[Indication for labor induction by prostaglandin E2 vaginal gel. Retrospective study of a continuous series of 170 patients].
OBJECTIVE
To assess the factors of efficacy, side effects and complications following vaginal application of prostaglandin E2 (PGE2).


METHODS
Retrospective study of 170 women in whom a PGE2 vaginal gel was administered between June 1, 1999 and June 1, 2000. The efficacy (labor effectively induced), quality of myometrial response, side effects and complications were studied globally and in each clinical context: intra-uterine delayed growth (IUDG), pre-eclampsia without IUDG, diabetes, pregnancy prolonged without IUDG, anomaly in fetal heart rate (FHR) and/or in amniotic liquid without IUDG discovered during the systematic monitoring at the end of pregnancy, premature rupture of the membrane without IUDG.


RESULTS
The overall success (defined as the onset of labor) was of 94.1%. This rate was of 90.7% in primiparous and of 100% in multiparous women. Twenty-three patients (13.5%) experienced side effects (hyperkinesia or hyperthermia) and 35 patients (20.6%) complications (hyperkinesia or hypertonia with fetal repercussion). The maternal-response to infection was significantly improved (p < 0.05) in cases of prolonged rupture of the membranes or anomaly discovered during monitoring, but only in patients with diabetes. In cases of IUDG of vascular etiology with multiparity, the total quantity of PGE2 necessary was only of 1.14 mg and 85% of patients subsequently delivered without ocytocine.


CONCLUSIONS
IUDG and prolonged pregnancy are the principle indications for PGE2 vaginal gels. The quality of response depends on the clinical context. In cases of premature rupture of the membranes or of anomaly discovered during monitoring (FHR and amniotic liquid), response was only improved in diabetic patients. In cases of vascular IUDG and multiparity, the response was excellent and the majority of women subsequently delivered without ocytocine, thus confirming the quality of myometrial response. Hence, the quantity of PGE2 required varied, depending on the subjecent pathology. This strategy could limit the risk of excessive myometrial response (hyperkinesia or hypertonia) and thus improve fetal tolerance.
Carbillon
Lionel
L
Service de Gynécologie Obstétrique Hôpital Jean-Verdier Assistance Publique-Hôpitaux de Paris Avenue du 14 Juillet 93143 Bondy. lionel.carbillon@jvr.ap-hop-paris.fr
Fournial
Céline
C
Prudhomme
Sophie
S
Seince
Nathalie
N
Uzan
Michèle
M
D000282:Administration, Intravaginal; D015232:Dinoprostone / Q000008:administration & dosage* / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D005260:Female; D005323:Fetal Monitoring; D005782:Gels; D006801:Humans; D007231:Infant, Newborn; D007751:Labor, Induced / Q000379:methods*; D010298:Parity; D011247:Pregnancy; D012189:Retrospective Studies; D016896:Treatment Outcome
D005782:Gels; D015232:Dinoprostone