Agent For Induction Of Labor Research Articles

A benefit-risk assessment of misoprostol for cervical ripening and labour induction.

Misoprostol, a prostaglandin E(1) analogue, is widely used in the US and other countries for cervical ripening and labour induction. Its use for these indications is not approved by the US Food and Drug Administration (FDA). The manufacturer of misoprostol issued a letter to American healthcare providers in August 2000, cautioning against the use of misoprostol in pregnant women and citing a lack of safety data for its use in obstetrical practice. The only FDA-approved indication in the product labelling is the treatment and prevention of intestinal ulcer disease resulting from nonsteroidal anti-inflammatory drug use. Multiple trials have proven that when applied vaginally, misoprostol is an effective agent for cervical ripening and labour induction in term pregnancy. The use of oxytocin augmentation is reduced when intravaginal misoprostol is used compared with other agents. Misoprostol use in obstetrics carries the added benefits of temperature stability at room temperature, which is unlike other prostaglandin preparations which require refrigeration or freezing, and reduced cost. However, debate continues regarding the optimal dose, dosage regimen, and route of administration. Uterine contraction abnormalities are often found in association with higher misoprostol doses (50 microg or more) given vaginally or orally. Some trials also indicate increased frequencies of meconium passage, neonatal acidaemia and caesarean delivery for fetal distress in women receiving higher doses of vaginally applied misoprostol. However, most trials fail to demonstrate a significant change in the caesarean delivery rate with the use of misoprostol, although a recent meta-analysis indicated that the use of intravaginal misoprostol is associated with a lowering of the caesarean rate when compared with pooled controls. Low-dose misoprostol (25 microg) is an effective agent for cervical ripening and labour induction when used in a judicious and cautious fashion. There are insufficient data to support the widespread use of oral misoprostol for cervical ripening and labor induction. Some trials suggest that this approach may be effective; however, the ideal dose and administration regimen have yet to be defined.

A randomized prospective study of misoprostol and dinoproston for induction of labor

Misoprostol, a prostaglandin E1 analog registered for the prevention of gastric ulcers in NSAID-drug users, has been reported to be more effective for labor induction than the standard prostaglandin, dinoproston after vaginal application. There have been some concerns about possible hyperstimulation of the uterine activity and about the safety for the fetus with this new drug. Two hundred and ten patients, 36 weeks pregnant or more, with an unfavorable cervix, single pregnancy, and intact membranes were randomized to receive misoprostol, 50 micrograms intravaginally every 6 hours, or dinoproston 0.5 mg intracervically every 12 hours for a maximum of 24 hours, for labor induction. Time from induction to delivery was shorter in both primigravidae and multigravidae after the application of misoprostol than dinoproston and failed induction was more common after dinoproston than after misoprostol. There were no differences in the condition of the newborns in the two groups, according to Apgar score, umbilical artery pH or referral to the neonatal unit, even if there were more operative deliveries for suspected fetal asphyxia after misoprostol than after dinoproston. We did not find any significant difference in the frequency of uterine hyperstimulation between the two groups. In the dosage used, misoprostol seems to be an effective agent for induction of labor in patients with an unfavorable cervix. Low cost and ease of administration make this drug a promising alternative for this purpose. Surprisingly, there is little interest from the manufacturer to promote the use of this drug for labor induction.

The effect of vaginal pH on the efficacy of vaginal misoprostol for induction of labor

Misoprostol was reported to be an effective agent for cervical ripening and induction of labor. Our purpose was to evaluate whether vaginal pH affected the efficacy of misoprostol for induction of labor. The vaginal pH of 103 women admitted for induction of labor were measured. According to the vaginal pH, two groups were generated, those with a vaginal pH <5 (n= 65), and those with a vaginal pH > or =5 (n=38). All women received intravaginal misoprostol tablets, 50 microg every 4 hours up to three doses. Further medication was not given after entry into active labor or spontaneous rupture of membranes. In cases of failed induction or arrest disorders oxytocin augmentation was used. The average interval from start of induction to vaginal delivery was shorter, and oxytocin augmentation was required less commonly in the lower pH group. We did not find any significant difference in cesarean section rates, or incidence of adverse maternal or fetal outcome. Vaginal pH may affect the pharmacokinetics of vaginally administered misoprostol, and may cause an alteration in induction to delivery interval.

