[Evidence-based medicine: labor induction with prostaglandins].
OBJECTIVE
Because 10-15% of all births in Germany are induced with prostaglandins (PG), a survey of the scientific evidence for the efficacy of PG in promoting cervical ripening was undertaken.


METHODS
Randomized controlled trials and meta-analyses of the efficacy of the local (intravaginal and intracervical) administration of PGE2 and PGE1 compared to the effects of conservative management (no specific therapy), placebo, and intravenous oxytocin were evaluated.


RESULTS
PGE2 was found to be more effective than conservative management and placebo, and to reduce significantly the incidences of cesarean section and instrumental vaginal delivery, without having any impact on measures of fetal outcome. PGE2 was also found to be more effective than oxytocin, especially when the cervix is unripe (Bishop score < or = 5): unsuccessful induction was less frequent and the induction-delivery intervals were shorter, although fetal outcome and the incidences of cesarean section and instrumental vaginal delivery were unaffected. Initial experience also indicates that PGE1 given at a dosage of 25 micrograms every three hours is more effective than intravenous oxytocin or local PGE2, but this advantage appears to be accompanied by an increase in the incidence of uterine hyperstimulation and associated fetal heart rate changes.


CONCLUSIONS
It is surprising that, even today, there is little hard scientific data concerning the efficacy of PG in the induction of cervical ripening. This fact should be discussed with the parturient. Further randomized controlled trials using well-defined, standardized measures are needed to clarify the situation.
Winkler
M
M
Frauenklinik für Gynäkologie und Geburtshilfe, Universitätsklinikum der Rheinisch-Wesffälischen Technischen Hochschule, Aachen.
Rath
W
W
D000282:Administration, Intravaginal; D000527:Alprostadil / Q000008:administration & dosage* / Q000009:adverse effects; D015232:Dinoprostone / Q000008:administration & dosage* / Q000009:adverse effects; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007751:Labor, Induced / Q000379:methods*; D015201:Meta-Analysis as Topic; D010120:Oxytocics / Q000008:administration & dosage* / Q000009:adverse effects; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic
D010120:Oxytocics; D000527:Alprostadil; D015232:Dinoprostone