Sequential use of drugs (prostaglandin e1 after failed trial of PGE2 gel) for induction of labour: Retrospective observational study.

With advancements in medicine, the scope of pregnancies have increased. This has subsequently increased the number of inductions and therefore more caesarean sections. We looked at the efficacy and safety of sequential induction with PGE2 gel followed by PGE1 tablets after a period of rest in a retrospective observational study. Women with failed induction of labour with 3 PGE2 gel were re-induced with 25ug vaginal PGE1 tablets, with a maximum of five doses (sequential regimen). Fetomaternal outcome and vaginal delivery rates were compared between the only-PGE2 gel group and the sequential group.There were 296 inductions of labour, of which 41 were included in the sequential group, amongst whom the vaginal delivery rate was 56%. Caesarean delivery rate with only PGE2 gel would have been 32%, but with the addition of PGE1 vaginal tablet (sequential induction), it reduced by >8% (p  =  0.02). Fetomaternal outcomes were comparable in the two groups. We thus conclude that sequential induction with PGE1 tablets is an effective option.