Randomized comparison of the effects of the endocervical and the vaginal prostaglandinE2 in women with various degrees of cervical ripeness

Sang, Mi Ran; Kwon, Yong Il; Park, Tae Chul; Kwon, Dong Jin; Lee, Yong Suk; Bae, Tae Wook; Lee, Jin Woo; Kim, Su Pyung

Abstract

OBJECTIVES
The trial was performed to obtain an unbiased comparison of the relative merits of endocervical and vaginal prostaglandin E2(PGE2) in the case of parous and nulliparous woman with favorable and unfavorable cervical features. This study was performed to determine the clinical usefullness of endocervical PGE2 comparing with the vaginal PGE2 in cervical ripening and induction of labor. METHOD: The randomized trial with 65 Participants was performed with sealed envelopes for parity and Bishop score (from March to september, 1998). PGE2 tablet(3mg Dinoprostone) was administrated intravaginally to the 32 pregnant women and endocervically to the 33 pregnant women every eight hours with maximum three times until the regular labor develped. RESULT: Outcomes of labor and delivery were clearly related to cervical score at trial entry. endocerval PGE2 had a more marked effect on cervical ripeness than did vaginal PGE2. There were no significant differences on age distribution, gestatioanal period, primiparity, cervical status, initial B-score in each group. There were no significant differences in cesarian section rate, fetal distress, uterine hyperstimulation, side effect and poor infant outcome between the groups The mean induction time was statistically shorter in cervical group with multiparous women than other group(p=0.0195). In the induction-active labor time, cervical with primi group was statistically shorter than other group(p=0.0245). Statistically significant differences were noted between the nulliparous woman and multiparous women in mean induction time, induction-active labor time, time to B-score 8. In the factor that effects induction-active labor, route was significantly better than other factor.(p=0.0001) CONCLUSION: edocervical PGE2 is more effctive than vaginal PGE2 in cervical ripening and induction of active labor. the endocervical PGE2 resulted in a significantly shorter induction to active labor time compared with vaginal PGE2 and has almost no side effect. Because differences in effectiveness between endocervical and vaginal PGE2 are marginal, preference of woman and clinicians can the choice between them.