title: Sequential use of Prepidil and extra-amniotic saline infusion for the induction of labor in nulliparous women with very low Bishop scores.
abstract: 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.
authors.affiliation: Department of Obstetrics and Gynecology, College of Medicine, University of Illinois at Chicago, 60612, USA.
authors.forename: M F
authors.initials: MF
authors.lastname: Chammas
authors.forename: T M
authors.initials: TM
authors.lastname: Nguyen
authors.forename: R A
authors.initials: RA
authors.lastname: Vasavada
authors.forename: B S
authors.initials: BS
authors.lastname: Nuwayhid
authors.forename: L C
authors.initials: LC
authors.lastname: Castro
mesh_terms: 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
chemical_list: D010120:Oxytocics; D012965:Sodium Chloride; D015232:Dinoprostone