Difference In Cervical Length Research Articles

The utility of maternal serum endocan level to predict preterm delivery within seven days in patients with threatened preterm labor

Objective The aim of the current study was to determine serum endocan levels in patients with threatened preterm labor and to assign whether endocan levels in patients with true preterm labor who give birth within 7 days differ from those of false preterm labor and uncomplicated pregnancy. Materials and methods This cross-sectional study was conducted on 58 patients diagnosed with threatened preterm labor and 31 healthy pregnant women matched for gestational age. Patients with threatened preterm labor were divided into two groups; preterm delivery (28) and term delivery (30) groups. Maternal serum endocan levels were measured with the use of an enzyme-linked immunosorbent assay kit. Results The median serum endocan level (pg/mL) in patients with threatened preterm labor was significantly higher than that of women with uncomplicated pregnancies (725, IQR 619–823 versus 310, IQR 218–423; p < .001 Figure 1). Subgroup analysis performed among threatened preterm labor group revealed that median serum endocan level (pg/mL) in preterm delivery group was higher compared with the other two groups (preterm 823, IQR 718–905 versus term 637, IQR 590–729 p < .001 and preterm 823, IQR 718–905 versus control 310, IQR 218–423 p < .001). The threshold value of maternal serum endocan level for predicting delivery within 7 days after admission was calculated 655 pg/mL, (the area under curve was 0.934, 95% CI 0.88–0.98, p < .001) with 85.7% sensitivity and 78.7% specificity. The mean cervical length measurement was significantly higher in the control group (p < .001); there was no significant difference in cervical length between the term and preterm delivery groups. Maternal characteristics including age, BMI, gravidity, gestational age at blood sampling, CRP and Hb levels were not significantly different between groups (p > .05). Conclusions The maternal serum endocan level may be a useful marker to define high risk group for preterm delivery in patients with threatened preterm labor and similar cervical length measures.

Transperineal versus transvaginal sonographic measurements of cervical length in pregnant women between 16 and 24 weeks of gestation.

To investigate the correlation between cervical length measurements using transvaginal and transperineal approaches at 16-24 weeks of gestation. The prospective study recruited 110 singleton pregnant women. All the measurements were performed by one operator who was blinded to the results of both approaches. Cervical length was first measured by transvaginal sonography (TVUS) then transperineal sonography (TPUS). The transvaginal approach was used as the reference measurement. Patient preference regarding the sonographic approaches was evaluated using questionnaire. Cervical length was successfully measured by TVUS in all cases. TPUS was successful in 108/110 participants. There was high correlation between the results of TVUS and TPUS (Pearson's correlation coefficient was .94; 95% CI .9 to .95. Lin's concordance correlation coefficient was .94; 95% CI .92-.96). The estimated difference in cervical length measured using TVUS and TPUS was .2 mm. The 95% tolerance interval for paired observation was -1.8 to 2.3 mm. The interobserver coefficient of TPUS measurement was .98 (95% CI .92-.99). TPUS was rated as resulting in mild or no discomfort and was preferred by most women. TVUS and TPUS techniques showed high correlation in cervical length measurement with high interobserver reliability. More patients preferred TPUS. TPUS should be considered as an alternative method of cervical length measurement.

431: Differences in cervical length in african american and non-african american women

431: Differences in cervical length in african american and non-african american women

Cervical length dynamics in triplet pregnancies: a retrospective cohort study

PurposeTo review our experience with a screening program that included sequential cervical length measurements in our large population of triplet pregnancies.MethodsSeventy-eight triplet pregnancies were retrospectively included. Cervical length measurements were performed by transvaginal ultrasound in 2-week intervals from week 16 + 0 onwards in a tertiary-care center in Vienna. The main outcome measurement was preterm delivery prior to 32 + 0 weeks of gestation. Statistical analyses were performed using paired and unpaired t tests and a stepwise linear regression model.ResultsThere were 26 cases of preterm delivery (33.3%). Women with preterm delivery revealed significant cervical length shortening from week 22 + 0 (median 33 mm, interquartile range, IQR 17–39) to 24 + 0 (median 21 mm, IQR 7–30; p = 0.005). This was not observed in women without preterm delivery. From week 22 + 0 onwards, both groups showed further significant 2-week differences in cervical length (p < 0.05). Univariate analysis of cervical length in weeks 20 + 0, 22 + 0, and 24 + 0 as well as cervical length dynamics from 22 + 0 to 24 + 0 predicted preterm delivery.ConclusionsIn triplet pregnancies, a decrease in cervical length seems physiological from week 22 + 0 onwards. A sharp decrease in cervical length from the 22 + 0 to the 24 + 0 week as well as the smaller cervical length in weeks 20 + 0, 22 + 0, and 24 + 0 increase the risk of preterm delivery.

