Intracervical PGE2 Gel Research Articles

EVALUATION OF INDUCTION OF LABOUR IN TERM PREMATURE RUPTURE OF MEMBRANES BY PGE2 GEL VS INTRAVENOUS OXYTOCIN INFUSION

Premature rupture of membranes (PROM) refers to rupture of fetal membranes prior to onset of regular uterine contractions. It continues to be one of the most vexing issues of obstetrics due to increased maternal and fetal morbidity and mortality due to delayed intervention. A total of 240 women were divided into two equal groups to receive either i.v. oxytocin or intracervical PGE2 gel by odd-even method with the aim to compare induction to delivery interval and maternal and fetal outcome in both groups. They were followed from admission till discharge of the patient after delivery. Induction to delivery interval was found to be more in PGE2 group but maternal and fetal outcomes were comparable in both groups

Comparison of Labour Induction between Intracervical PGE2 Gel and Intravaginal PGE1 Analogue Tablet among Patients with Intra Uterine Foetal Death- A Cross-Sectional Study

Introduction: In spite of modern medical advancement, there is some significant pregnancy loss during antepartum period. In majority of cases labour soon follows death of the foetus, but sometimes labour does not start for several weeks. So induction of labour is needed but the unfavourable cervix remains a well-recognized impediment to success of induction of labour in intrauterine foetal death. Prostaglandins in different Seems in different routes have been widely investigated to be used for induction of labour particularly when the cervix is unripe. Both Prostaglandin E1, and Prostaglandin E2 have been proved effective equally. Dinoprostone (PGE2), has been widely used for cervical ripening and labour induction. Misoprostol, a methyl ester of prostaglandin analogue, has been shown to be effective for cervical ripening and labour induction. Aim of the study: The aim of this study was to compare the effectiveness of vaginal misoprostol (PGE1 tablet) and prostaglandin (PGE2 gel) in order to induce labour among patients with intrauterine foetal death. Methods: This was a cross-sectional study and was conducted in the Department of Obstetrics and Gynaecology of Dhaka Medical College Hospital, Dhaka, Bangladesh during the period from July, 2004 to June, 2005. In our study we included 70 patients who were given and during labour induction. Our patients were equally divided into two groups – i) Group A (Patients were given Per- vaginal prostaglandin tablet) & ii) Group B (Patients were given Intra-cervical prostaglandin gel). Result: In total 70 patients from both the groups completed the study. In our study we found the mean age was 23.94±4.19 and 24.46±2.44 years in group A and group B respectively and the mean induction to onset of labour time was less in prostaglandin E2 group (5.97±3.75) hours, than in prostaglandin E1 group (8.24±3.19) hour but induction to delivery interval time was not significantly different in most of the patients in both groups. With a .......

Assessment of outcome of induction of labor with intracervical dinoprostone gel with and without foley's catheter balloon

Background: Induction of labour (IOL) is indicated when continuing a pregnancy is no longer beneficial to the mother or foetus. The present study was conducted to assess and compare outcome of induction of labor with intracervical dinoprostone gel with and without foley’s catheter balloon. Materials and Methods: 60 patients at term with various indications for induction of labor were alternatively allocated to either PGE2 gel (Group I, n = 30), PGE2 gel with Foley’s catheter (Group II, n = 30) method. Results: The mean age was 28.2 years in group I and 29.1 years in group II, mean parity was 0.27 in group I and 0.14 in group II and mean period of gestation (POG) at IOL was 38.2 weeks in group I and 38.5 weeks in group II. The difference was non- significant (p> 0.05).Conclusion: Administering one dose of an intracervical PGE2 gel with Foley was superior to intracervical dinoprostone gel alone for cervical ripening and IOL.

