Skip to main content
SpringerLink
Log in

Cost Implications in the Management of Induction of Labour

  • Review Article
  • Published:
PharmacoEconomics Aims and scope Submit manuscript

Summary

For many years the standard treatment of induction of labour has been amniotomy followed by intravenous oxytocin. More recently prostaglandin E2 (PGE2; dinoprostone), in various preparations, has been used to both ripen the cervix before amniotomy and administration of oxytocin, and to induce labour on its own. Since the acquisition cost of PGE2 is approximately 15 times that of oxytocin, it is important to justify the use of PGE2.

In this paper, literature from 1970 to 1996 has been reviewed and outcomes following the use of PGE2, plus amniotomy and oxytocin if necessary, have been compared with outcomes following the use of amniotomy plus oxytocin alone. No significant differences in the mode of delivery and no serious adverse effects in mothers or babies were detected.

Three economic analyses of these approaches to induction of labour have been reviewed. While under certain conditions there may be some cost savings associated with the use of PGE2, neither of the studies reviewed showed substantial, reliable cost savings. Further research is required to identify the patients who would gain most benefit from the use of PGE2.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Bishop EH. Pelvic scoring for elective induction. Obstet Gynaecol 1964; 24 (2): 266–268

    CAS  Google Scholar 

  2. Keirse MJNC, van Oppen ACC. Comparison of prostaglandins and oxytocin for inducing labour. In: Chalmers I, Enkin M, Keirse MJNC, editors. Effective care in pregnancy and childbirth. Oxford, New York: Oxford Medical, 1989: 1080–1111

    Google Scholar 

  3. Keirse MJNC, van Oppen ACC. Preparing the cervix for induction of labour. In: Chalmers I, Enkin M, Keirse MJNC, editors. Effective care in pregnancy and childbirth. Oxford (NY): Oxford Medical, 1989: 988–1056

    Google Scholar 

  4. Silva Cruz A, Godinho F, Pinto JM, et al. Prostaglandin E2 gel compared to oxytocin for medically-indicated labour induction at term: a controlled clinical trial. Pharmatherapeutica 1988; 5 (4): 228–232

    Google Scholar 

  5. MacLennan A, Fraser I, Jakubowicz D, et al. Labour induction with a low dose PGE2 vaginal gel: result of an Australian multicentre randomized trial. Aust N Z J Obstet Gynaecol 1989; 29: 124–128

    Article  PubMed  CAS  Google Scholar 

  6. Lamont RF, Neave S, Baker AC, et al. Intrauterine pressures in labours induced by amniotomy and oxytocin or vaginal pros- taglandin gel compared with spontaneous labour. Br J Obstet Gynaecol 1991; 98: 441–447

    Article  PubMed  CAS  Google Scholar 

  7. Wing DA, Jones MM, Rahall A, et al. A comparison of misoprostol and prostaglandin E2 gel for preinduction cervical ripening and labour induction. Am J Obstet Gynecol 1995; 172 (6): 1804–1810

    Article  PubMed  CAS  Google Scholar 

  8. Wing DA, Jones MM, Rahall A, et al. Misoprostol: an effective agent for cervical ripening and labour induction. Am J Obstet Gynecol 1995; 17 (6) 1811–1816

    Article  Google Scholar 

  9. Chuck FJ, Huffaker BJ. Labour induction with intravaginal misoprostol versus intracervical prostaglandin E2 gel (pre-pidil gel): randomized comparison. Am J Obstet Gynecol 1995; 173 (4): 1137–1142

    Article  PubMed  CAS  Google Scholar 

  10. Varaklis K, Gumina R, Stubblefield PG. Randomized controlled trial of vaginal misoprostol and intracervical prostaglandin E2 gel for induction of labour at term. Obstet Gynecol 1995; 86 (4 Pt 1): 541–544

    PubMed  CAS  Google Scholar 

  11. Meehan FP, Burke G, Kehoe JT. Update on delivery following prior caesarean section: a 15-year review 1972–1987. Int Gynecol Obstet 1989; 30: 205–212

    Article  CAS  Google Scholar 

  12. Ray DA, Garite TJ. Prostaglandin E2 for induction of labour in patients with rupture of membranes at term. Am J Obstet Gynecol 1992; 166 (3): 836–843

