[Labor induction with prostaglandin E2 in post-term pregnancy-- results of a multicenter study]

Post-term pregnancy has been the indication for induction of delivery in 542 patients from a multicenter study with 1472 patients undergoing induction with prostaglandin E2 given as vaginal tablet (3 mg) or as intracervical gel (0.5 mg), according to cervical ripeness. The obstetric characteristics of these 542 patients were compared to the data of the Baden-Wuerttemberg obstetrical trial as controls. Although cervical ripeness parameters differed significantly from those of the controls, birth intervals were significantly shorter in the study group. Fetal outcome parameters (umbilical artery pH, Apgar values, frequency of admission to pediatric ward) turned out to be more favorable in the study group. Frequency of operative vaginal deliveries (12.7%) and of Cesarean sections (15.5%) was significantly higher in the study group as compared to the reference group (operative vaginal deliveries 8.1%, secondary Cesarean sections 7.3%). If we relate these frequencies to data from prospective, randomized studies comparing active management of post-term pregnancies, it can be demonstrated that active management in general is associated with lower frequencies of operative deliveries. Additionally, the data from our study with active management of post-term pregnancy revealed even lower frequencies for operative deliveries as seen from actively managed post-term deliveries in the literature reviewed. Hence, the induction protocol adapted to cervical ripeness reported in this study is an efficient and safe management for post-term pregnancy minimizing the rate of operative deliveries.