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179: Failure of cervical ripening with PGE2 –can it be predicted?

      Objective

      Limited data exists concerning risk factors for ripening failure using PGE2. Thus, we aimed to identify which factors are associated with cervical ripening failure using vaginal PGE2 tablets

      Study Design

      A case control retrospective study. Study group included all women admitted for cervical ripening with unfavorable Bishop's score (<7) between January 2003 and December 2007 and failed to respond to cervical ripening using PGE2 vaginal tablets (no change in Bishop's score after 5 applications of PGE2, 6-8 hours apart). A cohort of women who underwent successful cervical ripening with vaginal PGE2 in the same time period in a 3:1 served as the control group. All women were treated by the same protocol.

      Results

      1. overall 488 women were included of them 122 in the research group and 366 in the control group. 2. A comparison between the two groups has revealed that maternal age > 30 years (OR=2.7, 95%-CI 1.3-5.6), nulliparity (OR=4.1, 95%-CI 1.7-10.0), pre-pregnancy BMI> 25 (OR=3.5, 95%-CI 1.7-7.1), cervical dilatation <1 cm at admission (OR=9.1, 95%-CI 3.5-13.4), cervical effacement < 50% at admission (OR=5.0, 95%-CI 2.2-8.8) and gestational age < 37 weeks (OR=2.9, 95%-CI 1.3-6.6), were independently and significantly associated with cervical ripening failure with PGE2. 3. The prediction model based on these factors accounts for almost 50% of the cervical ripening failure outcome (R2 = 0.47). 4. No significant association was found between cervical ripening failure and indication for ripening, rupture of membranes, weight gain during pregnancy, diabetes or preeclampsia during pregnancy, and birthweight.

      Conclusion

      This novel study identifies risk factors for ripening failure with PGE2. Characterization of women who have high probability for cervical ripening failure with PGE2 will help to improve the consultation prior to induction and may help to choose the optimal method for labor induction in these cases.