OUTPATIENT CERVICAL RIPENING

A limited number of studies have provided preliminary data on the efficacy and safety of PGE2 used as an outpatient cervical ripening agent. Multiple inpatient studies have confirmed the effect of PGE2 in favorably changing the cervical score, reducing the incidence of failed inductions and instrumental deliveries, shortening the induction-to-delivery interval, and reducing oxytocin use with few maternal side effects and no known adverse effects on neonatal outcome. These studies, however, are difficult to compare because of differences in study design, PGE2 formulation, patient selection (including differences in cervical scoring criteria), indications for labor induction, placement of the PGE2 agent, and outcome variables, and they certainly cannot be extrapolated to outpatient use. Intracervically applied Prepidil is the only form of PGE2 approved by the Food and Drug Administration available for cervical ripening. The commercial production of an intravaginal form of PGE2, which would require less effort and expertise in administration and greater patient comfort, may warrant exploration. In an environment of increasing pressures for cost containment, the convenience and cost-effectiveness of outpatient cervical ripening provides a stimulus for further controlled studies in this area to delineate an effective and safe dose and vehicle for widespread application.