Adult; D016022:Case-Control Studies; D002584:Cervix Uteri / Q000187:drug effects* / Q000502:physiology*; D002585:Cesarean Section; D015232:Dinoprostone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005782:Gels / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D007751:Labor, Induced; D007752:Obstetric Labor, Premature; D016104:Oligohydramnios / Q000188:drug therapy; D010120:Oxytocics / Q000008:administration & dosage / Q000627:therapeutic use; D011225:Pre-Eclampsia / Q000188:drug therapy; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy; D011262:Pregnancy Trimester, Second; D011263:Pregnancy Trimester, Third; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
D005782:Gels; D010120:Oxytocics; D015232:Dinoprostone