Cervical ripening and labor induction with a controlled-release dinoprostone vaginal insert: a meta-analysis

Objective: To systematically review published randomized trials that compared efficacy of a 10-mg, controlled-release dinoprostone vaginal insert with other prostaglandins for cervical ripening and labor induction. Data Sources: We supplemented a search of entries in electronic databases with references cited in original studies and review articles to identify randomized clinical trials of dinoprostone vaginal inserts for cervical ripening and labor induction. Methods of Study Selection: We evaluated, abstracted data, and assessed the quality of randomized clinical trials on the efficacy of dinoprostone vaginal inserts as cervical ripening and labor induction agents. Only published randomized trials were included in this meta-analysis. Tabulation, Integration, and Results: Seventeen studies were identified, eight of which met our criteria for meta-analysis. Those eight trials included 964 subjects, 490 of whom were allocated to dinoprostone vaginal inserts and 474 to other prostaglandin (PG) preparations. We calculated an estimate of the odds ratio (OR) and risk difference for dichotomous outcomes, using a random- and fixed-effects model. Continuous outcomes were pooled using a variance-weighted average of within-study difference in means. Compared with women who received other PG preparations, those who received dinoprostone vaginal inserts had lower incidence of vaginal delivery within 12 hours of PG application (OR 0.55, 95% confidence interval 0.39, 0.79). Vaginal inserts were associated with longer intervals to vaginal delivery and lower rates of active labor. There were no differences in cesarean delivery rates, incidence of hyperstimulation, or need for oxytocin augmentation between dinoprostone and other PGs. Conclusion: Dinoprostone vaginal insert was less effective than other prostaglandins for cervical ripening and labor induction.

Labor induction with misoprostol

Misoprostol, a prostaglandin E 1 analog, is widely used in the United States for cervical ripening and labor induction. Its use for these indications is not approved by the US Food and Drug Administration. The only Food and Drug Administration–approved indication in the product labeling is the treatment and prevention of intestinal ulcer disease resulting from nonsteroidal anti-inflammatory use. Multiple trials have proved that misoprostol is an effective agent for cervical ripening and labor induction in term pregnancy; however, investigations continue regarding the optimal dose, dosing regimen, and route of administration. Uterine contraction abnormalities are often found in association with higher misoprostol doses. Some trials also indicate increased frequencies of meconium passage, neonatal acidemia, and cesarean delivery for fetal distress in women receiving higher doses of misoprostol. Overall, most trials fail to demonstrate a significant change in the cesarean delivery rate with the use of this agent. Misoprostol is an effective agent for cervical ripening and labor induction when used in a judicious and cautious fashion. (Am J Obstet Gyneol 1999;181:339-45.)

Misoprostol for induction of labour: a systematic review.

To determine, from the best available evidence, the effectiveness and safety of misoprostol administered vaginally or orally for third trimester cervical ripening or induction of labour. Clinical trials of misoprostol used for cervical ripening or labour induction in the third trimester were identified from the register of randomised trials maintained by the Cochrane Pregnancy and Childbirth Group. All identified trials were considered for inclusion in the review according to a prespecified protocol. Primary outcomes were chosen to address clinical effectiveness (delivery within 24 hours) and safety (uterine hyperstimulation, caesarean section, serious maternal and neonatal morbidity) and were determined a priori. All meta-analyses were based on the intention-to-treat principle. In the absence of heterogeneity the summary statistics have been expressed as typical relative risk (RR) and 95% confidence interval (CI). Vaginal misoprostol: one small study showed that the use of misoprostol results in more effective cervical ripening and reduced need for oxytocin when compared with placebo. When compared with oxytocin, vaginal misoprostol was more effective for labour induction. The relative risk of failure to achieve vaginal delivery within 24 hours was 0.48 (95% CI 0.35 to 0.66). However, the relative risks for uterine hyperstimulation with and without fetal heart rate abnormalities were 2.54 (95% CI 1.12 to 5.77) and 2.96 (95% CI 2.11 to 4.14), respectively. In three out of four trials which studied women with intact membranes and unfavourable cervices, failure to achieve vaginal delivery within 24 hours was reduced with misoprostol when compared with other prostaglandins (RR 0.71, 95% CI 0.62 to 0.81). Vaginal misoprostol was associated with increased uterine hyperstimulation both without fetal heart rate changes (RR 1.67, 95% CI 1.30 to 2.14) and with associated fetal heart rate changes (RR 1.45, 95% CI 1.04 to 2.04). There was also an increase in meconium stained amniotic fluid following vaginal misoprostol (RR 1.38, 95% CI 1.06 to 1.79). Oral misoprostol: one small trial suggests that, when compared with placebo, oral misoprostol reduces the need for oxytocin and shortens the time between induction and delivery. Compared with other prostaglandins one small trial showed a reduced need for oxytocin with oral misoprostol. Two trials compared oral with vaginal misoprostol using different doses. No significant differences were evident. Overall, misoprostol appears to be more effective than conventional methods of cervical ripening and labour induction. Although no differences in perinatal outcome were shown, the studies were not sufficiently large to exclude the possibility of uncommon serious adverse effects. In particular the increase in uterine hyperstimulation with fetal heart rate changes following misoprostol is a matter for concern. It is possible that, if sufficient numbers are studied, an unacceptably high number of serious adverse events including uterine rupture and asphyxial fetal deaths may occur. The data at present are not robust enough to address the issue of safety. Thus, though misoprostol shows promise as a highly effective, inexpensive and convenient agent for labour induction, it cannot be recommended for routine use at this stage. Lower dose misoprostol regimens should be investigated further.

