Effectiveness of prostaglandin E2 intracervical gel (Prepidil), with immediate oxytocin, versus vaginal insert (Cervidil) for induction of labor

OBJECTIVE: Our purpose was to compare the effectiveness of labor induction with use of prostaglandin E-2 either as an intracervical gel (Prepidil), with immediate oxytocin, or as a sustained-release vaginal insert (Cervidil) with subsequent oxytocin as needed. STUDY DESIGN: Hospitalized patients at greater than or equal to 37 weeks' gestation requiring labor induction and having an unfavorable cervix (Bishop score less than or equal to 6) were randomly assigned to receive either Prepidil or Cervidil. Oxytocin was begun immediately after Prepidil placement or 30 minutes after removal of the Cervidil insert if needed. RESULTS: Of the 150 patients, there were no differences in demographics and eventual pregnancy outcomes between the Prepidil group (n = 77) and the Cervidil group (n = 73). Those pregnancies receiving the Prepidil-immediate oxytocin regimen were delivered sooner than those receiving the Cervidil among nulliparous (11.3 +/- 7.3 hours vs 25.2 +/- 12.5 hours, P < .001) and multiparous (8.4 +/- 7.8 hours vs 18.4 +/- 7.2 hours, P < .001)women. The mean cost savings, which favored the Prepidil-immediate oxytocin regimen, was $458 (range $204 to $630) per patient. CONCLUSION: Compared with Cervidil, the Prepidil-immediate oxytocin regimen resulted in a shorter induction-to-vaginal delivery interval and in more hospital cost savings without increasing adverse outcomes.