The prevalence of short cervix between 20 and 24 weeks of gestation and vaginal progesterone for prolonging of gestation

Objective: The objective of this study is to understand the prevalence of short cervical length between 20 and 24 weeks gestation in China and to evaluate the efficacy of micronized progesterone for prolonging gestation in nulliparous patients with a short cervix.Methods: From May 2010 to May 2015, a total of 25 328 asymptomatic women with singleton pregnancies at Peking University First Hospital had their cervical length routinely measured between 20 and 24 weeks of gestation. A cervical length of 25 mm or less was defined as a shortened cervical length. The therapies prescribed include vaginal micronized progesterone capsules (200 mg each night) or bed rest from 20 to 34 weeks of gestation. The primary outcome was spontaneous delivery before 33 weeks.Results: (1) One hundred fourteen women had a cervical length of ≤25 mm (0.45%). (2) Twenty-nine of which with previous spontaneous preterm delivery or late pregnancy loss had cervical cerclage, the remaining 85 women by the use of vaginal progesterone or simply resting activity restriction to prevent preterm birth. (3) In 85 nulliparous women treated by progesterone or bed rest, progesterone use in cervical length between 10 and 20 mm was associated with a statistically significant reduction in the incidence of preterm birth at <33 weeks of gestation (9.5% versus 45.5%, p = 0.02) compared with bed rest. There were no significant differences in cervical length between 20 and 25 mm in their rates of spontaneous preterm delivery at <33 (5.3% versus 3.2%, p = 0.72), <37 (33.3% versus 54.5%, p = 0.25), or <35 weeks (14.3% versus 45.5, p = 0.06) of gestation between vaginal progesterone and bed rest.Conclusion: The rate of short cervical length was less than expected. Vaginal progesterone is efficacious for the prolonging of gestation in women with a cervical length of 10–20 mm in the mid-trimester for a singleton gestation and nulliparous women. For a cervical length of 20–25 mm in the mid trimester, vaginal progesterone compared with bed rest did not prolong pregnancy.

Cervical Length and Androgens in Pregnant Women With Polycystic Ovary Syndrome: Has Metformin Any Effect?

Women with polycystic ovary syndrome (PCOS) have increased risk of preterm delivery. Shortening of the cervix is a sign of preterm delivery. This study aimed to investigate potential effect of metformin on cervical length and whether androgen levels correlate with cervical length in PCOS pregnancies. This was a sub-study of a randomized, placebo-controlled, multicenter study (The PregMet study) performed at 11 secondary or tertiary centers from 2005 to 2009. Two-hundred sixty-one pregnancies of 245 women with PCOS, age 18-42 years participated. Participants were randomly assigned to metformin or placebo from first trimester to delivery. We compared cervical length and androgen levels in metformin and placebo groups at gestational weeks 19 and 32. We also explored whether cervical length correlated with androgen levels. We found no difference in cervical length between the metformin and the placebo groups at gestational week 19 and 32. Dehydroepiandrosterone (DHEAS) tended to be higher in the metformin group. There were no correlations between androgens and cervical length at week 19. At gestational week 32, androstenedione (P = .02) and DHEAS (P = .03) showed a trend toward negative correlation to cervical length. High androstenedione level correlated with shortening of cervical length from week 19 to 32 when adjusted for confounders (P = .003). T (P = .03), DHEAS (P = .02), and free testosterone index (P = .03) showed a similar trend. Metformin in pregnancy did not affect cervical length in women with PCOS. High maternal androgen levels correlated with cervical shortening from the second to the third trimester of pregnancy, as a sign of cervical ripening.

Can maternal height predict shorter cervical length in asymptomatic low-risk pregnant women?