Misoprostol as a Labor Induction Agent

Misoprostol as a Labor Induction Agent

Misoprostol as a labor induction agent

Misoprostol as a labor induction agent

Misoprostol in Early and Late Pregnancy

Misoprostol is a synthetic prostaglandin analogue approved for use as an agent to prevent gastric ulcers induced by non-steroidal anti-inflammatory agents. It is found to have similar labour induction effects as the currently available prostaglandins marketed specifically for labour induction. This article reviews misoprostol as an agent for labour induction, and other ancillary use. The concern is that misoprostol is not approved to be used for induction of labour, and that the easily available medication could be used unscrupulously.

Misoprostol for cervical ripening and labor induction: A meta-analysis

To analyze published randomized trials assessing the safety and efficacy of misoprostol for cervical ripening and labor induction. We supplemented a search of entries in electronic data bases with references cited in original studies and review articles to identify randomized trials of misoprostol for cervical ripening and labor induction. Two blinded investigators performed independent trial quality evaluation and data abstraction of randomized clinical trials assessing the efficacy of misoprostol as a cervical ripening and labor-inducing agent. We calculated an estimate of the odds ratio (OR) and risk difference for dichotomous outcomes, using both a random- and fixed-effects model. Continuous outcomes were pooled using a variance-weighted average of the within-study difference in means. Of 16 studies identified, eight met our criteria for meta-analysis. These eight trials included 966 patients (488 received misoprostol and 478 were controls). Women who received misoprostol for cervical ripening and labor induction had a significantly lower overall cesarean rate (OR 0.67, 95% confidence interval [CI] 0.48, 0.93) and a higher incidence of vaginal delivery within 24 hours of misoprostol application (OR 2.64, 95% CI 1.87, 3.71). Use of misoprostol was associated with a higher incidence of tachysystole (OR 2.70, 95% CI 1.80, 4.04) but not hyperstimulation (OR 1.91, 95% CI 0.98, 3.73). The incidences of abnormal 5-minute Apgar scores and admissions to the neonatal intensive care unit were similar in the misoprostol and control groups. The pooled estimate of the mean interval from start of induction to delivery was 4.6 hours fewer (95% CI -3.5, -5.7) in the misoprostol group. Published data confirm the safety and efficacy of intravaginal misoprostol as an agent for cervical ripening and labor induction.

A randomized comparison between misoprostol and dinoprostone for cervical ripening and labor induction in patients with unfavorable cervices

To compare the efficacy and safety of two prostaglandin derivatives, misoprostol and dinoprostone, for ripening the cervix and inducing labor in women with an unfavorable cervix. One hundred fifty-five women admitted for induction of labor to St. John's Mercy Medical Center, a teaching community hospital, were randomized to one of two methods: intravaginal misoprostol, 50 microg every 4 hours up to three doses (n = 76); and intracervical dinoprostone gel, 0.5 mg every 6 hours up to three doses (n = 79). Misoprostol was more effective than dinoprostone in causing cervical ripening (P = .01), inducing labor (P < .001), shortening the duration of labor (P < .001), and decreasing the need for oxytocin augmentation (P < .001). Nonreassuring fetal heart monitoring patterns associated with hyperstimulation were significantly more frequent (P < .001), and the incidence of cesarean deliveries because of this indication was significantly higher (P = .002) in patients receiving misoprostol. Misoprostol is an effective agent for cervical ripening and labor induction, but it causes an increase in cesarean deliveries associated with uterine hyperstimulation.

