Clinical amnionitis and endometritis in patients with premature rupture of membranes: Endocervical prostaglandin E(2) gel versus oxytocin for induction of labor

Objective: To compare the rates of clinical amnionitis and endometritis in patients with premature rupture of membranes (FROM), using endocervical prostaglandin E(2) (PGE(2)) gel for induction of labor versus immediate oxytocin induction of labor, Methods: We randomized 118 patients to receive either endocervical 0.5 mg of PGE(2) gel (study group) or immediate oxytocin induction of labor (control group). If labor was not established in the group receiving PGE(2) gel in 24 hours, intravenous oxytocin was given in incremental doses. The rates of clinical amnionitis and endometritis in the two groups were analyzed. also compared were hours of labor, duration of rupture of membranes and number of vaginal examinations. Student t test, chi(2) or Wilcoxon rank-sum test were used for statistical analysis, as appropriate. P < .05 was considered significant. Results: The rates of clinical amnionitis were 5.3% in the PGE(2) group and 8% in the control group. Endometritis developed in 1.7% of PGE(2) patients and 3.2% of controls, These differences in maternal infection rates were not statistically significant. The two groups were comparable with respect to age, parity, and antepartum group B streptococcal colonization. No significant differences in hours of labor, duration of ruptured membranes, or vaginal examinations were observed. Neonatal outcome data (mean birth weight, Apgar scores at 1 and 5 minutes, apgar score less than 7 at 5 minutes) were not statistically significant. Conclusion: Endocervical placement of 0.5 mg of PGE(2) gel does not increase the incidence of clinical amnionitis and endometritis in patients with PROM at term when compared with immediate induction of labor with oxytocin.