Intracervical prostaglandin E2 gel for cervical ripening

Forty-five women with an unfavourable cervix (cervical score less than 3) and an obstetric indication for delivery were given intracervical prostaglandin E2 (PGE2) gel 0.5 mg/3 g to prime the uterine cervix. Twenty-one women (47%) went into labour after PGE2 gel application only. In 13 women (29%) the cervical score sufficiently improved within 12 hours and labour was successfully induced with intravenous oxytocin. The rate of adverse effects was notably: there were two uterine ruptures, the rate of cesarean sections was 33%, hypertonic uterine contractility 25%, premature rupture of membranes 16%, and neonatal asphyxia 21%. In our experience, cervical ripening with PGE2 gel, although efficient, may also bring about complications, which appear partly iatrogenic. Therefore, a critical evaluation of indications and the risk/benefit ratio is required.