ObjectiveTo evaluate the association between maternal height and cervical length in the first and second trimesters in low-risk asymptomatic pregnant women. Study designMaternal height and cervical length of 146 asymptomatic women with singleton pregnancies at low risk for preterm birth were measured during the first and second trimesters. Preterm birth was defined as birth before <37 gestational weeks. Correlations between maternal height and cervical length measurements were determined using Pearson correlation analysis. The women were also divided into three groups based on height percentiles: <25% (Group I), 25–75% (Group II) and >75% (Group III). Cervical lengths were compared among groups. Correlations between cervical length and maternal height and statistically significant differences in cervical length among height percentile groups were the main outcomes. ResultsMaternal height was positively but weakly correlated with first and second trimester cervical lengths (p=0.047, r=0.167 and p=0.039, r=0.197 respectively). The mean first trimester cervical lengths were significantly different between the groups (p=0.04). There were no significant differences, however, in the mean second trimester cervical lengths among the three groups although the difference was close to significance (p=0.06). ConclusionAlthough our results indicate a relationship between maternal height and cervical length in our population, maternal height seems to have only limited value in identifying women to be screened for shorter cervical length in a low risk asymptomatic population.

Role of Cervical Length as Predictor of Preterm Labor and a Comparison of Transabdominal versus Transvaginal Ultrasound in Determining the Accuracy of Cervical Length

ABSTRACT Objectives 1. To evaluate the mean cervical length at 22 to 28 weeks of gestation by TAS and TVS and correlate its association with preterm labor. 2. To compare the difference in cervical length measured by the above two methods. Methods This was a prospective trial involving 100 pregnant women spanning a period of ten months. Results Eighteen women out of the 100 studied had preterm labor; of which 17 had a cervical length of less than 3 mm at 22 to 28 weeks. The percentage of women with preterm delivery with a short cervix was 83% by transabdominal scan (TAS) and 94% with transvaginal scan (TVS). Conclusion The mean cervical length was lesser amongst women who had a preterm delivery as compared to those with a term delivery. The mean cervical length by TAS was more than that by TVS thereby suggesting that TVS has a higher sensitivity for detection of preterm labor than TAS.

Effect of progesterone on cervical shortening in women at risk for preterm birth: secondary analysis from a multinational, randomized, double‐blind, placebo‐controlled trial

To determine whether progesterone supplementation alters cervical shortening in women at increased risk for preterm birth. We performed a planned secondary analysis from a large, multinational preterm birth prevention trial of daily intravaginal progesterone gel, 90 mg, compared with placebo in women with a history of spontaneous preterm birth or premature cervical shortening. Transvaginal cervical length measurements were obtained in all randomized patients at baseline (18 + 0 to 22 + 6 weeks' gestation) and at 28 weeks' gestation. For this secondary analysis, the difference in cervical length between these time points was compared for the study population with a history of spontaneous preterm birth and for a population with premature cervical shortening (< or = 30 mm) at randomization. Differences between groups in cervical length for the 28-week examination were analyzed using ANCOVA, including adjustment for relevant clinical parameters and maternal characteristics. Data were analyzed from 547 randomized patients with a history of preterm birth. The progesterone-treated patients had significantly less cervical shortening than the placebo group (difference 1.6 (95% CI, 0.3-3.0) mm; P = 0.02, ANCOVA). In the population of 104 subjects with premature cervical shortening at randomization, the cervical length also differed significantly on multivariable analysis, with the treatment group preserving more cervical length than the placebo group (difference 3.3 (95% CI, 0.3-6.2) mm; P = 0.03, ANCOVA), with adjustment for differences in cervical length at screening. A significant difference was also observed between groups for categorical outcomes including the frequency of cervical length progression to < or = 25 mm and a > or = 50% reduction in cervical length from baseline in this subpopulation. Intravaginal progesterone enhances preservation of cervical length in women at high risk for preterm birth.