A Comparative Study of Safety & Efficacy of Foley’s Induction with Prostaglandin E2 Gel Induction

Abstract: Background: To compare maternal and fetal outcome with intracervical foley’s catheter and intracervical PGE2 gel on pre-induction cervical ripening for induction of labor. Methods: A Prospective Longitudinal study was carried out in antenatal cases beyond 37 weeks at tertiary care hospital, maharashtra. Pertinent data was collected and analyzed. Results: 50% patients were induced with PGE2 Gel (Group 1) and 50% patients were induced with Foley’s catheter (Group 2). The mean time interval between time of induction and delivery was 14.63±3.42 hours in Group 1 and 15.73±2.20 hours in Group 2. 52 (69.4%) patients in Group 1 had Full Term Normal Delivery (FTND) while 21 (28%) had Lower Segment Caesarean Section (LSCS). 73 (97.4%) patients in Group 2 had FTND while 1 (1.3%) patient had LSCS. The preinduction and postinduction bishops score between the groups was (3.53±0.84 vs. 3.44±0.74) and (6.91±1.24 vs. 7.33±0.83) respectively. Conclusion: Induction with foley’s catheter has significant improvement in Bishop’s score and shorter induction delivery interval as compared to PGE2 gel. Foleys catheter is advantageous as it lacks specific storage condition. It could be considered a cost effective alternative for pre induction cervical ripening.

TO COMPARE THE EFFICACY OF INTRA CERVICAL FOLEY’S CATHETER WITH INTRA CERVICAL DINOPROSTONE GEL IN CERVICAL RIPENING FOR THE SUCCESSFUL INDUCTION OF LABOR

Background: This study compared the efficacy and safety of the intracervical Foley catheter and dinoprostone insert for cervical ripening to achieve successful labor induction.
 Methods: This was a randomized controlled study conducted. Group A received Dinoprostone cervical gel 0.5mg instilled in the cervical canal. Maximum of three doses (1.5mg dinoprostone) could be administered 6 hours apart. Patients randomized to group B were subjected to Foleys catheter insertion. Primary efficacy parameter was change in Bishops score as compared to baseline.
 Conclusion: Our study showed that for pre induction cervical ripening there was no difference in efficacy between intracervical Foleys catheter and PGE2 gel.
 Keywords: Foleys catheter, Induction of labour, Prostaglandins

Comparison of intracervical Foley catheter used alone or combined with a single dose of dinoprostone gel for cervical ripening: a randomised study

Prostaglandins and intracervical catheters are similarly effective for cervical ripening and for an induction of labour (IOL). Studies comparing the combined use with either method alone have administered repetitive doses of prostaglandins vaginally, which may increase the risk of tachysystole and chorioamnionitis. These disadvantages may be offset by co-administering a single dose of prostaglandin. Women (n = 110) planned for IOL, ≥37 weeks of gestation and with a Bishop Score of ≤6 were randomised into two groups: intracervical Foley catheter alone or combined with dinoprostone gel (0.5 mg) for 12 hours followed by oxytocin. The primary outcome was the IDI and the others were: change in Bishop Score, caesarean section (CS) requirement, any complications and neonatal outcome. The baseline Bishop was ≤4 in all and >80% were nulliparous. The post-ripening Bishop was significantly higher (6.67 vs. 5.98; p = .045) and the IDI was significantly lower in the combined group (16 hours and 16 minutes vs. 20 hours 44 minutes, p = .002). The CS rate was similar (29.1 vs. 25.5%; p = .669). No woman had hyperstimulation or chorioamnionitis and the neonatal outcomes were similar. Thus, co-administering one dose of an intracervical PGE2 gel with Foley was superior to Foley alone for cervical ripening and IOL.Impact statementWhat is already known on this subject? Prostaglandins and intracervical balloon catheters used individually are similarly effective for ripening an unfavourable cervix prior to the induction of labour (IOL). A few studies which have compared their found it to result in a shorter cervical ripening time and induction delivery interval (IDI) as compared to prostaglandins alone, though chorioamnionitis was a concern. When compared to balloon catheter used alone, combined use was either similarly or more effective. The studies comparing combined use with either method used alone have administered repetitive doses of prostaglandins vaginally, which may increase the risk of tachysystole, and possibly of chorioamnionitis. Co-administering a single dose of prostaglandin with a balloon catheter may offset these disadvantages.What do the results of this study add? A combined method for cervical ripening using a single dose of intracervical dinoprostone gel (PGE2, 0.5 mg) coadministered with an intracervical Foley catheter was superior to Foley catheter alone. The combined method improved the Bishop score after 12 hours and reduced the IDI significantly compared to the Foley catheter alone; while the caesarean rate and neonatal outcomes were similar. No woman had chorioamnionits or hyperstimulation.What are the implications of these findings for clinical practice and/or further research? The combined methods for cervical ripening should be compared to individual methods in more women, and the combinations may explore the use of other single use prostaglandins like the dinoprostone vaginal insert or misoprostol tablets.

