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Efficacy and safety of a 2-tier prostaglandin labor induction schedule

OBJECTIVES
To determine the efficacy and safety of a 2-tier, Bishop score-driven induction schedule using gel and tablet formulations of PGE2 to establish new monitoring guidelines.


DESIGN
Prospective descriptive study.


SETTING
eight Germany University obstetric departments.


SUBJECTS
467 high risk patients.


INTERVENTIONS
Bishop score < 5: intracervical 0.5 mg PGE2 gel; Bishop score 5-7: intravaginal 3 mg PGE2 tablet.


MAIN OUTCOME MEASURES
Uterine hyperstimulation: > 5 contractions/min, contraction duration > 2 min and emergency tocolytic therapy; perinatal outcome: secondary caesarean section rate, operative vaginal delivery and fetal acidosis.


RESULTS
PGE2 induction resulted in spontaneous delivery in 76.9% (6.4% fetal acidosis) and 14.1% secondary c. section. The gel was associated with more adverse uterine effects and a poorer fetal outcome than the tablet. Adverse uterine events increased significantly on repeat dosing with the gel (39.5 vs 29.3%), but not the tablet: they also increased with a dosing interval < 8 h with either formulation. Overall, adverse uterine events were fewer and perinatal outcome better in multiparae than in nulliparae.


CONCLUSIONS
The higher adverse uterine event rate with the gel should be viewed against the backdrop of the low Bishop score. The interval between repeat dosing should not be less than 8 h after PGE2 gel treatment. Primigravidae must be monitored with special care following labour induction with PGE2.