Prostaglandin vaginal gel induction of labor comparing amniotomy with repeat prostaglandin gel

Beckmann, Michael, Kumar, Sailesh, Flenady, Vicki and Harker, Ellen (2015) Prostaglandin vaginal gel induction of labor comparing amniotomy with repeat prostaglandin gel. American Journal of Obstetrics and Gynecology, 213 6: 859.e1-859.e9. doi:10.1016/j.ajog.2015.07.043

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Author Beckmann, Michael
Kumar, Sailesh
Flenady, Vicki
Harker, Ellen
Title Prostaglandin vaginal gel induction of labor comparing amniotomy with repeat prostaglandin gel
Journal name American Journal of Obstetrics and Gynecology   Check publisher's open access policy
ISSN 0002-9378
Publication date 2015-12-01
Year available 2015
Sub-type Article (original research)
DOI 10.1016/j.ajog.2015.07.043
Open Access Status File (Author Post-print)
Volume 213
Issue 6
Start page 859.e1
End page 859.e9
Total pages 9
Place of publication Philadelphia, PA United States
Publisher Mosby
Language eng
Formatted abstract

The purpose of this study was to compare 2 inductions of labor protocols.

Study Design

Women with live singleton pregnancies at ≥37 + 0 weeks gestation who were booked for prostaglandins 2 (PGE2) vaginal gel induction with a modified Bishop’s score of <7 were eligible for inclusion. After an evening dose of PGE2 vaginal gel, women were assigned randomly the next morning into the amniotomy or repeat-PGE2 group. The amniotomy group underwent artificial rupture of membranes (ARM), regardless of modified Bishop’s score, and received further PGE2 doses only if ARM was not technically possible. The repeat-PGE2 group received further PGE2 (to a maximum of 3 doses) until a modified Bishop’s score ≥7 occurred, when an ARM was performed. In both groups, Syntocinon was commenced once membranes were ruptured. The primary outcome measure was time from commencement of induction until birth.


Two hundred forty-five women were assigned randomly into either the amniotomy (n = 121) or repeat-PGE2 group (n = 124). The time for induction of labor–to-birth was >5 hours shorter in the amniotomy group (24.8 vs 30.0 hours; mean difference, 5.2 h; 95% confidence interval, –2.5 to –7.8). Fewer women in the amniotomy group remained undelivered after 24 hours (47.1% vs 67.7%; P < .01). However, the likelihood of an in-hours birth and the length of hospital stay were no different between the groups. There was no difference in the mode of birth or any of the secondary outcomes.


After an initial dose of PGE2 vaginal gel, an amniotomy (once technically possible) is associated with a shorter induction of labor–to-birth time compared with the use of repeat doses of PGE2. Administering more PGE2 with the aim of starting contractions or making the cervix “more favorable,” appears to have no clinical advantage.
Keyword Cervical ripening
Induced labor
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Mater Research Institute-UQ (MRI-UQ)
Official 2016 Collection
School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 5 times in Thomson Reuters Web of Science Article | Citations
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