Effectiveness of Oral PGE1 versus Intracervical PGE2 in Induction of Labor



Background: Induction of labor is a common obstetric intervention used to initiate or augment
labor in pregnant women for various indications. Two commonly used agents for induction of
labor are oral prostaglandin E1 (PGE1) and intracervical prostaglandin E2 (PGE2). Both have
been shown to be effective in inducing labor, however, there are some differences in their use,
efficacy, and safety profiles.
Objective: To determine the effectiveness of oral PGE1 versus intracervical PGE2 in terms of
induction of labor, mode of delivery and feto-maternal outcomes.
Subjects and Methods
Setting: Department of gynecology and obstetrics of Bahawal Victoria Hospital, Bahawalpur
Study design: Comparative study
Duration of study: Six months from April 2022 to September 2022
Inclusion criteria: All the pregnant women at or beyond 37 weeks of gestation, with a singleton
pregnancy and a live fetus, clinically favorable cervix, determined by Bishop score of 6 or less,
who are not currently in active labor, and have not received any other cervical ripening or
induction agents in the 24 hours prior to study enrollment and who are able to attend the hospital
for follow-up and monitoring during the induction process were included.
Methods: After taking informed consent, all the study subjects as per the randomization were
divided into two groups: one group receiving oral PGE1 and the other group receiving
intracervical PGE2. Administration of the allocated induction agent according to a pre-
determined protocol, as 25-mcg oral misoprostol every 4-hourly interval or 3 applications of
intracervical PGE2 at a 6-hour interval for effective cervical ripening. Oxytocin augmentation
was used once the cervical ripening was successful. Outcomes was evaluated in terms of time to
onset of active labor, duration of labor, mode of delivery and feto-maternal complications. All
the information was collected via study proforma and SPSS version 26 was used for the data
Results: A total of 80 women were comparatively studied; their overall mean age was
31.23+4.22 years and mean gestational age was 38.12+1.33 weeks. Average time duration
cervical ripening interval was 8.11±2.51 hours in oral PGE1 group and 9.32±3.44 hours in
intracervical PGE2 group (>0.05). However average duration of interval was statistically
insignificant according to parity and maternal complications (p=.0.05).
Conclusion: Both oral PGE1 and intracervical PGE2 are effective in inducing labor, with
similar success rates and similar maternal and fetal outcomes. However, oral PGE1 appears to
have a faster onset of action and a shorter duration of labor compared to intracervical PGE2.
Additionally, oral PGE1 is associated with a lower risk of hyperstimulation of the uterus and a
lower risk of fetal distress compared to intracervical PGE2. Although oral PGE1 to be associated

with a higher incidence of maternal side effects such as nausea, vomiting, and diarrhea, which
can be a concern for some women.
Key words: Induction of labour, prostaglandin, cervical ripening, complications

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