Cervical ripening. A retrospective experience with prostaglandin E2 "chips"

To improve the unfavorable cervix we instituted a policy of cervical ripening with "chips" of prostaglandin E2 suppositories. A standard, 20-mg suppository was cut into six equal parts, and one of the chips was inserted just inside the vaginal introitus every four to six hours. Repeat doses were utilized if no cervical change was evident and uterine activity was minimal. All the patients underwent continuous monitoring in the labor-and-delivery unit. Fifty patients with Bishop's scores of less than 4 underwent cervical ripening for a variety of obstetric indications. Forty-two patients (84%) achieved vaginal delivery. Three patients underwent cesarean delivery for fetal distress unrelated to hyperstimulation. Two additional patients experienced hyperstimulation; one of them required subcutaneous terbutaline. No other neonatal or maternal complications were encountered. Cervical ripening with prostaglandin chips may be a reasonable clinical alternative when one is faced with an obstetric indication for delivery in a patient with an unfavorable cervix.