Antepartum cervical ripening: Applying prostaglandin E2 gel in conjunction with scheduled nonstress tests in postdate pregnancies


      OBJECTIVE: Our purpose was to evaluate whether inserting prostaglandin E2 gel at the time of scheduled nonstress tests in patients with postdate pregnancies can decrease rates of intervention.
      STUDY DESIGN: A multicenter pilot study enrolled women with postdate pregnancies with Bishop score ≤6 who were undergoing antepartum fetal heart rate testing. Patients were randomized in a double-blind fashion to receive either a prostaglandin E2 intracervical gel (Prepidil) or a placebo gel after each of their scheduled nonstress tests.
      RESULTS: There were no significant differences in the number of antepartum tests, labor inductions, or cesarean sections, the maximum oxytocin dosage, or the interval from admission to delivery in the prostaglandin E2 gel and placebo gel groups (n = 90). In the subset of patients with a Bishop score between 3 and 6 (63 patients), there were fewer inductions in the prostaglandin E2 group (30% vs 55%, P < .05).
      CONCLUSION: Application of prostaglandin E2 gel at the time of scheduled antepartum testing in patients with postdate pregnancies with unfavorable cervices decreased the induction rate only among patients with intermediate Bishop scores. (Am J Obstet Gynecol 1998;179:453-8.)


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        • Rayburn WF.
        Prostaglandin E2 gel for cervical ripening and induction of labor: a critical analysis.
        Am J Obstet Gynecol. 1989; 160: 529-534
        • Trofatter KF.
        Endocervical prostaglandin E2 gel for preinduction cervical ripening: clinical trial results.
        J Reprod Med. 1993; 38: 78-82
        • Keirse MJ.
        Prostaglandins in preinduction cervical ripening: meta-analysis of worldwide clinical experience.
        J Reprod Med. 1993; 38: 89-100
        • Owen J
        • Winkler C
        • Harris BA
        • Hauth JC
        • Smith MC.
        A randomized, double-blind trial of prostaglandin E2 gel for cervical ripening and meta-analysis.
        Am J Obstet Gynecol. 1991; 165: 991-996
        • Sawai SK
        • O’Brien WF
        Outpatient cervical ripening.
        Clin Obstet Gynecol. 1995; 38: 301-309
        • Rayburn W
        • Gosen R
        • Ramadei C
        • Woods R
        • Scott J.
        Outpatient cervical ripening with prostaglandin E2 gel in uncomplicated postdate pregnancies.
        Am J Obstet Gynecol. 1988; 158: 1417-1423
        • Dyson DC
        • Miller PD
        • Armstrong MA.
        Management of prolonged pregnancy: induction of labor versus antepartum fetal testing.
        Am J Obstet Gynecol. 1987; 156: 928-934
        • Elliott JP
        • Clewell WH
        • Radin TG.
        Intracervical prostaglandin E2 gel: safety for outpatient cervical ripening before induction of labor.
        J Reprod Med. 1992; 37: 713-716
        • Smith MA
        • Swan L
        • Caruthers BS
        • Heaton C.
        Outpatient use of prostaglandin gel for ripening of the cervix and induction of labor.
        J Fam Pract. 1990; 30: 656-664
        • Sue-A-Quan AK
        • Hannah ME
        • Cohen MM
        • Hellmann J
        • Liston R.
        How has clinical practice changed (1980 to 1994) for post-term pregnancy?.
        Am J Obstet Gynecol. 1997; 176 ([abstract 422]): S124
        • Smith LP
        • Nagourney BA
        • McLean FH
        • Usher RH.
        Hazards and benefits of elective induction of labor.
        Am J Obstet Gynecol. 1984; 148: 579-585
        • Macer JA
        • Macer CL
        • Chan LS.
        Elective induction versus spontaneous labor: a retrospective study of complications and outcome.
        Am J Obstet Gynecol. 1992; 166: 1690-1697
        • Bishop EH.
        Pelvic scoring for elective induction.
        Obstet Gynecol. 1964; 24: 266-268
        • Freeman RK
        • Garite TJ
        • Nageotte MP.
        Fetal heart rate monitoring.
        in: Williams and Wilkins, Baltimore1991: 161
        • Hales KA
        • Rayburn WF
        • Turnbull GL
        • Christensen HD
        • Patatanian E.
        Double-blind comparison of intracervical and intravaginal prostaglandin E2 for cervical ripening and induction of labor.
        Am J Obstet Gynecol. 1994; 171: 1087-1091
        • Sawai SK
        • Williams MC
        • O’Brien WF
        • Angel JL
        • Mastrogiannis DS
        • Johnson L
        Sequential outpatient application of intravaginal prostaglandin E2 gel in the management of postdates pregnancies.
        Obstet Gynecol. 1991; 78: 19-23
        • Sawai SK
        • O’Brien WF
        • Mastrogiannis DS
        • Krammer J
        • Mastry MG
        • Porter GW
        Patient-administered outpatient intravaginal prostaglandin E2 suppositories in postdate pregnancies: a double-blind, randomized, placebo-controlled study.
        Obstet Gynecol. 1994; 84: 807-810
        • O’Brien JM
        • Mercer BM
        • Cleary NT
        • Sibai BM
        Efficacy of outpatient induction with low-dose intravaginal prostaglandin E2: a randomized, double-blind, placebo-controlled trial.
        Am J Obstet Gynecol. 1995; 1173: 1855-1859
        • Doany W
        • McCarty J.
        Outpatient management of the uncomplicated post-date pregnancy with intravaginal prostaglandin E2 gel and membrane stripping.
        J Matern Fetal Med. 1997; 6: 71-78
        • Brindley BA
        • Sokol RJ.
        Induction and augmentation of labor: basis and methods for current practice.
        Obstet Gynecol Surv. 1988; 43: 730-743
        • Farmer KC
        • Schwartz WJ
        • Rayburn WF
        • Turnbull G.
        A cost-minimization analysis of intracervical prostaglandin E2 for cervical ripening in an outpatient versus inpatient setting.
        Clin Ther. 1996; 18: 747-756
        • Somerset DA
        • Das-Munshi T
        • Godman B
        • Swain I
        • Dooley MM.
        Induction of labour using prostaglandin E2 gel: the effect of changing the time of first insertion.
        J R Soc Med. 1995; 88: 105P-107P