Ripening of the unfavourable cervix with prostaglandin E<inf>2</inf>: Intracervical versus intravaginal route

Abstract

Forty-eight term primiparae women with unripe cervix (Bishop score of 4 or less) were randomly given either 1.5 mg of prostaglandin E2 in 3 ml of gel intracervically or 3 mg prostaglandin E2 tablet intravaginally to ripen the cervix. Intracervical administration caused favorable cervix in 36 per cent compared with 12 per cent in the intravaginal group, and induced spontaneous labor in 41 per cent compared with 69 per cent in the intravaginal group. Oxytocin augmentation was required in 88 per cent in the intracervical group compared to 62 per cent in the intravaginal group. The only significant difference statistically was the mean duration of the insertion of PGE2 to delivery being 16 hours and 23.5 hours in the intracervical and intravaginal routes respectively (P = 0.02). There was one case of hyperstimulation and one case of maternal death from amniotic fluid embolism in this study.