'Weeënstorm' na cervixrijping met prostaglandinegel

In three pregnant women aged 26, 31 and 26 years with post-term pregnancy and (or) worsening preeclampsia and an immature cervix, parturition was induced by intracervical application of dinoprostone. This was followed within a few hours by bradycardia of the infants, with a labour frequency of about 5 per 10 minutes and contractions lasting at least 1 minute. After suppression of labour (in two patients, one of whom meanwhile had developed placental detachment), caesarean section was performed without delay. One child by then had sustained major cerebral damage; the other two recovered well.

A potentially dangerous adverse effect of intracervical application of prostaglandin gel is excess uterine activity. The higher sensitivity to prostaglandins in several conditions complicating pregnancies (such as serotinity and preeclampsia), may play a role in this complication. Careful application of the gel, adequate foetal monitoring and using half the normal dose in risk patients could be helpful in preventing foetal distress after intracervical application of prostaglandin gel.