Comparative Study of Extraamniotic Saline Infusion with Transcervical Foleys Catheter and Intracervical PGE2 Gel in Cervical Ripening and Labor Induction

Comparative Study of Extraamniotic Saline Infusion with Transcervical Foleys Catheter and Intracervical PGE2 Gel in Cervical Ripening and Labor Induction

Intravaginal vs. intracervical PGE 2 gel first application for labor induction

International Journal of Gynecology & ObstetricsVolume 75, Issue 2 p. 195-197 Brief communications Intravaginal vs. intracervical PGE2 gel first application for labor induction F Corrado, Corresponding Author F Corrado [email protected] Institute of Gynecology, University of Messina, Messina, ItalyCorresponding author. Tel.: +39-0902212165; fax: +33-090695201Search for more papers by this authorM.L Cannata, M.L Cannata Institute of Gynecology, University of Messina, Messina, ItalySearch for more papers by this authorG Facciola, G Facciola Institute of Gynecology, University of Messina, Messina, ItalySearch for more papers by this authorN. Carlo Stella, N. Carlo Stella Institute of Gynecology, University of Messina, Messina, ItalySearch for more papers by this author F Corrado, Corresponding Author F Corrado [email protected] Institute of Gynecology, University of Messina, Messina, ItalyCorresponding author. Tel.: +39-0902212165; fax: +33-090695201Search for more papers by this authorM.L Cannata, M.L Cannata Institute of Gynecology, University of Messina, Messina, ItalySearch for more papers by this authorG Facciola, G Facciola Institute of Gynecology, University of Messina, Messina, ItalySearch for more papers by this authorN. Carlo Stella, N. Carlo Stella Institute of Gynecology, University of Messina, Messina, ItalySearch for more papers by this author First published: 22 October 2001 https://doi.org/10.1016/S0020-7292(01)00503-3Citations: 2Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume75, Issue2November 2001Pages 195-197 RelatedInformation

Second Trimester Abortion Using Prostaglandin E2 Suppositories With or Without Intracervical Laminaria japonica

In Brief Objective To compare the abortifacient efficacy of vaginal prostaglandin (PG) E2 suppositories with and without pretreatment with intracervical PGE2 gel and Laminaria japonica. Methods One hundred seventy-five women between 16 and 20 weeks' gestation requesting abortion were divided randomly into three groups. Forty-one received PGE2 vaginal suppositories alone to induce abortion, 72 had Laminaria placed 24 hours before vaginal PGE2, and 62 were given intracervical 0.5 mg PGE2 gel plus Laminaria 24 hours before vaginal PGE2. Maternal demographic characteristics, induction to delivery time, number of suppositories required, and complications were analyzed. Results The mean maternal age, gravidity, parity, race, and gestational age were similar among groups. Ninety-five percent of all women delivered within 24 hours. The induction to delivery time was significantly longer in the PGE2-only women (mean ± standard deviation 689 ± 319 minutes) compared with that of those receiving PGE2 plus Laminaria (487 ± 321 minutes) and PGE2 plus Laminaria plus gel (547 ± 374 minutes, P = .01). There was a statistically significant difference in the number of suppositories needed to complete the abortion process. The PGE2-only group required more suppositories (median three, range 1-8) compared with PGE2 plus Laminaria (median 3, range 1-3) and PGE2 plus Laminaria plus gel (median 2.5, range 1-9; P = .001). Patients in the PGE2 plus Laminaria plus gel group reported more pain associated with placement (median pain score 4, range 0-10) compared with PGE2 plus Laminaria (median 2, range 0-9; P = .003). There was a lower incidence of febrile episodes in the PGE2-only group (29%) compared with PGE2 plus Laminaria (68%) and PGE2 plus Laminaria plus gel (54%, P = .002). Conclusion Placement of Laminaria japonica 24 hours before PGE2 vaginal suppository-induced abortion resulted in a significantly shorter induction-to-delivery time, and pretreatment with Laminaria japonica decreased the number of suppositories required to complete abortion. Pretreatment with intracervical PGE2 gel increased pain associated with Laminaria placement and did not improve the efficacy of the procedure. Pretreatment with Laminaria japonica improves the induction to delivery time in patients undergoing second trimester abortions with prostaglandin E2.

