Comparative study of oral PGE 1 and intracervical PGE2 gel for pre-induction cervical ripening in prelabour rupture of membranes >37 weeks gestational age

Alka N. Nadar, Sirisha P. S. R. N. S.


Background: Active induction of labour in prelabour rupture of membranes resulted in a lower risk of maternal and fetal sepsis as compared to conservative management. Pre-induction cervical ripening helps in successful induction of this study we have compared the efficacy of low dose 25 mcg oral misoprostol versus intracervical PGE2 gel for cervical ripening in term PROM patients.

Methods: Women with pregnancies between 37 and 41 weeks gestational age presenting with PROM at term and a Bishop score of 4 or less were randomly assigned to receive either a 25-mcg oral misoprostol every 4-hourly interval or 3 applications of intracervical PGE2 gel at a 6-hour interval for effective cervical ripening. Oxytocin was initiated if labor had not started after 6 hours of last effective dose of prostaglandin.

Results: Fifty-three women (75.73%) (n = 70) in the oral misoprostol group with 2 doses, 4 hours apart had successful cervical ripening within 8 hours in comparison to sixty-two women (88.58%) (n = 70) in the intracervical PGE2 gel group with 2 doses, 6 hrs apart approximately 12 hrs for successful ripening. (p = 0.021). Oral misoprostol group needed shorter mean duration interval for the Bishop score <4 to >6 than intracervical PGE2 gel group, 7.84±3.64 hours and 9.39±4.20 hours respectively (p = 0.022). Similarly, the mean time duration interval from ruptured membranes to vaginal delivery in oral misoprostol was shorter i.e. 12.60±3.78 hours versus 14.66±4.08 hours (p = 0.005).

Conclusions: Low dose 25 mcg oral misoprostol is a safe, efficacious and better tolerated alternative to intracervical PGE2 gel for pre-induction cervical ripening in especially in PROM patients at term.


IOL, Oral Misoprostol, Pge2 gel, PROM

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Mozurewich E. Management of premature rupture of membrane at term: an evidence based approach. Clin Obstet Gynaecol. 1999;42:749-56.

Shetty A, Stwart G, Stewart G, Rice P, Danielian P, Templeton A. Active management of term prelabour rupture of membranes with oral misoprostol. Br J Obstet Gynaecol. 2002;109:1354-8.

Edwards RK, Richards DS. Preinduction cervical assessment. Clin Obstet Gynecol. 2000;43:440-6.

Royal College of Obstetricians and Gynaecologists. Induction of Labour. Guideline. No. 9. London, UK: RCOG Press. 2001.

Wing DA. Labor induction with misoprostol. Am J Obstet Gynecol. 1999;181:339-45.

Zieman M, Fong SK, Benowitz NL, Banskter D, Darncy PD. Absorption kinetics of misoprostol with oral or vaginal administration. Obstet Gynecol. 1997;90:88-92.

Butt KD, Bennett KA, Crane JMG, Hutchens D, Young DC. Randomized comparison of misoprostol and oxytocin for labour induction in term prelabour membranes rupture. Obstet Gynecol. 1999;94:994-9.

Sanchez-Ramos L, Kaunitz AM, Gaudier FL, Delke I. Cervical ripening and labor induction with a controlled-release dinoprostone vaginal insert: a meta-analysis. Obstet Gynecol. 1999;94:873-83.

Chong YS, Su LL, Arulkumaran S. Misoprostol: a quarter century of use, abuse, and creative misuse. Obstet Gynecol Surv. 2004;59:128-40.

Wing DA, American College of Obstetricians and Gynecologists. Induction of Labor. ACOG Committee Opinion no 10. Washington, DC: ACOG. 1999.

Monika NB, Chitra R, Saili A. Oral misoprostol versus prostaglandin E2 gel for active management of premature rupture of membranes at term. Int J Gynecol Obstet. 2009;106:23-6.

Iris C, Kathya C, Kennith H, Maurice DL, Mark TM. Prospective randomized clinical trial of inpatient cervical ripening with stepwise oral misoprostol versus vaginal misoprostol. Am J Obstet Gynecol. 2005;192:747-52.

Jindal P, Avasthi K, Kaur M. A comparison of vaginal versus oral misoprostol for induction of labour-double blind randomized trial. J Obstet Gynecol India. 2011:61(5):538-42.

Ngai SW, To WK, Lao T, Ho PC. Cervical priming with oral misoprostol in pre-labor rupture of membranes at term. Obstet Gynecol. 1996;87:923-6.

Aqueela A, Shazia S, Usman FM, Fayaz A, Ali BL, Iftikhar A. Prelabour rupture of membranes at term in patients with unfavorable cervix: active versus conservative management. Taiwan J Obstet Gynecol. 2008;47(2):192-6.

Al-Hussaini TK, Abdel-Aal SA, Youssef MA. Oral misoprostol versu intravenous oxytocin for labor induction in women with prelabor rupture of membranes at term. Int J Gynecol Obstet. 2003;82(1):73-5.

Hoffman RA, Anthony J, Fawcus S. Oral misoprostol versus placebo in the management of prelabor rupture of membranes at term. Int J Gynecol Obstet. 2001;72:215-21.

Levy R, Vaisbuch E, Furman B, Brown D, Volach V, Hagay ZJ. Induction of labor with oral misoprostol for premature rupture of membranes at term in women with unfavorable cervix: a randomized, double-blind, placebo-controlled trial. J Perinat Med. 2007;35(2):126-9.