Feras Alkharouf, Nada F Alqudaibi, Aminah A Alhamdan, Majd A Alomar, Danah I Alnahari
PGE2 was effective for induction of labor in this cohort. The vaginal tablet was associated with a higher observed vaginal delivery rate than the pessary; however, this finding should be interpreted cautiously because formulation selection was not randomized and was based on availability. Individualized assessment, method selection, and fetal monitoring remain important. Women with relevant medical comorbidities should be counseled regarding their increased risk of cesarean delivery. Further prospective multicenter studies comparing efficacy, maternal safety, and neonatal outcomes are warranted.
OBJECTIVE: Induction of labor (IOL) is a common obstetric procedure performed when continuation of pregnancy poses maternal or fetal risks. Prostaglandin E2 (PGE2) is widely used for cervical ripening and induction. This study assessed the success rate of PGE2-induced labor and identified obstetric predictors of failed induction and cesarean delivery at a tertiary center in Riyadh.
METHODS: This retrospective cross-sectional study included 1303 women who underwent IOL with PGE2 (tablet or pessary) at the Women's Health Hospital, National Guard Health Affairs, Riyadh, during 2023. Maternal characteristics, obstetric factors, and induction-related variables were analyzed using descriptive and inferential statistics. Logistic regression was applied to determine independent predictors of failed induction and cesarean section, with statistical significance set at P < 0.05.
RESULTS: The overall success rate of PGE2 induction was 74.2%, consistent with global benchmarks. The vaginal tablet demonstrated higher effectiveness (80.6%) compared with the pessary (59.4%). Advanced maternal age, pre-eclampsia, and type 1 diabetes significantly increased the likelihood of failed induction and cesarean delivery. Intrapartum factors, particularly nonreassuring cardiotocography and inadequate cervical response, were strong determinants of cesarean section.
CONCLUSION: PGE2 was effective for induction of labor in this cohort. The vaginal tablet was associated with a higher observed vaginal delivery rate than the pessary; however, this finding should be interpreted cautiously because formulation selection was not randomized and was based on availability. Individualized assessment, method selection, and fetal monitoring remain important. Women with relevant medical comorbidities should be counseled regarding their increased risk of cesarean delivery. Further prospective multicenter studies comparing efficacy, maternal safety, and neonatal outcomes are warranted.