Prostaglandin E 2 gel for cervical ripening in patients with an indication for delivery

To determine if labor can be induced safely and efficiently in patients with a medical or obstetric indication for delivery before 41 completed weeks of gestation by pre-induction cervical ripening with prostaglandin (PG) E2 gel. One hundred eighteen women with confirmed indication for induction of labor before 41 completed weeks were randomized in a double-blind fashion to either intracervical PGE2 gel or placebo before induction by a standard oxytocin protocol. Data regarding the change in Bishop score, interval to complete dilation, maximal oxytocin dose required to establish labor, and route of delivery were collected. Apgar scores and umbilical artery pH were also recorded. The maximum oxytocin dose required to establish progressive labor was significantly lower in the PGE2 group (10.06 +/- 8.50 versus 13.35 +/- 9.27 mU/minute, P = .014). The cesarean rate was also significantly lower in the PGE2 group (13.1 versus 31.6%, P = .016). Pre-induction intracervical deposition of 1 mg PGE2 gel decreased the amount of oxytocin required to induce progressive labor and decreased the cesarean rate in patients who had medical or obstetric indications for delivery before 41 completed weeks. This was accomplished without negative effect on Apgar score or umbilical artery pH.

İkinci Trimester Missed Abortus Ve İntrauterin Ölü Fetus Olgularında Prostaglandin E2 Ve Oksitosin Kullanımı

The use of oxytocin and PGE2-gel in cases of second trimestr missed abortion and intrauterine fetal death ✓34 women who had missed abortion or intrauterin exitus and required surgical termination of pregnancy from 12-24 weeks of gestation were treated with intracervical PGE2-gel and oxytocin infusion. The patients were divided into two groups. First group were treated with only oxytocin. There was signilicant difference between the two groups according to mean duration of abortion (p<0.05). According to this preliminary experience the intracervical application of the new ready-for use pge2-gel repesents a practicable and efficient method for abortion and preoperative cervical ripening. Intracervical application of gel didn't have any side effects, not induced hypertonic contractions but only locally riped. We didn't confront any complications in the Pge2-gel treated group. ✓ Gebelik haftasi 12-24 hafta arasi olan, missed abortus veya intrauterin eksitus tanilari ile gebeliklerinin cerrahi olarak bosaltilmasi gereken 34 olguda intraservikal PGE2 jel ve oksitosin kullanildi, olgular iki gruba ayrildi. Ilk grupta intraservikal PGE2-Jel ve oksitosin kullanilirken 2.grup olgularda ise sadece oksitosin infuzyonu yapildi. Ortalama dusuk eylemi ,suresi bakimindan gruplar arasindaki farkin onemli oldugu saptandi (0.02<p<0.05).