Accuracy of 2-D versus 3-D ultrasound in measurement of cervical length

OBJECTIVE: Validation and reliability of 2-D vs. 3-D ultrasound measurement of cervical length (CL) and comparison to the gold-standard (3-D ultrasound with a balloon catheter at the internal os) DESIGN: Validation study comparing 2-D and 3-D ultrasound CL measurements MATERIALS AND METHODS: 20 non-gravid volunteers, ages 18 to 39, had mid-follicular ultrasounds for CL. Three 2-D and three 3-D measurements were recorded by a single ultrasonographer who was blinded to the results. A balloon catheter was then placed at the internal os and the measurements were repeated. Data were compared using Pearson correlation coefficients and paired t-tests. RESULTS: Internal reliability of measurements were analyzed using Pearson correlations (2-D, 2-D with balloon, 3-D, and 3-D with balloon). The 1st measurement in each set was discarded, and the 2nd and 3rd were compared. All correlation coefficients were 0.80 or higher. Measurements were validated by comparing without balloon measurements to with balloon measurements.Tabled 1Comparison of Differences in Cervical Length by Various Ultrasound MeasurementsMeasurementDifference in Cervical LengthSD95% Confidence Intervalp value2-D vs. 2-D with balloon0.510.620.22, 0.800.0023-D vs. 3-D with balloon0.350.690.03, 0.670.042-D vs. 3-D with balloon0.580.680.26, 0.900.001 Open table in a new tab Without balloon measures significantly overestimated CL when compared to with balloon measure. When compared to the gold standard, 2-D and 3-D significantly overestimated CL (0.58 cm and 0.35 cm respectively), but 3-D provided a better approximated of the gold-standard. CONCLUSIONS: All measurment techniques were internally reliable in the hands of an experienced ultrasonographer. Both without balloon measurement overestimated cervical length in the non-gravid uterus, but 3-D measurements better approximated the “gold standard” CL than 2-D measurements.

Cervical length evaluation by transvaginal sonography in nongravid women with a history of preterm delivery.

To evaluate cervical length in the nongravid period in women with a past history of preterm delivery. The study population comprised 54 women who had delivered spontaneously before 34 weeks of gestation. Etiology of preterm delivery was suspected to be related to cervical incompetence, defined as a painless and progressive dilatation of the cervix in the absence of other causes. Patients with pre-eclampsia, intrauterine growth restriction, uterine anomalies, fetal anomalies, multiple gestation and similar complications were excluded. Shortening of the cervix was recorded during pregnancy in all study patients. One hundred and four women matched for age, parity and body mass index who had given birth at term served as the control group. Cervical length was evaluated in all women at least 12 weeks after delivery by transvaginal sonography in the mid-sagittal plane. The mean gestational age at delivery was 30.8 +/- 1.2 weeks in the study group and 38.8 +/- 2.1 weeks in the control group (P = 0.03). The mean cervical length in the two groups was 36 +/- 6 and 38 +/- 4 mm, respectively. This difference was not statistically significant (P = 0.9). In nongravid women with unexplained preterm delivery there is no difference in cervical length compared to patients who deliver at term. Shortening of the cervix is most probably a reversible phenomenon that occurs during pregnancy and represents a failure of the competence mechanism to adapt to pregnancy.

Avaliação do risco para parto prematuro espontâneo pelo comprimento do colo uterino no primeiro e segundo trimestres da gravidez

Objetivos:avaliar, no primeiro e segundo trimestres da gravidez, a correlação entre o comprimento do colo uterino e a ocorrência de parto prematuro espontâneo. Métodos:em 641 grávidas do pré-natal geral, a medida do comprimento do colo uterino foi realizada em dois momentos: entre a 11ª e a 16ª e entre a 23ª e a 24ª semana da gravidez. A avaliação do colo uterino foi feita pela ultra-sonografia transvaginal, com a grávida em posição ginecológica e tendo realizado previamente esvaziamento da bexiga. O comprimento do colo uterino foi medido linearmente do seu orifício interno ao externo. A medida do comprimento do colo uterino foi correlacionada com a idade gestacional no momento do parto. Para comparação das médias do grupo de grávidas que tiveram parto prematuro e a termo utilizamos o teste t de Student. A sensibilidade, especificidade, taxa de falso-positivos, falso-negativos e acurácia para o parto prematuro foram calculadas para os comprimentos de colo menores ou iguais a 30 mm, 25 mm e 20 mm. Resultados:a medida do comprimento do colo uterino entre a 11ª e a 16ª semana de gestação não apresentou diferença significativa entre o grupo de parto prematuro e o grupo a termo (40,6 mm e 42,7 mm, respectivamente, p=0,2459). A diferença entre os grupos, no entanto, foi significativa quando o colo foi medido entre a 23ª e a 24ª semana de gravidez (37,3 mm para o grupo que evoluiu com parto prematuro e 26,7 mm para o grupo a termo, p=0,0001, teste t de Student). Conclusões:o comprimento do colo uterino entre a 11ª e a 16ª semana de gravidez não foi significativamente diferente entre as gestantes com parto prematuro ou a termo. No entanto, na 23ª e 24ª semana esta diferença foi significativa, podendo ser um método de predição da prematuridade.