Induction of Labour with Misoprostol—A Review

Misoprostol is a prostaglandin E1 analogue marketed for oral prophylaxis of non-steriodal anti-inflammatory drug induced gastric ulcers, and treatment of gastric and duodenal ulcers. Its cost per dose is one hundredth that of commercial prostaglandin gels used for labour induction. It is listed as being contra-indicated for use in pregnancy.Recent investigations have found that vaginal misoprostol is cost effective for second trimester medical termination of pregnancy. In the first trimester, it is effective only after use of another abortifacient, including mifepristone or methotrexate.Vaginal misoprostol, in a much lower dose, is now being applied as a labour induction agent at term. It is inexpensive and effective, and appears safe for mother and newborn in the reported randomized controlled trials. A concern regarding uterine hyperstimulation exists.Our group has experience with vaginal misoprostol use in the second trimester, and for labour induction. We have now looked at oral administration for labour induction. We review our experience and that in the literature.

A comparison of differing dosing regimens of vaginally administered misoprostol for preinduction cervical ripening and labor induction

OBJECTIVE: Our purpose was to compare two dosing regimens of vaginally administered misoprostol for preinduction cervical ripening and induction of labor. STUDY DESIGN: Five hundred twenty-two patients with indications for induction of labor and unfavorable cervices were randomly assigned to one of two dosing regimens of vaginally administered misoprostol. Twenty-five microgram tablets of misoprostol were placed in the posterior vaginal fornix either every 3 hours to a maximum of eight doses or every 6 hours to a maximum of four doses. The maximal period of cervical ripening was 24 hours regardless of the number of misoprostol doses administered. Medication was not given after either spontaneous rupture of membranes or the beginning of active labor. RESULTS: Among 522 patients enrolled, 261 were randomized to receive misoprostol every 3 hours and 261 to receive misoprostol every 6 hours. The average interval from start of induction to vaginal delivery was shorter in the 3-hour dosing group (903.3 ± 482.1 minutes) than in the 6-hour dosing group (1410.9 ± 869.1 minutes) ( p < 0.001). Oxytocin augmentation of labor occurred more commonly in the 6-hour dosing group (51.4%) than in the 3-hour dosing group (41.8%) ( p < 0.05). There were no significant differences between routes of delivery. Overall, 108 patients (20.8%) were delivered by cesarean section. There was a slightly higher prevalence of tachysystole (six or more uterine contractions in a 10-minute window for two consecutive 10-minute periods) in the 3-hour group (14.6%) than in the 6-hour group (11.2%), but this difference was not statistically different. There were no significant differences in the frequency of uterine hyperstimulation or hypertonus. There was no significant difference between groups in the frequency of abnormal fetal heart rate tracings, meconium passage, 1- or 5-minute Apgar scores <7, neonatal resuscitations, or admissions to the neonatal intensive care unit. CONCLUSIONS: Vaginally administered misoprostol is an effective agent for cervical ripening and induction of labor. Patients with the 6-hour dosing schedule had longer intervals to delivery, more frequently required oxytocin augmentation, and had more failed inductions than did patients with 3-hour dosing. Further investigation to characterize the safety of misoprostol is needed. (Am J Obstet Gynecol 1996;175:158-64.).

Cervical priming with oral misoprostol in pre-labor rupture of membranes at term

To investigate the effectiveness of oral misoprostol as a cervical priming agent for patients presenting with pre-labor rupture of membranes at term. Eighty patients presenting with pre-labor rupture of membranes at term were randomized to receive either 200 micrograms of misoprostol or 50 mg of vitamin B6 orally 1 hour after admission. Labor was induced with intravenous oxytocin infusion 12 hours after oral medication if the patient did not go into labor. We compared the induction rate, duration of labor, mode of delivery, and leaking-to-delivery interval in the two groups. The cervical score was significantly improved and the induction rate was also reduced in the misoprostol group when compared with the control group. The interval from recruitment to onset of labor, duration of labor, and the interval from recruitment to delivery were significantly shorter in the misoprostol group. The mode of delivery and the perinatal outcome were similar for the two groups. Oral misoprostol is an effective agent for cervical priming and labor induction in patients with pre-labor rupture of membranes at term.

