Prepidil compared to Propess for cervical ripening.
OBJECTIVE
To compare the efficacy and safety of intracervical PGE(2) gel (Prepidil) with intravaginal PGE(2) insert (Propess) in cervical ripening and induction of labour.


METHODS
This was a retrospective analysis of patients with single pregnancies, intact membranes and a viable fetus who required cervical ripening. In the first half of 1998, all patients received Prepidil and in the first half of 1999 all patients received Propess. In both periods 50 consecutive files were retrieved and compared.


RESULTS
The Prepidil and Propess group were similar in patient characteristics, indication for induction of labour and delivery outcome. Cervical ripening within 24 h was achieved in the Propess group in 80% as compared to 56% in the Prepidil group. The application-membrane rupture-interval was shorter in the Propess group compared to the Prepidil group (23.7 +/- 21.3 h versus 56.4 +/- 77.7 h, P = 0.009) as well as the application-delivery interval (29.8 +/- 22.0 h versus 62.0 +/- 78.8 h, P = 0.039). In the Propess group 62% delivered within 24 h compared to 28% in the Prepidil group. A smaller number of applications was observed in the Propess group (1.2 versus 1.8, P < 0.005). Both methods proved to be safe in cervical priming and no relevant differences in mode of delivery and outcome of labour were detected. None of the patients required an emergency caesarean section during the treatment with prostaglandines.


CONCLUSIONS
Both prostaglandin E(2) agents are safe and effective in achieving cervical ripening; however the vaginal insert demonstrated a shorter application-delivery interval. The hospital stay was consequently shorter, contributing to cost effectiveness.
Vollebregt
A
A
Department of Obstetrics and Gynaecology, Spaarne Ziekenhuis Haarlem, Afdeling Verloskunde en Gynaecologie, Postbus 1644, 2003 Haarlem BR, The Netherlands.
van't Hof
D B
DB
Exalto
N
N
D000282:Administration, Intravaginal; D000328:Adult; D020070:Cervical Ripening / Q000187:drug effects*; D002584:Cervix Uteri / Q000187:drug effects; D002585:Cesarean Section; D015232:Dinoprostone / Q000008:administration & dosage* / Q000627:therapeutic use*; D005260:Female; D005865:Gestational Age; D006340:Heart Rate, Fetal; D006801:Humans; D006973:Hypertension; D007751:Labor, Induced; D008297:Male; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular; D011256:Pregnancy Outcome; D011273:Pregnancy, Prolonged / Q000187:drug effects; D012189:Retrospective Studies
D015232:Dinoprostone