Intravaginal prostaglandin-E2 for cervical priming and induction of labour

A prospective study examined the safety, efficacy and labour outcome in 436 women undergoing labour induction using intravaginal prostaglandin E2. Women with singleton pregnancies [235 nulliparas and 201 multiparas] were recruited if they had a clinically unfavourable cervix, and indications for induction. The mean [standard deviation] interval from initiation to delivery was statistically significantly shorter in multiparas than nulliparas: 13.5 hours [SD 1.8] versus 15.5 hours [SD 2.4]. No more than 2 x 3 mg tablets were needed to achieve a clinically feasible cervix for amniotomy. The overall need for oxytocin augmentation of labour was 42%, significantly higher in nulliparas [47%] than multiparas [35%]. Intrapartum complications, caesarean section and perinatal deaths showed no statistically significant differences between the groups

Cervical ripening with intravaginal prostaglandins E2 gel

Ripening of the cervix by intravaginal application of a prostaglandin containing gel was evaluated. Thirty patients with an unfavorable cervix needing labor induction were studied in a double-blind prospective fashion. The prostaglandin gel proved superior to placebo in ripening the cervix [p<0.5], reducing induction failure [p<0.25] diminishing the oxytocin dosage necessary for induction [p<0.5]. and lowering the rate of cesarean section [p<0.1]. One hundred fifty additional patients with varying Bishop scores and differing clinical situation were also studied. There were 35 cesarean sections [23.3%], nine failed inductions [6%], a spontaneous labor rate of 46% and an average Bishop score change of 2.5. Twenty patients with premature rupture of the membranes and an unfavorable cervix received a modified gel containing 2.5mg of prostaglandin E2. Average Bishop score change was 2.9, and there was 55% incidence of spontaneous labor

Translabial ultrasonic assessment of cervix compared to Bishop score for women undergoing induction of labor

To determine if translabial sonographic measurement of the cervical length is a useful method to predict successful labor induction. One hundred women indicated for induction of labor were included and examined to assess Bishop score. All were then subjected to translabial sonographic measurement of the cervical length before labor induction. Induction of labor was performed within 6h of the ultrasonographic examination, intravaginal prostaglandin E2 3mg inserted in the posterior vaginal fornix repeated if needed every 6h for up to three doses. The mean age was 27.6 years and mean parity of 1.4. While there was no statistically significant differences between the initial Bishop score among women with successful and unsuccessful labor induction, there was a highly significant difference in the mean cervical index with higher indices among women with successful induction [p<0.001]. There was a highly significant difference between women with successful labor induction who have a cervical index of 0.4- 0.8 and >0.8 [p<0.001]. After 6 hours there was a statistically significant difference in the mean Bishop score with higher values among women with successful labor induction [p<0.05]. Translabial sonographic measurement of cervical length is safe and effective predictor of a successful labor induction at term

Low Dose Prostaglandin [E1] for Duct Dependent Congential Heart Disease

To assess the efficacy of prostaglandin E[1][PGE[1]] on duct dependent congenital heart diseases at our center, a hospital-based retrospective study of neonates with congenital heart disease, cyanotic and acyanotic, who were treated by intravenous prostaglandin at King Khalid University Hospital, Riyadh, Saudi Arabia, over five years period. A total of28 neonates, 16 males and 12 females, divided into three groups; Group I were given PGE[1], to increase pulmonary blood flow, Group II to improve mixing of blood and Group III to increase systemic blood flow. The drug was successful in all cases, with one episode of apnea; a common drug side effect. PGE [1]helped many cyanotic babies to reach safely to the well-equipped centers where accurate cardiac diagnosis and cardiac surgery could be done. When used in the suggested low dose for a reasonable period of time, only few babies will experience the expected side effects

Comparison of intravenous oxytocin with and without vaginal prostaglandin E2 gel in term pregnancy with premature rupture of membranes and unfavorable cervix.

Forty-seven nulliparous term pregnant women with PROM and unfavorable cervix, were randomly divided into 23 patients who were observed for four hours then followed by intravenous oxytocin, and 24 patients who were given 3 mg PGE2 gel intravaginally then followed by intravenous oxytocin four hours later. No statistically significant difference was observed between the two treatment groups with regard to Bishop score four hours after observation, intravenous oxytocin to delivery time, Apgar score at 1 and 5 minutes and maternal puerperal complications in both groups. It can be concluded that PGE2 did not significantly improve Bishop score or shorten the induction to delivery time in cases of PROM with unfavorable cervix. Intravenous oxytocin is still preferable both in terms of cost and effectiveness.

Experiencia preliminar con prestaglandina intramuscular / Preliminary experience with intramuscular prostaglandin

Se presenta una serie de 40 casos en los cuales se interrumpió la gestación, mddiante el uso de inyecciones intramusculares de un análogo de la prostaglandina PGE2 conocido con el nombre genérico de sulprostone. El tiempo promedio entre la inyección y la expulsión fue de 16 horas. Las complicaciones más frecuentes fueron: hemorragia (10%), desgarro cervical (5%), ésto último en nulíparas. Los efectos digestivos a pesar de presentarse en el 47,5%, sólo necesitaron medicación sintomática en el 7,5%. Se concluye que es un método efectivo en la interrupción del embarazo, siendo un recurso terapeútico de gran utilidad en el arsenal obstétrico