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Objective: The aim of study was to compare the effect of intracervical prostaglandin E2 (dinoprostone) gel and intravaginal prostaglandin E2 (dinoprostone) pessary on ripening of cervix and induction of labor along with their effect on fetal heart rate and caesarian delivery rate.
Study Design: A randomized controlled clinical trial conducted in the Department of Obstetrics and Gynaecology, Hussain Memorial Hospital, Multan Road Lahore.
Methodology: One hundred and forty two patients who needed induction of labour and fulfilling the inclusion criteria were assigned randomly to one of two groups. Group A, was induced intravaginally with prostaglandin E2 pessary 3 mg (n=71). Group B, was induced intravaginally with prostaglandin E2 gel 0.5 mg (n=71). On the basis of bishop scores, the pessary or gel was reapplied at six hours interval for a maximum of two doses. Labour was augmented with oxytocin in selected cases who failed to undergo labour.
Results: Average age of the patients was 28.5 years (19-38 years). Maximum number of patients who were included in both groups was primigravidas. Most common indication for induction of labour was pregnancy induced hypertension/preeclampsia and postdates pregnancy. There was greater change in Bishop score with prostaglandin E2 gel (Group B) but no significant difference in induction delivery interval (P value=0.513) and oxytocin required for augmentation in both groups. 80.28% patients delivered in <24 hours in both groups. The caesarian delivery rate in the two groups was 33.80% and 42.25% respectively. Most common indications for caesarian section were fetal distress and failure of induction. Mean apgar score at 5 minute was 7.03 + 1.42 in group A and 7.00 + 2.27 in group B that was not significant (P value=0.929) statistically. Fetal bradycardia, nausea, vomiting, and diarrhea were more in group A as compared to group B. While two patients in group B had uterine hyper stimulation.
Conclusion: Prostaglandin E2 endocrvical gel is more effective in achieving cervical ripening however induction to delivery interval, oxytocin requirement and apgar score are similar with these two agents. The overall cost of dinoprostone gel is more. So there is no extra advantage of using gel over pessary.
Syeda Shaista Waheed, M. Naeem Dilawar Kazmi, Tahir Siddiqui. (2016) A Randomized Controlled Clinical Trial to Compare The Effect of Intracervical Prostaglandin E2 (Dinoprostone) Gel and Intravaginal Prostaglandin E2 (Dinoprostone) Pessary on Ripening of Cervix and Induction of Labour, Journal of the Society of Obstetrics and Gynaecologists of Pakistan , Volume-06, Issue-4.
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