A randomised controlled trial comparing vaginally administered misoprostol to vaginal dinoprostone gel in labour induction

SummaryProstaglandins are the most efficient cervical ripening and labour inducing agents in the presence of an unfavourable cervix. Unfortunately commercially manufactured prostaglandins registered for cervical ripening and labour induction are expensive and require continuous refrigeration, rendering them inappropriate for the developing world. Misoprostol has been found to be superior to placebo. while as effective as dinoprostone tablets and intracervical gel in cervical ripening and labour induction. This is the first study that compares misoprostol with dinoprostone vaginal gel. In our study there was a significantly shorter induction delivery time and lower caesarean section rate in the misoprostol group. While the study shows misoprostol to be an efficient induction agent, we remain concerned about the safety of misoprostol as a labour induction agent.

Labor induction with intravaginal misoprostol versus intracervical prostaglandin E 2 gel (Prepidil gel): Randomized comparison

OBJECTIVE: Our purpose was to compare the safety and efficacy of intravaginal prostaglandin E 1, misoprostol, with that of intracervical prostaglandin E 2 (Prepidil gel) for labor induction. STUDY DESIGN: One hundred three patients with an indication for induction of labor were randomly assigned to induction with prostaglandin E 1, 50 μg intravaginally, or with Prepidil gel, 0.5 mg intracervically, every 4 hours until active labor. RESULTS: Four patients were excluded, leaving 49 patients who received prostaglandin E 1 and 50 who received prostaglandin E 2. The time from start of induction to vaginal delivery was significantly shorter in the prostaglandin E 1 group (11.4 vs 18.9 hours, p < 0.001), and fewer patients in the prostaglandin E 1 group required oxytocin augmentation (23% vs 55%, p < 0.005). No significant differences were noted in mode of delivery or in adverse maternal, fetal, or neonatal effects. CONCLUSION: Intravaginal prostaglandin E 1 is a more effective, lower-cost agent for induction of labor than is intracervical prostaglandin E 2 gel and is comparable in safety.

A comparison of misoprostol and prostaglandin E 2 gel for preinduction cervical ripening and labor induction

Objective: Our purpose was to compare the safety ad efficacy of intravaginal misoprostal versus intracervical prostaglandin E 2 (dinoprostone) gel for preinduction cervical ripening and induction of labor. Study design: One hundred thirty-five patients with indications for induction of labor and unfavorable cercices were randomly assigned to receive either intravaginal misoprostol or intracervical dinoprostate. Fifty microgram tablets of misoprostol were placed in the posterior vaginal fornix every 3 hours for a maximum of six doses. Prostaglandin E 2 in gel form, 0.5 mg, was placed into the endocervix every 6 hours for a maximum of three doses. Medication was not given after either spontaneous rupture of membranes or beginning of active labor. Results: Among 135 patients enrolled, 68 received misprostol and 67 dinoprostone. The average interval from start of induction to vaginal delivery was shorter in the misoprostol group (903.3 ± 482.1 minutes) than in the dinoprostone group (1410.9 ± 869.1 minutes) ( p < 0.001). Oxytocin augmentation of labor occurred more often in the dinoprostone group (65.7%) than in the misoprostal group (33.8%) p < 0.001). There were no significant differences between routes of delivery. Ten of the misoprostol-treated patients (14.7%) and 13 of the dinoprostone-treated patients (19.4%) had cesarean deliveries. There was a higher prevalence of tachysystole (six or more uterine contractions in a 10-minute window for two consecutive 10-minute periods) in the misoprostol group (36.7%) than in the dinoprostone group (11.9%) ( p < 0.001). However, there were no significant differences in frequency of uterine hyperstimulation or hypertonus. There was a higher prevalence of meconium passage in the misoprostol group (27.9%) than in the dinoprostone group (10.5%) ( p < 0.05). Thee was no significant difference in frequency of abnormal fetal heart rate tracings, 1- or 5-minute Apgar scores <7, neonatal resuscitations, or admissions to the neonatal intensive care unit between the two groups. Conclusions: Vaginally administered misoprostol is an effective agent for cervical ripening and induction of labor; however when given at this dosage, it is associated with a higher prevalence of tachysystole and meconium passage than is dinoprostone. Further studies to compare the safety of misoprostol to that of dinoprostone and to delineate an optimal dosing regimen for misoprostol are needed.

