A randomized trial of prostaglandin E(2) gel and extra-amniotic saline infusionwith high dose oxytocin for cervical ripening.
Seyedeh-Hajar Sharami, Froozan Milani, Ziba Zahiri, Fariborz Mansour-Ghanaei
Med Sci Monit 2005; 11(8): CR381-386
Background: Our purpose was to compare the efficacy of extra-amniotic salineinfusion plus high dose oxytocin with prostaglandin E(2) intracervical gel (Dinoprostone) for preinductioncervical ripening. Material/Methods: 166 nulliparous women with term pregnancies, vertex presentation,intact membranes and a Bishop score (2) intracervical gel and extra-amniotic saline infusion (EASI) plushigh-dose oxytocin. Changes in the Bishop scores, labor progress, various labor end points and outcomesof labor were assessed. Data were analyzed using chi(2) analysis or the Student t-test. Results: 151women were studied after 15 exclusions, 75 were assigned to PGE(2), and 76 to EASI. The groups were similarin age, race, indication for induction and gestational age. The EASI group had a significant improvementin Bishop score and greater dilation. The mean time to vaginal delivery was 11.4+/-4.8 hours and 18.9+/-6.4hours for the EASI and PGE(2) groups respectively (P=0.001). The cesarean delivery rate was not significantlydifferent between the two groups (25% for the EASI group; 34.6% for the PGE(2) group). The cesarean ratedue to failure to progress, fetal labor intolerance, and maternal and neonatal outcomes were similarin the two groups. Conclusions: Preinduction cervical ripening with EASI plus high dose oxytocin resultedin greater changes in Bishop score, and shorter time to normal vaginal delivery than with PGE(2) gelin nulliparous women, without increasing the cesarean rate due to failure to progress or fetal laborintolerance.
Keywords: Cervical Ripening - drug effects, Adult, Amniotic Fluid, Cervical Ripening - drug effects, Dinoprostone - pharmacology, Female, Gels, Humans, Infant, Newborn, Labor, Obstetric - drug effects, Oxytocin - pharmacology, Pregnancy, Pregnancy Outcome, Sodium Chloride - pharmacology