Serial intravaginal prostaglandin E2 gel cervical ripening in preterm pregnancies

To determine if prostaglandin (PG) E2 cervical ripening is safe and effective in high-risk preterm pregnant women who do not have an indication for immediate delivery.

This was a retrospective case-control study of preterm pregnant women treated with sequential PGE2 gel between 3/1/92 and 3/1/95. Study subjects were between 24 and 36 weeks gestation, had intact membranes, and complications requiring inpatient monitoring but not immediate delivery. PGE2 gel was inserted serially until either maternal or fetal deterioration required intervention, fetal maturity was achieved, a Bishop > or = 7 was reached, or the patient improved and was discharged. Control subjects were matched for inclusion criteria and diagnoses on admission.

A total of 22 study and 22 control patients were evaluated. The gestational age at admission was 32.3 +/- 2.8 versus 31.8 +/- 2.9 weeks. The mean number of PGE2 gel applications was 11.6 over a mean of 5.0 days. Intervention during ripening was required in 11 (50%). A Bishop score > or = 7 without labor was achieved in 11 (50%), and labor during the ripening process occurred in 2 (9%). The mean time from Bishop > or = 7 to delivery was 2.6 days. The total cesarean delivery rate was 10 (45%) versus 15 (68%), in the control group (P = NS). Neonatal outcomes were similar.

Sequential PGE2 gel cervical ripening when used in preterm pregnant women improves the Bishop score, and has a low incidence of spontaneous preterm labor.