Randomized comparison of the effects of endocervical and vaginal prostaglandin E(2) gel in women with various degrees of cervical ripeness

OBJECTIVE: The trial was conducted to obtain an unbiased comparison of the relative merits of endocervical and vaginal prostaglandin E(2) gel in a weighted case mix of parous and nulliparous women with favorable and unfavorable cervical features. STUDY DESIGN: Multicenter ranodmized trial with 285 participants, (three exclusions) was performed with sealed envelopes stratified for parity and Bishop score. RESULTS: Outcomes of labor and delivery were clearly related to the cervical score at trial entry, especially in nulliparous women. Endocervical prostaglandin E(2) had a more marked effect on cervical ripeness than did vaginal prostaglandin E(2), but this did not result in any differences in more substantive outcomes. Frequencies of delivery within 12 (50%) and 24 hours (77.7%), cesarean section (7.3%), instrumental vaginal delivery (11.7%), and poor infant outcomes were similar with both preparations. CONCLUSION: Because differences in effectiveness between endocervical and vaginal prostaglandin E(2) in triacetin gel are marginal, preferences of women and clinicians can determine the choice between them.