Cervical priming prior to dilatation and evacuation: A comparison of methods

Vaginal administration of prostaglandin analogues resulted in cervical changes that facilitated dilatation and evacuation in 80 patients in the late first trimester and the second trimester of pregnancy. When 0.5 mg and 1.0 mg of 15(S)-15-methyl-prostaglandin F_2α (15-ME-PGF_2α) was compared to 30 and 60 mg of 9-deoxo-16, 16-dimethyl-9 methylene prostaglandin E₂ (PGE₂ analogue), the PGE₂ analogue appeared to have more cervical ripening effect than did the 15-ME-PGF_2α. Overall, the 30 mg PGE₂ vaginal suppository seemed to offer the most optimal combination of effectiveness, sufficient cervical dilatation, and minimal side effects. With the prostaglandins, maximal cervical effect was observed at 4 to 5 hours; this rapid effectiveness allows administration of the prostaglandin to accommodate a 1-day stay for surgical evacuation. The preoperative cervical priming results with the prostaglandins were compared to those obtained with the use of laminaria tents. Although the number of patients who needed further dilatation at the time of operation was less with the laminaria, the incidence of complications and the time for adequate dilatation were higher in that group.     

A comparison between vaginal prostaglandin E2 suppositories and intrauterine extra-amniotic prostaglandins in the management of fetal death in utero

This retrospective study was undertaken to compare the efficacy, side effects, and complications of prostaglandin E₂ (PGE₂) given as a vaginal suppository with those of PGE₂ administered via the intrauterine extra-amniotic route to induce labor after fetal death. The induction-to-delivery intervals were comparable, with 9.2 ± 3.94 hours and 8.6 ± 4.49 hours, respectively. However, the mean total amount of PGE₂ administered was much less via the intrauterine extra-amniotic route (1.8 milligrams) than by the vaginal suppository (45.2 mg). There was a 100% success rate in the patients treated by the intrauterine extra-amniotic route, but only a 91.3% success rate in those patients treated via the vaginal route. The side effects (vomiting, diarrhea, fever) and the complications (incomplete abortion, uterine rupture, oxytocin augmentation) occurred more frequently with the use of PGE₂ as a vaginal suppository. The vaginal route of administration of PGE₂ is somewhat more convenient, but the intrauterine extra-amniotic route may offer a higher degree of efficacy and safety with fewer side effects in the management of fetal death in utero.     

Management of intrauterine fetal death with prostaglandin E2 vaginal suppositories

The recent Food and Drug Administration's approval of prostaglandin E₂ (PGE₂) vaginal suppositories provides the clinician with a technique for the immediate management of missed abortion and intrauterine fetal death (IUFD). During a 4-year period at our institution, 78 of 80 patients with gestations ranging from 13 to 42 weeks had pregnancy successfully terminated with PGE₂ suppositories with a dose schedule of 20 mg every 2 hours. The mean interval from induction to delivery of the fetus was 8.9 hours. Fifty percent of the patients spontaneously expelled the placenta; active intervention to remove the placenta within 2 hours of delivery of the fetus is recommended to avoid excessive vaginal bleeding. The most frequently encountered side effect was a temperature elevation, which was managed by less frequent administration of the prostaglandin. Gastrointestinal side effects were minimized by premedication with antidiarrheal and antiemetic agents, which also were administered during the induction period when indicated by the patient's symptoms. A concomitant oxytocin infusion was utilized in 38 patients. In gestations of less than 24 weeks the oxytocin was administered via intravenous drip at a rate of 10 U/hour. In the case of a patient with IUFD and a gestation of 24 weeks or more, oxytocin should be administered only with a constant-rate infusion pump starting at a dose schedule of 1 mU/minute with careful titration of the dose against the monitored uterine activity. The availability of the vaginal PGE₂ suppositories for missed abortion and IUFD makes it important for the clinician to fully acquaint himself with the drug, its administration, effects, and side effects.     

