Prostaglandin: cervical ripening in hypertensive pregnancies

To determine the outcome of cervical ripening with intracervical prostaglandin E2 (PEG2) in hypertensive and non-hypertensive high-risk pregnancies in terms of successful ripening, mode of delivery, time intercorring between ripening and the beginning of labor or parturition and, at least, duration of labor.

A total of 63 women with a diagnosis of hypertensive disorders were included in the study protocol. These 63 women were compared with 71 consecutive high-risk pregnancies requiring induction of labor for maternal and/or fetal indications. Cervical ripening was performed with single or multiple doses of 0.5 mg of intracervical PGE2 gel.

The rate of successful ripening was 84% for non-hypertensive patients (60/71) and 69% (43/63) for hypertensive patients ( p < 0.03). Twenty-four out of 63 hypertensive patients (38%) and 21 out of 71 non-hypertensive patients (30%) ( p < 0.05) were delivered by cesarean section. After stratification of hypertensive patients, the time interval from the first PGE2 administration to the onset of labor or vaginal delivery was significantly longer for preeclamptic patients vs. non-hypertensive patients or non-preeclamptic hypertensive patients. There were no differences in the duration of labor.

Among hypertensive patients, only preeclamptic patients showed a lower rate of successful ripening and vaginal delivery if compared with non-preeclamptic or non-hypertensive patients; however, a vaginal delivery might be obtained in most preeclamptic patients when suitable cervical ripening was performed in the presence of clinician-perceived urgency to delivery.