The value of ultrasonographic examination of the uterine cervix in predicting post-term pregnancy.

To assess whether transvaginal ultrasound is helpful in predicting the post-term onset of labor (> or = 1 weeks). Antenatal clinic of a University hospital and referral center. SUBJECT AND MEHODS: One hundred and twenty singleton uncomplicated pregnancies in primiparous women were enrolled at 37 weeks of gestation. Ultrasound examination of the cervical length by a transvaginal probe was performed at recruitment and at weekly intervals until 40 completed weeks. Subjects were divided into Group A (those with spontaneous onset of labor < or = 1 completed weeks) and Group B (those not in labor by that date). Eighty women delivered < or = 41 completed weeks, forty were not in labor by that date. The cervix was significantly shorter at 39 and 40 weeks in group A, but no particular cervical length was predictive of post-term delivery. There is a significant difference in cervical length in women delivering at term compared with those due to have a post-term delivery. This difference is significant from 39 weeks of gestation onwards. We speculate that targeted transvaginal ultrasound may be useful in predicting the post-term onset of labor and possibly in assisting its active management.

Ultrasonography for Cervical Length Measurement

In Brief Objective To assess agreement between transvaginal and translabial ultrasonography for measuring cervical length in the second and third trimesters. Methods Eighty-four obstetric patients at 14–40 weeks' gestation were enrolled. Three images of the cervix were obtained by translabial (3.5-MHz curvilinear transducer) and transvaginal (6.5-MHz endovaginal probe) ultrasonography. The mean cervical length obtained by using each method was used for data analysis. The McNemar χ2 test was used to assess the difference between techniques in their ability to obtain a measurement. The paired t-test was used to evaluate the differences between the measurements. The mean difference and SD for the differences were used to calculate the limits of agreement. An acceptable difference was defined as less than 0.5 cm. Results Cervical length measurements were obtained in 84 patients (100%) by using the transvaginal technique and in 80 patients (95%) by using the translabial technique (P = .1). Eighty patients had both transvaginal and translabial measurements for comparison. The mean difference in cervical length was 0.37 cm (P < .001; 95% confidence interval [CI] 0.21, 0.52). The upper and lower limits of agreement were 1.75 cm (95% CI 1.48, 2.02) and −1.01 cm (95% CI −0.74, −1.28), respectively. The differences between the two measurements were within these limits 95% of the time. These limits of agreement were greater than the acceptable difference of 0.5 cm. Conclusion Transvaginal and translabial techniques should not be used interchangeably for clinical assessment of cervical length because agreement between the methods is not within an acceptable range. Better agreement between transvaginal and translabial ultrasonographic measurements is needed before these techniques can be used interchangeably for clinical assessment of cervical length.

Ultrasonography for cervical length measurement: agreement between transvaginal and translabial techniques

Objective: To assess agreement between transvaginal and translabial ultrasonography for measuring cervical length in the second and third trimesters. Methods: Eighty-four obstetric patients at 14–40 weeks’ gestation were enrolled. Three images of the cervix were obtained by translabial (3.5-MHz curvilinear transducer) and transvaginal (6.5-MHz endovaginal probe) ultrasonography. The mean cervical length obtained by using each method was used for data analysis. The McNemar χ 2 test was used to assess the difference between techniques in their ability to obtain a measurement. The paired t-test was used to evaluate the differences between the measurements. The mean difference and SD for the differences were used to calculate the limits of agreement. An acceptable difference was defined as less than 0.5 cm. Results: Cervical length measurements were obtained in 84 patients (100%) by using the transvaginal technique and in 80 patients (95%) by using the translabial technique ( P = .1). Eighty patients had both transvaginal and translabial measurements for comparison. The mean difference in cervical length was 0.37 cm ( P < .001; 95% confidence interval [CI] 0.21, 0.52). The upper and lower limits of agreement were 1.75 cm (95% CI 1.48, 2.02) and −1.01 cm (95% CI −0.74, −1.28), respectively. The differences between the two measurements were within these limits 95% of the time. These limits of agreement were greater than the acceptable difference of 0.5 cm. Conclusion: Transvaginal and translabial techniques should not be used interchangeably for clinical assessment of cervical length because agreement between the methods is not within an acceptable range.