Effect of prostaglandin E2 and its metabolites on lower segment myometrium in vitro

The spontaneous activity of pregnant human lower segment myometrium has been studied in vitro using strips removed at cesarean section. Contractions were measured isometrically. During the 4-h experiments there was an increase in amplitude and decrease in frequency of contractions in control preparations. Prostaglandin F_2α (PGF_2α), its metabolites and prostaglandin E₂ (PGE₂) have been shown to be oxytocic in vivo, but there are no published data on the oxytocic effect of PGE₂ metabolites. The effect on contractile activity of adding either PGE₂ or one of its initial metabolites (15-keto-PGE₂, 13,14-dihydro-15-keto-PGE₂ or 13,14-dihydro-PGE₂) or prostaglandin A₂ (PGA₂) to the tissue baths has been tested.No significant or consistent change in contractility was observed after the addition of any of the compounds tested. This probably indicates an inherent difference in the response of different portions of the uterine muscle, and cannot be taken to exclude activity in the intact uterus, particularly since PGE₂ is a well-known oxytocic agent in vivo. The difficulty of working with this type of preparation is stressed, since there is wide variation in contractility as well as a constantly changing pattern.     

Prostaglandin secretion by adrenal tissue of human anencephalic fetuses

Previously we reported that the human fetal adrenal gland secreted various prostaglandins and that prostaglandin secretion was inhibited by endogenously synthesized glucocorticoids. Furthermore, we reported that the neocortex secreted larger quantities of prostaglandins than did fetal zone tissue and that the pattern of secretion of prostaglandins of the two zones differed. In the present investigation the rate and pattern of prostaglandin secretion by adrenal tissue of anencephalic fetuses were assessed and compared to either whole or separated zones of human fetal adrenal tissue. The rate of prostaglandin secretion into the culture medium was determined by measuring prostaglandin E₂ or prostaglandin F_2α with use of specific radioimmunoassays in media collected at 24-hour intervals. The rate of prostaglandin E₂ secretion by adrenal glands obtained from two anencephalic fetuses declined rapidly from 1.71 ± 0.65 ng/mg⁻¹ of protein per 24 hours and 0.82 ± 0.46 ng/mg⁻¹ of protein per 24 hours on day 1, respectively, to 0.36 ± 0.03 and 0.12 ± 0.04 ng/mg⁻¹ of protein per 24 hours by the fifth day in culture. The rate and pattern of prostaglandin F_2α secretion by anencephalic tissue was similar to that of prostaglandin E₂. The pattern of prostaglandin secretion by anencephalic adrenal tissue was similar to that observed in neocortex tissue, but the rate of prostaglandin secretion was less. When the rates of prostaglandin secretion by anencephalic and neocortex adrenal tissue were compared to the rates of secretion of cortisol, an inverse relationship was observed. Finally, when whole human fetal adrenal glands or anencephalic tissues were incubated in the presence of adrenocorticotropic hormone, dexamethasone, metyrapone, or SU 10603, the data obtained seemed to suggest that the rate of prostaglandin secretion was regulated in both tissues by endogenously synthesized glucocorticosteroids. In summary, the pattern of secretion of prostaglandins by the anencephalic adrenal gland was similar to that of neocortex tissue, and the rate of secretion of prostaglandins was inhibited by endogenously synthesized cortisol.     

Induction of labor in women with a uterine scar

Objective: To evaluate the frequency of uterine rupture following induction of labor in women with a previous cesarean section. Misoprostol was compared to other methods of induction.

Methods: A retrospective cohort study of 208 women attempting induction of labor after one previous cesarean section. Delivery data were collected retrospectively and compared. Group 1(2009–2010) was compared with Group 2 (2012–2013). In Group 1, the main method of induction was vaginal PGE₂ (prostaglandin-E₂), amniotomy, oxytocin or a balloon catheter. In Group 2, the dominant method of induction was an oral solution of misoprostol. Main outcome measures: frequency of uterine rupture in the two groups.

Results: Nine cases (4.3%) of uterine rupture occurred. There was no significant difference in the frequency of uterine rupture following the change of method of induction from PGE₂, amniotomy, oxytocin or mechanical dilatation with a balloon catheter to orally administered misoprostol (4.1 versus 4.6%, p?=?0.9). All ruptures occurred in women with no prior vaginal delivery.

Conclusion: The shift to oral misoprostol as the primary method of induction in women with a previous cesarean section did not increase the frequency of uterine rupture in the cohort studied.     

