Effectiveness of prostaglandin E2 intracervical gel (Prepidil), with immediate oxytocin, versus vaginal insert (Cervidil) for induction of labor, , ,

Objective: Our purpose was to compare the effectiveness of labor induction with use of prostaglandin E2 either as an intracervical gel (Prepidil), with immediate oxytocin, or as a sustained-release vaginal insert (Cervidil) with subsequent oxytocin as needed. Study Design: Hospitalized patients at ≥37 weeks’ gestation requiring labor induction and having an unfavorable cervix (Bishop score ≤6) were randomly assigned to receive either Prepidil or Cervidil. Oxytocin was begun immediately after Prepidil placement or 30 minutes after removal of the Cervidil insert if needed. Results: Of the 150 patients, there were no differences in demographics and eventual pregnancy outcomes between the Prepidil group (n = 77) and the Cervidil group (n = 73). Those pregnancies receiving the Prepidil–immediate oxytocin regimen were delivered sooner than those receiving the Cervidil among nulliparous (11.3 ± 7.3 hours vs 25.2 ± 12.5 hours, P< .001) and multiparous (8.4 ± 7.8 hours vs 18.4 ± 7.2 hours, P< .001) women. The mean cost savings, which favored the Prepidil–immediate oxytocin regimen, was $458 (range $204 to $630) per patient. Conclusion: Compared with Cervidil, the Prepidil–immediate oxytocin regimen resulted in a shorter induction-to-vaginal delivery interval and in more hospital cost savings without increasing adverse outcomes. (Am J Obstet Gynecol 1998;179:1175-80.)