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Related Experiment Videos

Failed induction of labor despite sequential prostaglandin E2 therapy.

P T Karaiskakis1, W F Rayburn, C V Smith

  • 1Department of Obstetrics and Gynecology, University of Nebraska Medical Center, Omaha 68105.

American Journal of Perinatology
|March 1, 1991
PubMed
Summary

Preinduction cervical ripening with prostaglandin E2 (PGE2) can fail, especially with unfavorable cervices. In such cases, cesarean delivery may be better than prolonged labor induction.

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Area of Science:

  • Obstetrics and Gynecology
  • Maternal-Fetal Medicine

Background:

  • Preinduction cervical ripening with prostaglandin E2 (PGE2) is a common practice to reduce failed labor induction.
  • However, insufficient cervical dilation can still occur despite PGE2 and oxytocin therapy.

Purpose of the Study:

  • To investigate the reasons for failed labor induction in pregnancies with unfavorable cervices (pre-induction Bishop score ≤4) requiring delivery within 24 hours.
  • To identify factors associated with induction failure despite PGE2 treatment.

Main Methods:

  • Retrospective analysis of 124 pregnancies undergoing preinduction cervical ripening with PGE2.
  • Patients had pre-induction Bishop scores of 4 or lower and required delivery within 24 hours.
  • Two 2.5 mg intravaginal doses of PGE2 were administered.

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Main Results:

  • Fifteen patients (12.1%) experienced failed inductions despite PGE2 therapy.
  • All failures were associated with a very unfavorable cervix (pre-induction Bishop score 0-2).
  • Preterm delivery (33-37 weeks) was frequently observed in cases with unfavorable cervices.

Conclusions:

  • Pregnancies requiring urgent delivery with a very unfavorable cervix that do not respond to sequential PGE2 therapy may be candidates for cesarean section.
  • Avoiding prolonged induction attempts in these specific cases could be beneficial.
  • Cesarean delivery might offer a more efficient route to delivery when cervical ripening fails in complicated pregnancies.