Oxytocin,PGE2 and PGF2α stimulate the production of inositol phosphates in the rabbit myometrium

Summary Phosphoinositide breakdown is thought to be important in regulating a variety of transmembrane signal transduction in the action of oxytocic agent during uterine smooth muscle contraction. We investigated the effects of oxytocin and prostaglandins (PGE₂ and PGF_2α) on phosphoinositide hydrolysis in the myometrium taken from non-pregnant and pregnant rabbits by measuring the accumulation of total inositol phosphates (IP). Oxytocin strongly, and PGE₂ and (PGF_2α) slightly but significantly, stimulated IP production in both the non-pregnant and pregnant myometria. Oxytocin more markedly accelerated the IP production in pregnant myometrium than in non-pregnant myometrium. However, IP production stimulated by PGE₂ and PGF_2α was much the same in non-pregnant and pregnant myometria. The amount and time course of the increase in the production of the total IPs by oxytocin are quite different from those by PGs. It seems that the mechanism by which oxytocin stimulates phospholipase C is different from that of the PGs. It is suggested that transmembrane signalling pathways of phosphoinositide hydrolysis play an important role in the each mechanism.     

Prostglandis,angiotensin and blood pressure in pregnant rabbits

A total of 24 rabbits between days 26–29 gestation (term 31 days) were studied acutely. Five does had been pretreated with oral doses (40 mg p.d.) of a prostaglandin synthetase inhibitor (Flurbiprofen) since day 7 of gestation. Rabbits were anaesthetised with sodium phenobarbitone, 30 mg kg^?1, and breathed spontaneously. The pressor response to stepwise increments of infused angiotensin II (AII) over the range 16–64 ng kg^?1 min^?1 was determined in all animals. The 19 does which had not received Flurbiprofen were then subdivided into 4 groups, receiving infusions either of normal saline, 0.1 ml min^?1 (n=6) or prostaglandin E₁ (PGE₁) at 10 ng kg^?1 min (n=4), 20 ng kg^?1 min (n=5) or 50 ng kg^?1 min^?1 (n=4). The infusions of AII were then repeated during the additional infusion.

The administration of Flurbiprofen was associated with increased basal systolic and diastolic blood pressures. The doses of AII given evoked clear and consistent increases in both systolic and diastolic blood pressure. The previous administration of Flurbiprofen was associated with a consistently greater pressor response to AII than in the untreated does. Since the basal plasma renin concentration-was almost halved in these animals, the enhanced response may have been a function of circulating endogenous concentrations. Flurbiprofen had no effect on renal histology as sham by light or electron microscow.

The additional infusion of PGE₁ had a biphasic effect, dependent on administered dose, on the pressor response to AII. Thus PGE₁ 10 ng kg^?1 min^?1 was associated with a blunting of response to AII, while PGE₁ 50 ng kg^?1 min^?1 was associated with an enhanced response. A similar dose dependent biphasic effect has been reported in isolated segments of vascular tissue.     

Hysterectomy,decidualization, LH concentrations and corpus luteum function in the rat

In 1923 Loeb described that the uterus plays an important role in the control of corpus luteum function in the guinea pig: removal of the uterus resulted in a prolongation of the luteal phase. Similar findings have been reported for several other mammalian species (Anderson, 1972). In the rat, hysterectomy does not alter the duration of the estrous cycle (Perry and Rowlands, 1961), but the duration of pseudopregnancy (the equivalent of the luteal phase in the reproductive cycle of other mammalian species) is extended after hysterectomy.The fact that hysterectomy leads to a prolonged luteal phase in certain mammalian species, pointed to the existence of a uterine luteolytic factor (Schomberg, 1969). Some evidence for the existence of a uterine luteolytic substance is available for the rat. It was shown that after removal of the endometrium the duration of pseudopregnancy was extended to almost that observed in hysterectomized rats (Waynforth, 1965). Hechter, Fraenkel, Lev and Soskin (1940) could reduce in the rat the duration of pseudopregnancy with uterine transplants. Furthermore, the duration of pseudopregnancy was shortened after injections of endometrial suspensions (Bradbury, Brown and Gray, 1950) or aqueous endometrial extracts (Dobrowolski, Snochowski and Stupnicki (1974). These observations suggest that the endometrium is the source of the luteolytic factor, and recently evidence was provided that a prostaglandin could be the uterine luteolytic factor (Pharriss, Tillson and Brickson, 1972; Labhsetwar, 1974). Studies in sheep (McCracken, Carlson, Glew, Goding, Baird, Green and Samuelsson, 1972) and in the guinea pig (Blatchley, Donovan, Horton and Poyser, 1972) have provided some evidence for this concept. Also in the rat a prostaglandin may be the uterine luteolytic factor: treatment with prostaglandin F_2α terminates pseudopregnancy in the rat by reducing ovarian and peripheral progesterone concentrations (Pharriss and Wyngarden, 1969; Behrman, Yoshinaga and Greep, 1971). The fact, however, that only a slight increase in F prostaglandins around day 7 of pseudopregnancy and no increase in E prostaglandins was observed (Saksena, Watson, Lau and Shaikh, 1974) throws some doubt upon the idea that a prostaglandin is the luteolytic factor in the rat. On the other hand, the finding that in a bioassay the dose-response curve of endometrial extract from pseudopregnant rats runs parallel with that of prostaglandin F_2α; (Dobrowolski et al., 1974) could be considered as evidence that a prostaglandin is the uterine luteolytic factor in the rat.In the present paper the effects of hysterectomy and decidualization on certain aspects of pseudopregnancy in the rat are discussed.     

