Inducing labor with a sustained-release PGE2 vaginal insert. Experience at a community hospital.

OBJECTIVE

To determine the safety of initiating labor using a sustained-release prostaglandin E2 (PGE2) vaginal insert at a nonuniversity-based community hospital.

STUDY

DESIGN

Data were compiled from a chart review of all cases in which the insert (Cervidil) was used during a 16-month period. Continuous uterine activity and fetal heart rate (FHR) tracings were evaluated for 12 hours after dosing. The onset of regular uterine contractions or of active labor and the reason for any premature removal of the insert were sought.

RESULTS

Regular contractions ensued in 62 (35.8%) of 173 pregnancies. Primary reasons for removal of the insert in 59 (34.1%) cases were active labor (38), ruptured membranes (11), uterine hyperstimulation (7) and a nonreassuring FHR tracing. The average time from insertion until premature removal was 5.7 +/- 1.3 (SD) hours (95% confidence interval, 3.3-8.2). The insert fell out in nine (5.2%) cases. Cesarean delivery for failed labor induction was necessary in five (2.9%) cases. All immediate neonatal outcomes were reassuring. Following inservice training, nurses were capable of inserting and removing the insert.

CONCLUSION

This PGE2 vaginal insert, administered and removed by attending nurses, is associated with very low rates of uterine hyperstimulation and failed induction. Premature removal of the insert occurred in 34.1% of cases.