Misoprostol: An effective agent for cervical ripening and labor induction

Objective: Our purpose was to compare the safety and efficacy of intravaginal misoprostol versus intracervical prostaglandin E 2 gel (dinoprostone) for preinduction cervical ripening and induction of labor. Study design: Two hundred seventy-six patients with indications for induction of labor and unfavorable cervices were randomly assigned to receive either intravaginal misoprostol or intracervical dinoprostone. Twenty-five micrograms of misoprostol were placed in the posterior vaginal fornix every 3 hours, with a potential maximum of eight doses. Prostaglandin E 2 in gel form, 0.5 mg, was placed in the endocervix every 6 hours, with a maximum of three doses. Further medication was withheld with the occurence of spontaneous rupture of membranes, entry into active phase of labor, or a “prolonged contraction response.” Results: Among those evaluated, 138 received misoprostol and 137 received dinoprostone. The average interval from start of induction to vaginal delivery was shorter in the misprostal group (1323.0 ± 844.4 minutes) than in the dinoprostone group (1532.4 ± 706.5 minutes) ( p < 0.05). Need for oxytocin augmentation of labor occurred more commonly in the dinoprostone group (72.6%) than in the misprostol group (45.7%) ( p < 0.0001). There were no significant differences in the routes of delivery. Twenty-eight of the misoprostol-treated patients (20.3%) and thirty-eight of the dinoprostone-treated patients (27.7%) required abdominal delivery. Complications such as uterine lachysystole and thick meconium passage occurred with similar frequency in the two treatment groups. Conclusions: Intravaginal administration of misoprostol appears to be as effective as intracervical dinoprostone for cervical ripening and labor induction. Complications associated with prostaglandin administration were not statistically different between the two treatment groups. The cost of misoprostol ($0.36/100μg) is much less than that of dinoprostone ($75/0.5mg).

Drug therapy during labor and delivery

Situations related to labor and delivery that may require drug therapy are discussed, and treatment options are reviewed. The goal of labor induction and augmentation at term is to facilitate vaginal delivery of a healthy infant. The primary uterine stimulant used for this purpose is oxytocin. Low-, intermediate-, and high-dose protocols have been reported; augmentation requires approximately half as much oxytocin as induction does. Mifepristone has also been used for labor induction. Prostaglandins are the primary agents used for cervical ripening, but oxytocin, relaxin, and mifepristone have also been used. Mechanical dilators are available for cervical dilation, which may be necessary when prostaglandins are contraindicated. Oxytocin is the drug of choice for preventing postpartum hemorrhage; if it is not effective, methylergonovine or carboprost may be used to control the hemorrhage. Labor induction during the midtrimester may be necessary because of obstetrical or medical complications or fetal death. These situations call for aggressive dosing of uterine stimulants (e.g., high-dose oxytocin, intravaginal dinoprostone suppositories, carboprost, mifepristone). Drug therapy may be required for labor induction or augmentation, cervical ripening or dilation, and prevention or control of postpartum hemorrhage. Oxytocin is the most commonly used agent for labor induction or augmentation and for prevention of postpartum hemorrhage; prostaglandins are frequently used for cervical ripening. Aggressive dosing of uterine stimulants is required when labor must be induced during the midtrimester.

A comparison of single prostaglandin E 2 vaginal tablet with prostaglandin E 2 vaginal pessaries for induction of labor at term

This study represents the first of its kind in Kuwait. Two preparations of prostaglandin E 2 (PGE 2) have been compared as agents for induction of labor. In a randomized controlled study of 200 women of low parity and unfavorable cervical induction features, induction of labor by means of a single vaginal tablets of PGE 2 was compared with locally prepared PGE 2 vaginal pessaries. The gradual increase of uterine contractions and the establishment of labor in a similar way to that observed during spontaneous labor was more apparent after PGE 2 tablets. Labor induction was successful in 80% of patients in PGE 2 tablet group compared with 59% in PGE 2 pessaries group. The incidence of cesarean section was equal in both groups (4%), but none was performed due to uterine hyperactivity. The data presented indicate that the PGE 2 vaginal tablet is safe and effective in induction of labor in healthy women at term.