Current Status of Prostaglandins for Cervical Ripening.

OBJECTIVE: To review the safety and efficacy of administering various prostaglandin formulations to achieve cervical ripening and spontaneous vaginal delivery in women near or at term. STUDY DESIGN: Peer-reviewed clinical research articles in English and searchable on PubMed.com. A thorough literature search was conducted on PubMed.com using the following terms: [misoprostol], [dinoprostone], [prostaglandin E1], [prostaglandin E2], [PGE1], [PGE2], [cervical ripening], [induction of labor]. RESULTS: The review shows conflicting opinions concerning the safety and efficacy of current standard-of-care formulations for cervical ripening. A gold standard option for optimal treatment has not been confirmed. CONCLUSION: While the clinical evidence suggests that prostaglandin E1 (PGE1) and E2 (PGE2) both could be used for cervical ripening when no contraindications are present, PGE2 formulations remain the only commercially available prostaglandin products for cervical ripening approved by the U.S. Food and Drug Administration. We conclude that more research is warranted on the risks of treatment-emergent adverse events and serious complications during induction of labor.