Saima Qamar, Adeela Bashir, Faiza Ibrar


Background: Induction of labour is the intentional initiation of cervical ripening and uterine
contraction for the purpose of accomplishing delivery, prior to onset of spontaneous parturition. This
study was conducted to compare maternal and neonatal outcome in women induced with Prostaglandin
E2 gel, Prostaglandin E2 pessary and extra-amniotic saline infusion with oxytocin at Bishops score <5.
Methods: It was a quasi-experimental which was conducted at the Department of Gynaecology and
Obstetrics Unit-I, Mother and Child Health Care Centre, Pakistan Institute of Medical Sciences,
Islamabad during one year of time. Eighty cases in each group (prostaglandin gel, prostaglandinE2
pessary and extra-amniotic saline infusion with oxytocin) were collected. Systematic sampling was
done. First woman admitted was induced with prostaglandin gel, the second one with prostaglandin
pessary and the third was induced with extra amniotic saline infusion and oxytocin. Results: The most
common indication for induction was post dates followed by PIH. The induction labour interval was
less in EASI with oxytocin group (5.18±3.4) hours, as compared to prostaglandin pessary (8.81±5.60)
hours and prostaglandin gel (8.32±5.18) hours. Induction delivery interval in EASI with oxytocin was
(10±5.6) hours as compared to prostaglandin pessary (14±6.3) hours and prostaglandin gel (13±7.1)
hours. This difference was statistically significant. The primigravidas had longer duration of labour than
multigravidas. Induction labour interval in primigravidas was (8.2±5.1) hours while in multigravidas it
was (6.7±5.02) hours. Induction delivery interval was also more in primigravidas (13.6±6.80) hours as
compared to multigravidas (11.4±6.20) hours. Vaginal delivery rate was 89.2% while the caesarean
section rate was 10.4%. The most common indication for caesarean section was foetal distress. There
was no significant difference in perinatal morbidity and mortality in the three groups. Conclusion:
EASI with oxytocin is a better method of induction than prostaglandin E2 gel and pessary. Moreover it
is more economical in our country.
Keywords: Induction of labour, Bishop score, EASI, Prostaglandin E2

Full Text:



Creasy RK. Induction of labour. In: Creasy RK, editor.

Management of labour and delivery. Malden: Blackwell Sciences


American College of Obstetricians and Gynaecologists.

Induction and augmentation of labour. ACOG technical bulletin

No. 217. Washington DC: ACOG; 1995.

Rana S. Termination of pregnancy. In: Rana S, editor. Obstetrics

and perinatal care. Islamabad: SAF publishers 1998:937–53.

Harman JH, Kim A. Current trends in cervical ripening and

labour induction. Am Fam Physician 1999;60:477–84.

Mazhar SB, Sarwar S, Mahmud G. Induction of labour, a

randomized trial comparing prostaglandin E2 pessary,

intracervical Foley catheter and extra amniotic saline infusion. J

Surg 2000;19:12–8.

Buccellato CA, Stika CS, Frederiksen MC. A randomized trial of

misoprostol versus extra-amniotic sodium chloride infusion with

oxytocin for induction of labor. Am J Obstet Gynecol


Duff C, Sinclair M. Exploring the risks associated with induction

of labour. J Adv Nurs 2000;31:410–7.

Buist R. Induction of labour: indications and obstetric outcome in

a tertiary referral hospital. NZ Med J 1999;112:251–3.

Dublin S, Lydon RM, Kaplan RC, Critchlow CW, Watts DH.

Maternal and neonatal outcome after induction of labour without

an identified indication. Am J Obstet Gynaecol 2000;183:986–94.

Shetty A, Livingston I, Acharya S, Templeton A. Vaginal

prostaglandin E2 gel versus tablet in the induction of labour at

term-a retrospective analysis. Shetty A, Livingston I, Acharya S,

Templeton A. J Obstet Gynaecol. 2004;24(3):243–6.

Kho EM, Sadler L, McCowan L. Induction of labour: a

comparison between controlled-release dinoprostone vaginal

pessary (Cervidil) and dinoprostone intravaginal gel (Prostin E2).

Aust NZ J Obstet Gynaecol 2008;48:473–7.

Sharami SH, Milani F, Zahiri Z, Mansour-Ghanaei F. A

randomized trial of prostaglandin E2 gel and extra-amniotic

saline infusion with high dose oxytocin for cervical ripening.

Med Sci Monit 2005;11:CR381–6.

Guinn DA, Davies JK, Jones RO, Sullivan L, Wolf D. Labor

induction in women with an unfavorable Bishop score:

randomized controlled trial of intrauterine Foley catheter with

concurrent oxytocin infusion versus Foley catheter with extraamniotic saline infusion with concurrent oxytocin infusion. Am J

Obstet Gynecol 2004;191(1):225–9.

Mazhar SB, Imran R, Alam K.. Trial of extra amniotic saline

infusion with oxytocin versus prostaglandin E2 pessary for

induction of labour. J Coll Physicians Surg Pak. 2003;13:317–20.

Al-Taani MI. Intravaginal prostaglandin-E2 for cervical priming

and induction of labour. East Mediterr Health J 2007;13:855–61.

Rayburn WF, Lightfoot SA, Newland JR,

Smith CV, Christensen HD. A model for investigating

microscopic changes induced by prostaglandinE2 in the term

cervix. J Maternal Foetal Invest. 1994;4:137–40.

Keirse MJNC: Prostaglandins in preinduction cervical ripening.

Meta-analysis of worldwide clinical experience. J Reprod Med

;38(Suppl 1):89–100.


  • There are currently no refbacks.

Contact Number: +92-992-382571

email: [jamc] [@] []