title: Randomized trial of administration of prostaglandin E2 gel for induction of labor in the morning or the evening.
abstract: OBJECTIVE
  To compare the outcome of induction of labor and patient's preferences using a protocol with the first dose of prostaglandin E2 endocervical gel in the evening versus a protocol with the first dose in the morning.
  
  
  METHODS
  We performed a randomized trial comparing administration of prostaglandin E2 endocervical gel in the morning with administration of prostaglandin E2 gel in the evening, followed if necessary by a second dose being given after six hours if labor had not started or the cervix was still unripe. Formal induction of labor by amniotomy and oxytocin infusion was performed the morning after the initial prostaglandin E2 dose. Patients' preferences were assessed using a questionnaire that was completed after delivery.
  
  
  METHODS
  Tertiary care hospital in the Netherlands with 1,600 deliveries per year.
  
  
  METHODS
  One-hundred and twenty-six women with viable singleton pregnancies at term who had induction of labor with prostaglandins.
  
  
  METHODS
  Time of delivery (daytime, evening or night) and patient's satisfaction.
  
  
  RESULTS
  Fifty-eight women were allocated for administration of gel in the morning, whereas 68 had their gel in the evening. Administration of gel in the evening did not significantly reduce delivery between 23.00 hours and 08.00 hours, although there was a reduction in delivery between 23.00 hours and 08.00 hours in nulliparae. None of the multiparous women delivered between 18.00 hours and 23.00 hours after induction of labor in the evening. The relative risk for delivery by vacuum or forceps was increased after allocation of gel in the evening (4.2; 95% confidence limits 1.4 to 13). Patients' preferences favored administration of gel in the morning.
  
  
  CONCLUSIONS
  There was no benefit in starting induction of labor with prostaglandin E2 in the evening, compared with starting in the morning.
authors.affiliation: Department of Obstetrics and Gynecology, Saint Joseph Hospital, Veldhoven, The Netherlands. guidoei@knmg.nl
authors.forename: S G
authors.initials: SG
authors.lastname: Oei
authors.forename: L
authors.initials: L
authors.lastname: Jongmans
authors.forename: B W
authors.initials: BW
authors.lastname: Mol
mesh_terms: D002584:Cervix Uteri / Q000187:drug effects; D015232:Dinoprostone / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D005782:Gels; D006801:Humans; D007751:Labor, Induced / Q000379:methods*; D010298:Parity; D011247:Pregnancy; D012890:Sleep / Q000187:drug effects; D011795:Surveys and Questionnaires; D013997:Time Factors
chemical_list: D005782:Gels; D015232:Dinoprostone