Prostaglandin E2 gel versus misoprostol for cervical ripening in patients with premature rupture of membranes after 34 weeks

OBJECTIVE: To compare intravaginal misoprostol to prostaglandin (PG) E-2 for cervical ripening in women with premature rapture of the membranes (PROM) after 34 weeks of gestation. METHODS: Women with PROM after 34 weeks of gestation and an unripe cervix were randomized to receive PGE(2) (2.5 mg) or misoprostol (50 mug). Both agents were placed intravaginally immediately after randomization, and the dose was repeated 6 hours later if necessary. After another 6 hours from the second insertion, oxytocin treatment was started if labor had not begun. Forty patients in each group were required to show a 30% improvement in delivery within 12 hours in the misoprostol group. RESULTS: One hundred nine patients were randomized; 54 were assigned to misoprostol and 55 to PGE(2). Important demographic and clinical characteristics were similar between the groups. The mean time from first insertion to delivery was 16.4 hours in the misoprostol group and 22.0 hours in the PGE(2) group. A second dose was required less frequently in the misoprostol group (22% vs 62% in the PGE(2) group), and the percentage of patients delivered within 12 hours was higher in the misoprostol group (41% vs 16%). Tachysystole occurred in 20% and 6% of women in the misoprostol and PGE(2) groups, respectively. Hyperstimulation occurred in 9% and 0%, and cesarean delivery in 19% and 26% of women in the misoprostol and PGE(2) groups, respectively. Neonatal outcome was similar between groups. CONCLUSION: Intravaginal misoprostol is more effective than local PGE(2) application to treat PROM after 34 weeks of gestation, but tachysystole occurs more commonly with misoprostol. (C) 2002 by the American College of Obstetricians and Gynecologists.