A Study on Pre-Induction Cervical Ripening with PGE2 Vaginal Tablet One (3 mg) vs. Half (1.5 mg) in Low Risk Multi Parous Mothers at 40 Weeks of Gestation

Backgrounds: Induction of labor is a common practice. In women with immature cervix, PGE2 is commonly used for pre-induction. We hypothesized that PGE2 1.5 mg may be equally effective to PGE2 3 mg in multiparous women for labor induction. The present effort was an attempt to compare the efficacy and effects of pre-induction cervical ripening with PGE2 3 mg vs. 1.5 mg in multi-parous mothers (2nd and 3rd Pregnancy) at 40 weeks. Methods: A double-blind randomized controlled trial was carried out at Castle Street Hospital for Women, Colombo, Sri Lanka. Study subjects consisted of women with singleton pregnancy (no cesarean history) admitted for delivery at 40 weeks of their 2nd or 3rd pregnancy. PGE2 1.5 mg vs. 3 mg PGE2 vaginal tablet were used for treatment (n = 173) and control (n = 170) groups, respectively. Cervical ripening and maternal, fetal complications were observed. Unfavorable cervices were induced with the same PGE2 dose in the following day. Results: Study group, compared with the control group, achieved the same rate of favorable cervices in 1st and 2nd cycles (63.5% vs. 64%, respectively). Both groups showed the same rate of cervical dilatation achievement, and admissions to Special Care Baby Unit. Study group showed significantly less maternal complications (4% and 11%, respectively: p = 0.01). Conclusion: PGE2 of 1.5 mg is equally effective in achieving favorable cervices, adequate cervical dilatation with minimum maternal complications compared to the usual 3 mg dose in multiparous low-risk women.