Preinduction Cervical Priming with PGE2Intracervical Gel

A prospective, randomized, controlled clinical trial was conducted to evaluate the safety and efficacy of a single, 0.5-mg dose of prostaglandin E2 gel in a shelf-stable triacetin base administered intracervically in patients with an unfavorable cervix (Bishop score less than or equal to 4) 12 hours prior to oxytocin-induction of labor. forty-eight evaluable patients were enrolled, 25 in the PGE2 group and 23 in the control group. PGE2 gel treatment resulted in a significant improvement in the mean Bishop score compared to control (3.14 versus 0.70, P less than .00005). Sixty-four percent of the patients treated with PGE2 had regular uterine contractions during the 12-hour preinduction period beginning 2.18 +/- 2.0 hours after gel insertion, compared to 9% in the control group, P = .0001. Moreover, 12% (3/25) of the patients receiving PGE2 progressed into active labor and delivered during the preinduction period. The duration of oxytocin infusion required for the induction or augmentation of labor was significantly shorter for patients who received intracervical PGE2 gel compared to the control group (13.1 +/- 8.1 versus 19.0 +/- 8.7, P less than .05). However, there was no significant difference in the incidence of cesarean section between the two study groups (40 and 22% in the PGE2 and control groups, respectively). No episodes of uterine hypertonus or hyperstimulation or gastrointestinal side effects occurred as a result of PGE2 gel treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Premature membrane rupture: effect of intracervical PGE2 gel administration on plasma oxytocin, PGFM and PGEM levels in mother and child

Premature rupture (= PR) of the amnion is a serious complication even for the mature child if it occurs earlier than 24 hours before birth. To keep the interval as short as possible, the authors induce labour from week 35/0 in case of PR, provided the Bishop score is greater than 7. If the bishop score is lower, they conduct intracervical priming of the cervix with 0.4 mg PGE2 gel before induction of labour. This has proved clinically superior to intravenous procedures. In the study presented here, the authors attempted to find out whether intracervical administration of PGE2 gel would result in changes in the maternal and foetal plasma concentrations of oxytocin, PGFM, or PGEM when comparing conditions in case of ruptured amnion with those if the amnion remained intact. If the amnion is intact and the cervix immature (less than 2 cm), intracervical administration of 0.4 mg PGE2 gel produces a significant OT increase within 30 minutes. From a cervical width of 2 cm onwards, the OT levels are already primarily enhanced and will hardly change even after PGE2 gel administration. Similar conditions obtain in PR. PGFM plasma levels will rise only slightly within an hour after intracervical PGE2 gel administration, independent of whether there has been a rupture or not, or whether the cervix is dilated less than 2 cm or 2 cm and more.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of intracervical PGE 2-gel on myometrial activity and cervical state in first trimester pregnancy

In 7 primigravidae admitted for first trimester abortions by dilatation and evacuation, 0.5 mg PGE 2 in viscous gel (5 patients) or placebo gel (2 patients) was applied intracervically 6 hours prior to the operation. Throughout the treatment period intrauterine pressure was recorded. Application of placebo gel induced no cervical ripening or myometrical activation. In all patients receiving active gel, a marked improvement of the cervical state was induced by the treatment. In three cases, this priming occurred in parallel to minimal changes in myometrial activity, without regular uterine contractions. In two patients, marked uterine activation was registered due to partly extraamniotic application. It is suggested, that the PGE 2-gel has a direct effect on the cervical tissues. Further, the risk of partially applying the gel in the extraamniotuc space, thus stimulating the myometrium, depends on the gel volume relative to the dimensions of the cervical canal and the application technique.

Evidence for a local effect of intracervical prostaglandin E2-gel

Eight primigravid women with a mean gestational age of 9.4 weeks (9 to 10 weeks) who were admitted for first-trimester abortion by dilatation and evacuation were preoparatively treated for 6 hours with either intravenous infusion of oxytocin or a strictly intracervical application of prostaglandin E2 (PGE2) in viscous gel. Myometrial activity was monitored by intrauterine pressure recording throughout the treatment. Contractile activity was more pronounced in the oxytocin-treated group. whereas cervical priming occurred after the PGE2 treatment only. Intracervical PGE2-gel is suggested to have direct effects on the cervical tissues, independent of uterine contractile activity. Furthermore, myometrial stimulation induced by escape of gel into the extra-amniotic space can be avoided by adjusting the volume of gel and the technique of application to the dimensions of the cervix.