Background: Induction of labor using prostaglandin E2 (PGE2) gel is a widely utilized obstetric intervention aimed at achieving vaginal delivery while minimizing the need for lower segment cesarean section (LSCS). The effectiveness of PGE2 in reducing cesarean rates and its impact on maternal and neonatal outcomes remain areas of clinical investigation. This cross-sectional observational study was conducted to compare the success rate of vaginal delivery versus LSCS in patients induced with PGE2 gel and to evaluate maternal and neonatal outcomes associated with its use.
Methods: A total of 194 pregnant women were included, with 97 receiving PGE2 gel for labor induction and 97 undergoing spontaneous labor without PGE2. Data on delivery mode, time from induction to delivery, postpartum hemorrhage (PPH), neonatal intensive care unit (NICU) admissions, birth weight, and APGAR scores were collected at the time of delivery. Statistical analysis was performed to assess differences between the two groups.
Results: The proportion of vaginal deliveries was significantly higher in the PGE2 group (42.3%) compared to the No PGE2 group (33.0%) (p = 0.016). The odds of successful vaginal delivery were lower in the No PGE2 group (OR = 0.37, 95% CI: 0.17–0.83). The mean time from induction to delivery was significantly shorter in the PGE2 group (9.21 ± 3.32 hours) compared to 12.35 ± 3.49 hours in the No PGE2 group (p < 0.001). Each additional hour in delivery time was associated with a 26% decreased likelihood of LSCS (OR = 0.74, 95% CI: 0.65–0.85, p < 0.001).
Postpartum hemorrhage was more frequent in the PGE2 group (30.9%) compared to the No PGE2 group (15.5%), although this difference was not statistically significant (OR = 0.42, p = 0.08). Neonatal NICU admissions were higher in the PGE2 group (17.5%) compared to 5.2% in the No PGE2 group, though this difference was also not statistically significant (OR = 0.40, p = 0.17). Neonates in the No PGE2 group had significantly higher APGAR scores at one minute (8.03 ± 0.91 vs. 7.25 ± 0.99, p < 0.001) and at five minutes (9.07 ± 0.51 vs. 8.52 ± 0.52, p < 0.001).
Conclusion: PGE2 gel induction was associated with a higher success rate of vaginal delivery and a shorter time to delivery. However, its use also correlated with an increased incidence of postpartum hemorrhage and neonatal NICU admissions, though these differences were not statistically significant. Neonates in the No PGE2 group had significantly higher APGAR scores, suggesting potential neonatal implications of induction. These findings highlight the need for careful patient selection and further research to refine induction protocols and optimize maternal and neonatal outcomes.
Keywords: Labor induction, dinoprostone administration, cervical ripening, pregnancy outcome, postpartum hemorrhage, neonatal Apgar score.
How to cite this article: Sharma N, Aysha M. Comparative outcomes of PGE2 gel induction: a cross-sectional observational study on LSCS versus normal vaginal delivery. Int J Drug Deliv Technol. 2026;16(6s): 161-168; DOI: 10.25258/ijddt.16.6s.20
Source of support: None.
Conflict of interest: None