Randomized comparison of vaginal prostaglandin E2 pessary with vaginal prostaglandin E2 tablet for the induction of labor

Kim, Sun Kwon; Na, Sung Hun; Oh, Jee Young; Jung, Eui; Shim, Jae Yoon; Won, Hye Sung; Lee, Pil Ryang; Kim, Ahm

Abstract

OBJECTIVE
To compare the efficacy and the safety of two standardized preparations of vaginal prostaglandin E2 pessary (PGE2 pessary) and vaginal prostaglandin E2 tablet (PGE2 tablet) for the induction of labor.
METHODS
Pregnant women who were hospitalized for the induction of labor from December 2002 to June 2004 at the Asan Medical Center were included for the prospective randomized study. Subjects were randomly assigned to receive PGE2 pessary or PGE2 tablet as a cervical ripening agent. A successful outcome was defined as a change in Bishop score of >or=3, Bishop score of >or=6 at 12 hours, or vaginal delivery after the insert placement.
RESULTS
One hundred ninety-seven women (PGE2 pessary, 99 women; PGE2 tablet, 98 women) completed the protocol. There were no statistically significant differences between the two groups in terms of a successful outcome (85.9% vs 84.7%; p=0.952) and the following mean times: (1) time to active labor (851 vs 751 minutes; p=0.207), (2) time to vaginal delivery (1024 vs 873 minutes; p=0.091). However, in parous women the labor time interval was shorter in PGE2 tablet group. In addition, no differences were observed in the incidences of cesarean delivery, hyperstimulation syndrome, abnormal fetal heart rate patterns, and adverse neonatal outcomes.
CONCLUSION
Both PGE2 preparations were equally effective in achieving cervical ripening, initiating labor, and achieving a successful vaginal delivery. However, the vaginal PGE2 pessary may offer the advantage of prompt removal when it is required.