Failed Induction of Labor Despite Sequential Prostaglandin E2 Therapy

ABSTRACT Preinduction cervical ripening with prostaglandin E 2 (PGE 2 ) is useful in minimizing the chances for a failed induction of labor. The lack of sufficient cervical dilation despite PGE 2 and oxytocin therapy is uncommon. This investigation was undertaken to determine reasons for any failed inductions in pregnancies with pregel Bishop scores 4 or lower and requiring delivery within 24 hours. Fifteen (12.1%) of 124 eligible patients had failed inductions despite two 2.5 mg intravaginal doses. A finding in all the failures was a very unfavorable cervix (pregel Bishop score 0 to 2). The need for preterm delivery (33 to 37 weeks) was a common finding in the presence of a very unfavorable cervix. The data suggest that complicated pregnancies requiring delivery within 24 hours and failing to respond to sequential PGE 2 therapy in the presence of a very unfavorable cervix may benefit from cesarean section without a prolonged induction.