Maternal and fetal outcomes with the use of prostaglandins E2 as a cervical ripening agent for induction of labour

Authors

  • Shagun Gupta Department of Obstetrics and Gynecology, NIMS University, Jaipur, Rajasthan, India
  • Neha Kuntal Department of Obstetrics and Gynecology, SMS Medical College, Jaipur, Rajasthan, India
  • Virendra Kumar Gupta Department of Pediatrics and Gynecology, NIMS University, Jaipur, Rajasthan, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20195597

Keywords:

Bishops score, Caesarean section, Intravaginal prostaglandin E2, Induction of labour

Abstract

Background: In modern medicine induction of labour is required in patients for a good feto-maternal outcome. PGE2 is a prostaglandin analogue which has been used as a cervical ripening agent to improve bishops score. Objective of this study was to evaluate the efficacy of intravaginal PGE2 gel as a cervical ripening agent in unfavourable cervix for induction of labor and any complications associated with its use.

Methods: This study comprised of 90 women who required labor induction. Singleton pregnancy above 37 weeks, live intrauterine fetus, Cephalic presentation, Bishop score of 1-6, reactive FHR pattern were included. Women who required only single induction were categorized as Group 1. Those requiring more than one dose after reassessment of bishops scoring at 6, 12 and 18 hours belonged to Group 2.

Results: Group1 had more of younger population below 30 years consisting more primigravidas with > 80% women having gestational age of > 39 weeks. Most common indication for induction of labour in both groups was post-dated pregnancy. 65 patients received one dose of cerviprime gel forming Group 1. In Group 2, 72% received 2 doses and 28%, 3 doses of gel. Initial bishops score mean was 4.2 in Group 1 and 4.1 in Group 2. Mean change in bishop score was analysed after 6, 12, and 18 hours of instillations of PGE2 gel. Significant p value was obtained in all groups requiring one, two and three doses of gel. In Group 1, 12.3% and in Group 2, 16% had LSCS. Maternal side effects were minimal and neonatal outcome was good.

Conclusions: The study showed that intravaginal application of PGE2 is effective, safe and acceptable method as a cervical ripening agent for labor induction in women with poor bishops score. It reduces caesarean delivery rate without increasing maternal and neonatal morbidity.

Author Biography

Virendra Kumar Gupta, Department of Pediatrics and Gynecology, NIMS University, Jaipur, Rajasthan, India

 

 

References

American College of Obstetricians and Gynecologists. Induction of labor. Practice bulletin no. 10. Washington, D.C.: ACOG; 1999.

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

Ulmstein, Wingerup L, Anderson. Comparison of prostaglandin E2 gel and intravenous oxytocin for induction of labour. Obstet Gynecol. 1979;54:581-4.

Warke HS, Sarogi RM, Sanjawalla SM. Prostaglandin E2 gel in ripening of cervix in induction of labour. J Postgrad Med. 1999;45:105-7.

Maillot KV, Stunhsatz HW, Mohanaradhakrishnan V. Changes in glycosaminoglycan distribution in the human uterine cervix during pregnancy and labour. Am J Obstet Gynecol. 1979;135:503-6.

Parmar M, Aherwar R, Jahan I. Comparative study of 25 mg vaginal misoprostol versus cerviprime gel for induction of labour at term. Int J Reprod Contracept Obstet Gynecol. 2014;3(4):887-92.

Rayburn WF. PGE2 Gel for cervical ripening and sinduction of labor. Am J Obstet Gynecol. 1989;160:529-33.

Zanini A, Ghidini A, Norchi S. Beretta E, Bottinos. Pre-induction cervical ripening with PGE2 gel intracervical vs intravaginal route. Obstet Gynecol. 1990;76:681-3.

Bashutheen NS, Sharon M. A study of intracervical PGE2 gel for cervical ripening and induction of labour. Int J Contemp Med Res. 2018;5(3):C4-C7.

Bhatla N, Verma A, Buckshee KA. Multiple dose intra cervicalPGE2 gel for cervical ripening. J Obstet Gynaecol Ind. 1997:47-62.

Calder AA, Embrey MP. Prostaglandins and the unfavorable cervix. Lancet. 1973;2:1322.

Ramana MV, Fathima NMG. A comparative study of single versus multiple instillations of intravaginal PGE2 gel for induction of labour. Indian J Obstet Gynecol Res. 2019;6(3):282-7.

Mainprize T, Nimrod C, Dodd G, Persuad D. Clinical utilityof multiple dose administration of PGE2. Am J Obstet Gynecol. 1987;2:341-2.

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Published

2019-12-26

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Original Research Articles