COLUMBUS, Ohio -- Use of a special medical gel, placed into the cervix of a pregnant woman, can enhance the natural birth process by shortening both the time until labor begins and the time to delivery, new research suggests.
Thirty women received the gel -- called prostaglandin E2 -- and waited an average of two-and-a-half days before delivering, while 31 women received a placebo and waited an average of seven days. On average, the women in the PGE2 group spent three hours less in labor.
The findings suggest that PGE2 may be helpful for women who are having problem pregnancies and who are candidates to have labor induced.
"The real application of PGE2 is in potentially preventing the need for induced labor in problem pregnancies. It might also reduce the need for some Caesarean sections," said Philip Samuels, an associate professor of obstetrics and gynecology at Ohio State University.
The research appears in a recent issue of the journal Obstetrics and Gynecology.
The researchers assessed the time that 61 women spent in labor and delivery -- 30 received PGE2 and 31 received a placebo gel, all as outpatients. The PGE2 or placebo was inserted into each woman's cervix via a catheter attached to a syringe.
Of the women given PGE2 injections, 15 (50 percent) gave birth within two days, as did five (16 percent) in the placebo group. Time spent in labor was markedly shorter in the PGE2 group -- an average of 5.6 hours -- compared to 8.6 hours in the placebo group.
The patients received PGE2 after reaching 38 weeks' gestation. The women -- all healthy patients -- had no indication that labor should be induced.
"The goal was to get the cervix to the point that labor could be successfully induced," Samuels said. This study used healthy women as subjects to test the safety of using PGE2 to induce labor on an outpatient basis.
"We hope to use PGE2 on women with problem pregnancies -- the ones requiring induced labor because of a threat to the mother or the child," Samuels said.
Prostaglandins are hormone-like substances that affect body processes such as temperature and metabolism. They also stimulate smooth muscle -- such as the uterus -- to contract.
Inducing labor normally involves giving the woman a prostaglandin followed by the hormone oxytocin, which causes the uterus to contract. Ideally, labor soon follows.
"Induction usually takes a day or two to work," Samuels said. "And if it doesn't work, the patient will likely need a c-section."
This study shows, according to Samuels, that PGE2 can be administered without oxytocin and, if it doesn't induce labor, a physician can re-administer the gel in a few days.
"By using the prostaglandin only, we're not committing the patient to delivery," Samuels said. "Most obstetricians have always felt that a prostaglandin should be followed immediately by oxytocin followed by delivery.
"This study shows that it's not necessary to go immediately to induction after administering PGE2."
Samuels co-authored this study with David McKenna, a physician of maternal and fetal medicine at Wright-Patterson Air Force Base and Stephanie Costa, an obstetrician and gynecologist in private practice in Columbus.
Contact: Philip Samuels, 614-293-3773;
Samuels.8@osu.edu
Written by Holly Wagner, 614-292-8310;
Wagner.235@osu.edu
Journal
Obstetrics and Gynecology