British Journal of Obstetrics and Gynaecology March 1979. Vol. 86. pp 167-170
A COMPARISON OF PGE, AND PGF,, VAGINAL GEL FOR RIPENING THE CERVIX BEFORE INDUCTION OF LABOUR BY
I. Z . MACKENZIE, Clinical Lecturer AND
.M. P. EMBREY, Clinical Reader Nufield Department of Obstetrics and Gynaecology University of Oxford, John Radclire Hospital, Headington, Oxford
Summary The efficacy of a vaginal gel containing either 5 mg prostaglandin E, (PGE,) or 25 mg prostaglandin F,, (PGF,,) to ripen the unfavourable cervix for labour induction was assessed in a double blind trial. PGF,,, compared with PGE,, had little effect upon the clinical state of the cervix, but the resultant duration of labour in each of the two groups was shorter than in a control group. While the numbers of patients requiring oxytocin stimulation of labour and regional analgesia were reduced in both groups compared with the controls, PGF,, was much less effective than PGE,. Uterine hypertonus was observed using both prostaglandins during an experimental study and the implications are discussed. VIRTUALLY all the published work on the use of prostaglandins for cervical ripening prior to induction of labour in the human has involved the administration of prostaglandin E, (Calder et al, 1977; Thiery et al, 1977; Shepherd et al, 1976; MacKenzie and Embrey,. 1977). By contrast, in most of the similar animal studies prostaglandin F,, has been used (Fitzpatrick, 1977; Liggins et al, 1977). Although almost all the published results indicate that prostaglandin E, (PGE,) is efficient for the purpose of ripening the cervix, it seemed prudent to examine the comparative value of prostaglandin F,, (PGF,,) in this respect.
with single fetuses in cephalic presentations at gestations ranging from 37 to 43 weeks. Preparation of the prostaglandin gel has been described (MacKenzie and Embrey, 1977). In each instance, 10 ml of a 5 per cent solution of methyl hydroxy ethyl cellulose (Tylose MH 300: Hoechst) gel was used containing either 5 mg PGE, (Prostin E,: Upjohn) or 25 mg PGF2G( (Dinaprost F,,: Upjohn). Before the comparative trial, the effect of PGE, and PGF,, on uterine activity was studied by intrauterine pressure monitoring using a transcervical extra-amniotic catheter system connected to a strain gauge pressure transducer and a hot wire pen recorder (Hewlett-Packard 2703A); fetal heart rate was continuously recorded using an external ultrasound head. A number of patients in the trial were monitored by external tocographic methods. Subsequently a total of 48 patients were randomly allocated to treatment with gel
PATIENTS AND METHODS All patients studied had medical or obstetric indications for labour induction and gave informed consent. Each had unfavourable induction prospects as designated by a modified Bishop score of 0 to 3. All were primigravidae 167
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MACKENZIE AND EMBREY
containing either PGE2, or PGF,, or gel alone and the study was double blind. Cervical assessment and vaginal treatment were done by the same person between 1600 and 1900 hours in the evening before planned induction of labour. Fetal and maternal observations were made over the subsequent four to five hours. On the following morning, those patients who were not in labour had an amniotomy and started an intravenous infusion of oxytocin at 0830 to 0930 hours. Subsequent labour was managed by the duty obstetric staff.
RESULTS Table I summarizes results in the two treatment groups and the control group. In each of the three groups, the cervical score had significantly improved when assessed the following morning (p
A COMPARISON OF PGE, AND PGF,, VAGINAL GEL FOR RIPENING THE CERVIX BEFORE INDUCTION OF LABOUR BY
I. Z . MACKENZIE, Clinical Lecturer AND
.M. P. EMBREY, Clinical Reader Nufield Department of Obstetrics and Gynaecology University of Oxford, John Radclire Hospital, Headington, Oxford
Summary The efficacy of a vaginal gel containing either 5 mg prostaglandin E, (PGE,) or 25 mg prostaglandin F,, (PGF,,) to ripen the unfavourable cervix for labour induction was assessed in a double blind trial. PGF,,, compared with PGE,, had little effect upon the clinical state of the cervix, but the resultant duration of labour in each of the two groups was shorter than in a control group. While the numbers of patients requiring oxytocin stimulation of labour and regional analgesia were reduced in both groups compared with the controls, PGF,, was much less effective than PGE,. Uterine hypertonus was observed using both prostaglandins during an experimental study and the implications are discussed. VIRTUALLY all the published work on the use of prostaglandins for cervical ripening prior to induction of labour in the human has involved the administration of prostaglandin E, (Calder et al, 1977; Thiery et al, 1977; Shepherd et al, 1976; MacKenzie and Embrey,. 1977). By contrast, in most of the similar animal studies prostaglandin F,, has been used (Fitzpatrick, 1977; Liggins et al, 1977). Although almost all the published results indicate that prostaglandin E, (PGE,) is efficient for the purpose of ripening the cervix, it seemed prudent to examine the comparative value of prostaglandin F,, (PGF,,) in this respect.
with single fetuses in cephalic presentations at gestations ranging from 37 to 43 weeks. Preparation of the prostaglandin gel has been described (MacKenzie and Embrey, 1977). In each instance, 10 ml of a 5 per cent solution of methyl hydroxy ethyl cellulose (Tylose MH 300: Hoechst) gel was used containing either 5 mg PGE, (Prostin E,: Upjohn) or 25 mg PGF2G( (Dinaprost F,,: Upjohn). Before the comparative trial, the effect of PGE, and PGF,, on uterine activity was studied by intrauterine pressure monitoring using a transcervical extra-amniotic catheter system connected to a strain gauge pressure transducer and a hot wire pen recorder (Hewlett-Packard 2703A); fetal heart rate was continuously recorded using an external ultrasound head. A number of patients in the trial were monitored by external tocographic methods. Subsequently a total of 48 patients were randomly allocated to treatment with gel
PATIENTS AND METHODS All patients studied had medical or obstetric indications for labour induction and gave informed consent. Each had unfavourable induction prospects as designated by a modified Bishop score of 0 to 3. All were primigravidae 167
168
MACKENZIE AND EMBREY
containing either PGE2, or PGF,, or gel alone and the study was double blind. Cervical assessment and vaginal treatment were done by the same person between 1600 and 1900 hours in the evening before planned induction of labour. Fetal and maternal observations were made over the subsequent four to five hours. On the following morning, those patients who were not in labour had an amniotomy and started an intravenous infusion of oxytocin at 0830 to 0930 hours. Subsequent labour was managed by the duty obstetric staff.
RESULTS Table I summarizes results in the two treatment groups and the control group. In each of the three groups, the cervical score had significantly improved when assessed the following morning (p
