The safety of vaginal prostaglandin F2 alpha for the stimulation of labour.

In an audit of 15,102 consecutive deliveries between 1986 and 1991, 3,168 labours were induced with intravenous oxytocin and 824 with 40 mg prostaglandin F2 alpha (PGF2 alpha) vaginal gel. Four hundred and twenty women received PGF2 alpha alone and 404 received PGF2 alpha followed by oxytocin. The main aim of the study was to audit the safety of PGF2 alpha gel to stimulate labour. There were no maternal or neonatal complications attributable to this therapy. In particular, there were no cases of uterine rupture or hyperstimulation requiring surgical or pharmacological intervention. There was little difference in the evidence for fetal distress between induction methods. Although the prostaglandin and oxytocin groups were not comparable in all respects, the results of this large retrospective study confirmed the results of smaller prospective randomized trials showing a significantly shorter labour and reduced analgesia, surgical delivery and postpartum haemorrhage rates in women treated with PGF2 alpha alone. This is the largest reported series of PGF2 alpha induced labours and provides evidence of its safety and is in keeping with physiological data suggesting that PGF2 alpha is the main prostaglandin and oxytocic associated with normal progressive labour. Its apparent safety and potential to reduce both intervention in labour and postpartum complications merits greater attention.