    PubMed  CAS  Google Scholar 

  13. Abou El-Leil LAA, Nasrat AA, Fayed HM. Prostaglandin E2 vaginal pessaries in the grandmultipara with unripe cervix, a comparison of different parity groups. Int J Gynecol Obstet 1993; 40: 119–122

    Article  Google Scholar 

  14. Rymer J, Parker A. A comparison of syntocinon infusion with prostaglandin vaginal pessaries when spontaneous rupture of the membranes acoors without labour after 34 weeks gestation. Aust NZ J Obstet Gynecol 1992; 32 (1): 22–24

    Article  CAS  Google Scholar 

  15. Taylor AVG, Sellers S, Ah-Moye M, Mackenzie IZ. A propective random allocation trial to compare vaginal prostaglandin E2 with intravenous oxytocin for labour induction in women previously delivered by Caesarean section. J Obstet Gynecol 1993; 13: 330–333

    Google Scholar 

  16. Davies LM, Drummond MF. The costs of induction of labour by prostaglandin E2 or oxytocin: refining the estimates. York: The UK Centre for Health Economics; 1993. Discussion paper no.: 109 1–36

    Google Scholar 

  17. Hass SL, Lucas MJ. Net economic benefit of a manufactured dinoprostone gel for pre-induction cervical ripening. Phar-macoeconomics 1994; (1): 39–47

    Google Scholar 

  18. Keirse MJNC, de Koning Gans HJ. Randomized comparison of the effects of endocervical and vaginal prostaglandin E2 gel in women with various degrees of cervical ripeness. Am J Obstet Gynecol 1995; 173 (6): 1859–1864

    Article  PubMed  CAS  Google Scholar 

  19. Mahmood TA. A prospective comparative study on the use of prostaglandin E2 gel (2mg) and prostaglandin E2 tablet (3mg) for the induction of labour in primigravid women with unfavourable cervices. Eur J Obstet Gynecol Reprod Biol 1989; 33: 169–175

    Article  PubMed  CAS  Google Scholar 

  20. Rayburn W, Gosen R, Ramadei C, et al. Outpatient cervical ripening with prostaglandin E2 gel in uncomplicated postdate pregnancies. Am J Obstet Gynecol 1988; 158 (6 Pt 1): 1417–1423

    PubMed  CAS  Google Scholar 

  21. Sawai SK, O’Brien WF, Mastrogiannis DS, et al. Patient-administered outpatient intravaginal prostaglandin E2 suppositories in post-date pregnancies: a double blind, randomized, placebo-controlled study. Obstet Gynecol 1994; 84 (5): 807–810

    PubMed  CAS  Google Scholar 

  22. Noah ML, De Costa JM, Fraser TJ, et al. Preinduction cervical softening with endocervical PGE2 gel. Acta Obstet Gynecol Scand 1987; 66: 3–7

    Article  PubMed  CAS  Google Scholar 

  23. Bernstein EP. Prostaglandin E2 gel for cervical ripening and labour induction: a multicentre placebo-controlled trial. Can Med Assoc J 1991; 145 (10): 1249–1254

    CAS  Google Scholar 

  24. Bernstein EP. Therapeutic considerations for preinduction cervical ripening with intracervical prostaglandin E2 gel. J Reprod Med 1993; 38 Suppl. 1: 73–77

    PubMed  CAS  Google Scholar 

  25. Davies LM, Drummond MF. Management of labour: consumer choice and cost implications. J Obstet Gynaecol 1991; 11 Suppl. 1: S28–S33

    Article  Google Scholar 

  26. Data on file, the Upjohn Company, Kalamazoo, US

Download references

Author information

Authors and Affiliations

  1. Department of Pharmacy, University of Sydney, Building A15, Sydney, New South Wales, 2006, Australia

    Susan J. Taylor & Carol L. Armour

Authors
  1. Susan J. Taylor
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carol L. Armour
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Susan J. Taylor.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Taylor, S.J., Armour, C.L. Cost Implications in the Management of Induction of Labour. Pharmacoeconomics 12, 547–554 (1997). https://doi.org/10.2165/00019053-199712050-00005

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00019053-199712050-00005

Keywords

Search

Navigation