Sequential use of Prepidil and extra-amniotic saline infusion for the induction of labor in nulliparous women with very low Bishop scores.
OBJECTIVE
To evaluate the efficacy of sequential use of Prepidil (prostaglandin E2 gel) and extra-amniotic saline infusion for the induction of labor in nulliparous women with very low Bishop scores.


METHODS
Nulliparous women with singleton gestations, intact membranes and a cervical Bishop score of < or = 2 who received Prepidil gel and extra-amniotic saline infusion sequentially for the induction of labor between July 1996 and July 1998 were studied.


RESULTS
Thirty-one women met the inclusion criteria. Indications for induction included post-dates (six of 31), pre-eclampsia (ten of 31), diabetes (three of 31), oligohydramnios (three of 31), intrauterine growth restriction (two of 31) and non-reactive non-stress test (NST) (seven of 31). The average time from onset of induction to delivery was 38.1 +/- 13.5 h. Vaginal delivery was achieved in 80.6%. Women requiring > 2 doses of Prepidil had a higher risk of delivering abdominally (OR = 3.5). Three of seven (42.9%) women with labor induced for non-reactive NST but only three of 24 (12.5%) with labor induced for other indications had a Cesarean section delivery (p < 0.001).


CONCLUSIONS
Nulliparous women with very unfavorable cervices can be counselled that they have an 80% chance of vaginal delivery using sequential Prepidil and extra-amniotic saline infusion as an induction method, with 90% delivering within the first 48 h.
Chammas
M F
MF
Department of Obstetrics and Gynecology, College of Medicine, University of Illinois at Chicago, 60612, USA.
Nguyen
T M
TM
Vasavada
R A
RA
Nuwayhid
B S
BS
Castro
L C
LC
D000282:Administration, Intravaginal; D000293:Adolescent; D000328:Adult; D000650:Amnion / Q000187:drug effects*; D001034:Apgar Score; D020070:Cervical Ripening / Q000187:drug effects; D002585:Cesarean Section; D015232:Dinoprostone / Q000008:administration & dosage* / Q000627:therapeutic use*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007263:Infusions, Parenteral; D007745:Labor Onset / Q000187:drug effects; D007751:Labor, Induced; D010120:Oxytocics / Q000008:administration & dosage* / Q000627:therapeutic use*; D010298:Parity; D011247:Pregnancy; D011256:Pregnancy Outcome; D012965:Sodium Chloride / Q000008:administration & dosage* / Q000627:therapeutic use*; D013997:Time Factors
D010120:Oxytocics; D012965:Sodium Chloride; D015232:Dinoprostone