Failed induction of labor despite sequential prostaglandin E2 therapy

Preinduction cervical ripening with prostaglandin E2 (PGE2) is useful in minimizing the chances for a failed induction of labor. The lack of sufficient cervical dilation despite PGE2 and oxytocin therapy is uncommon. This investigation was undertaken to determine reasons for any failed inductions in pregnancies with pregel Bishop scores 4 or lower and requiring delivery within 24 hours. Fifteen (12.1%) of 124 eligible patients had failed inductions despite two 2.5 mg intravaginal doses. A finding in all the failures was a very unfavorable cervix (pregel Bishop score 0 to 2). The need for preterm delivery (33 to 37 weeks) was a common finding in the presence of a very unfavorable cervix. The data suggest that complicated pregnancies requiring delivery within 24 hours and failing to respond to sequential PGE2 therapy in the presence of a very unfavorable cervix may benefit from cesarean section without a prolonged induction.