Abstract
Objective: To study the effectiveness and morbidity of adding hygroscopic cervical dilators to prostaglandin gel for cervical ripening and labor induction.Study design: Patients of at least 34 weeks’ gestation with a medical indication for induction of labor and with a modified Bishop score of 5 or less were randomized to receive either prostaglandin gel or prostaglandin gel with hygroscopic cervical dilators. Primary outcomes were time to delivery, change in cervical score, and infection. Secondary outcomes included cesarean delivery rate and deliveries before 24 hours of induction. Continuous variables were analyzed by Wilcoxon sum rank test and categorical data by chi‐square or Fisher exact test, with P < 0.05 being significant.Results: Seventeen patients were randomized to intracervical prostaglandin alone and 23 patients received intracervical prostaglandin plus hygroscopic dilators. No demographic differences were noted between the groups. After six hours of ripening, the combined group achieved a greater change in Bishop score (3.6 vs. 2.1, P = 0.007) and tended to have a shorter induction time (21.7 vs. 26.4 hours, P = 0.085). The combined therapy group had a higher infection rate than the prostaglandin‐only group (59% vs. 12%, P = 0.003).Conclusion: Combining cervical dilators with prostaglandin gel provides more effective cervical ripening and a more rapid induction to delivery interval than prostaglandin alone but with a significant and prohibitive rate of infection.
Highlights
KEY WORDS infectious morbidity; cervical ripening; induction of labor; prostaglandin laminaria abor induction is common in modern obstetrics, with attention rightly directed toward the development of effective cervical ripening and induction techniques
Prostaglandin gel, intracervical mechanical devices, oral mifepristone, vaginal misoprostol, and extraamniotic saline infusions are some of the agents investigated in recent years. 1-6 The safety and efficacy of single-agent therapy with prostaglandin Ez (PGEz) gel for preinduction ripening of the cervix has been well documented.[4,5,6,7,8,9]
Hygroscopic cervical dilators have been investigated as a single-agent method of preinduction cervical ripening.6,1- These dilators absorb moisture through hygroscopic action, drawing fluid from the cervical stroma, resulting in softening of the tissue
Summary
This study was performed at the University of Chicago, Chicago Lying-in Hospital, between August 1, 1994, and May 1,1995, and all patients admitted for induction of labor were invited to participate. Inclusion criteria were gestational age of at least 34 weeks, a medical or obstetric indication for induction of labor, a modified Bishop score of 5 or less (Table 1),[13] cervical dilation less than 1 cm, vertex presentation, and intact membranes. Those excluded from participation were patients with previous cesarean delivery for cephalopelvic disproportion, severe asthma, overt cervicitis, nonreassuring fetal testing, fetal macrosomia, multiple gestation, and those with any contraindication to vaginal delivery. The study was approved by the University of Chicago Institutional Review Board
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