The studies in this review are limited by sample size which are often divided into multiple comparison groups. Most comparisons showed no significant differences, with wide confidence intervals. Although extra-amniotic prostaglandins may be as effective as other modalities in initiating labour, there is little conclusive information from this review to guide clinical practice. An adequately powered randomised controlled trial would be useful to determine if the use of extra-amniotic prostaglandins would lower the rate of caesarean section.
Comparative trial of extra-amniotic and vaginal prostaglandin E2 in tylose gel for induction of labor.
Two hundred and sixty-one patients of varying parity and cervical "ripeness" were given Prostaglandin E2 (PCE2) in tylose gel either vaginally (2.0 mgm) or extraamniotically (0.3 mgm) prior to planned surgical induction. Surgical inductions was avoided in 52 per cent of the vaginal group and 40 per cent of the extra-amniotic group. When subdivided according to parity and cervical ripeness, both groups were comparable except in the multigravid patients with high cervical 'scores', when the vaginal route was significantly more likely to establish labor. Both groups were without significant ill-effects to the mother or fetus.