Change in cervical length after cerclage as a predictor of preterm delivery

Objective: To determine whether the degree of cervical lengthening after cerclage and whether serial follow-up measurements of cervical length after cerclage are predictive of pregnancy outcome. Methods: Eighty women whose primary physician determined that a prophylactic ( n = 50) or urgent cerclage ( n = 30) was indicated had transvaginal ultrasonographic evaluation before and after cerclage. Thereafter, most women had three additional transvaginal ultrasound examinations until 32 weeks’ gestation. At each examination, the mean of three measurements was calculated. Statistical analyses were done by t test, analysis of variance, and logistic regression, with significance set at P < .05. Results: The mean ± standard deviation precerclage cervical length was 27.2 ± 10.3 mm and after cerclage was 34.1 ± 9.9 mm ( n = 80, P < .001, paired t test). No significant association was found ( r = −0.26) between the difference in cervical length (postcerclage − precerclage lengths) and pregnancy outcome. Patients with a prophylactic cerclage had a mean cervical length that was consistently longer in patients delivering at term compared with those who delivered preterm at 20 to 32 weeks’ gestation. In the urgent cerclage group a significant difference in cervical length between those who delivered at term compared with preterm was evident only at 28 to 32 weeks. Conclusion: The increase in cervical length after cerclage is not predictive of term delivery. Serial cervical length measurements in the late second or early third trimester predict preterm birth but could provide earlier warning in patients with a prophylactic cerclage than in patients with urgent cerclage.

Transperineal versus endovaginal ultrasonographic examination of the cervix in the midtrimester: A blinded comparison

Objective: Shortening of the cervix that occurs early in gestation as determined by ultrasonography has been correlated with subsequent spontaneous preterm birth. Because previous studies have compared transperineal and endovaginal ultrasonographic assessment of the cervix over a wide gestational age range, we compared these methods in the midtrimester. Study Design: We performed a prospective, blinded comparison of endovaginal and transperineal cervical ultrasonographic assessment. Unselected gravid women at 15-23 weeks’ gestation were sequentially examined by 2 experienced sonographers using an endovaginal probe and a curvilinear probe. For each patient the initial sonographer and examination method were randomly assigned. The sonographer who performed the second examination was blinded to the results and images from the first examination. Results: One hundred two women were studied at a mean of 19.6 weeks’ gestation. The overall intermethod correlation was poor ( R = 0.38). In 12 cases a transperineal measurement could not be obtained because of poor visualization of the required landmarks. In 33% of cases the intermethod difference in cervical length was ≥20%. There was no correlation in the identification of funneling at the internal os and very small correlation for the identification of a poorly developed lower uterine segment. Conclusion: Transperineal ultrasonographic imaging of the cervix is an unsatisfactory alternative to an endovaginal assessment in the midtrimester. (Am J Obstet Gynecol 1999;181:780-3.)

Prostaglandin E 2 cervical ripening without subsequent induction of labor

Objective: To determine whether outpatient administration of intracervical prostaglandin (PG) E 2 gel decreases the interval to delivery and duration of labor. Methods: A randomized, double-blind, placebo-controlled trial compared the intracervical placement of 0.5 mg PGE 2 gel with placebo in 61 pregnant women at 38 weeks’ or greater gestation with Bishop scores less than 9. Transvaginal cervical length, fetal fibronectin, and Bishop score were assessed before gel placement. Subjects were then allowed to go into spontaneous labor unless an indication for induction developed. Results: Thirty women were assigned to PGE 2 and 31 to placebo. There were no significant demographic differences between the groups and there were no differences in cervical length, fetal fibronectin status, or Bishop scores. Fifteen women in the PGE 2 group and five in the placebo group went into labor and delivered within the first 2 days after gel placement ( P = .007). The median interval to delivery was significantly shorter in the PGE 2 group, at 2.5 days, compared with placebo, at 7 days ( P = .02). Nulliparas in the PGE 2 group had a median interval to delivery of 2 days, compared with 7 days for nulliparas receiving placebo ( P = .03). Active phases of labor were significantly shorter in the PGE 2 group and for women with a negative fetal fibronectin test who received PGE 2. Conclusion: Outpatient administration of intracervical PGE 2 gel shortened intervals to delivery and shortened labor.