ENDOTHELIN AND BLOOD PRESSURE REGULATION IN THE FEMALE RAT: STUDIES IN NORMAL PREGNANCY AND WITH NITRIC OXIDE SYNTHASE INHIBITION-INDUCED HYPERTENSION

We have measured evoked changes in plasma renin concentration (PRO, plasma renin substrate (PRS) and plasm aldosterone concentration (ALD) during the infusion of angiotensin II (AII) with and without the simultaneous administration of rostaglandin E2, 5 μg min^?1 i.v. (PGE₂) or prostaglandin E₁, 15 ng kg^?1 min^?1 (PGE₁). Expriments have been carried out using PGE₂ in 20 patients, and in 5 patients to date with PGE₁. AII alone (16 ng kg-¹ min¹ i.v.) significantly reduced PRC in both groups of ptients without altering PRS, while ALD concentrations more than doubled. The infusion of PGE₂ stimlated basal PRC; PGE₁ at the dose used did not alter PFC. Neither prostaglandin altered basal Rs. or ALD concentrations. When AII was infused simultaneously, PRC was again suppressed, in the presence of PGE₂. However, only minimal feedback suppression occurred when PGE₁ was being used. Furthermore, AII was still associated with a more than two-fold rise in ALD concentration when given together with PGE₂, but the rise was considerably smaller and not significant in the presence of PGE₁.

PGE₂ is a known stimulus to renin secretion, apparently acting directly at the juxtaglanerular apparatus. These preliminary results suggest that while a similar mechanism exists in second trimester human pregnancy, PGE₁ may have a different effect. The apparent blockade of the normal feedback suppression of PRC in the presence of increased PGE₁ concentrations by raised concentrations of All is especially interesting.     

Interleukin-1β and bacterial endotoxin change the metabolism of prostaglandins E2 and F2α in intact term fetal membranes

There is strong evidence that prostaglandins E₂ and F_2α (PGE₂ and PGF_2α) are involved in the initiation and maintenance of human parturition and that their production can be stimulated by a number of cytokines and in infection-induced preterm labour by bacterial endotoxin. This study used an intact fetal membrane disk model to investigate the regulation of PGE₂ and PGF_2α metabolism by interleukin-1 beta (IL-1β and bacterial endotoxin [lipopolysaccharide (LPS)]. Fetal membrane explants were incubated with IL-1β (0.1 or 1.0 ng/ml) or LPS (10 ng/ml) for 24 h. A mixture of ³H-prostaglandin (0.1 μCi) and unlabelled prostaglandin (1 μg) was then added at selected times after the addition of inflammatory mediators. The radiolabelled prostaglandins and their metabolites were then extracted from the culture medium and quantified by high-pressure liquid chromatography. Levels of prostaglandin metabolites were generally decreased following incubation with IL-1β or LPS, which is consistent with a decrease in the activity of 15-hydroxyprostaglandin dehydrogenase (PGDH). It is concluded that IL-1β and LPS moderately decrease the metabolism of prostaglandins, which may contribute to increasing the local levels of active prostaglandins induced by these stimuli.     

The Effect of Prostaglandin E1on the Pressor Response to Angiotensin II in Second Trimester Human Pregnancy and in the Non-Pregnant Subject

The effect of a simultaneous infusion of prostaglandin E₁ (PGE₁) on the pressor response to angiotensin II (AII) has been studied in 8 pregnant and six non-pregnant subjects to date. PGE₁ 15 ng kg^?1 min^?1 had no effect on basal blood pressures in the pregnant patients, but increased heart rate by 9.1 ± 1.6 bpm (P<0.001). Six of these eight wanen had scanewhat diminished pressor responses to AII (4, 8 and 16 ng kg^?1 min^?1) during PGE₁ infusion; this difference reached statistical significance at the lowest dose of AII (P<0.05). PGE₁ 10 ng kg^?1 min^?1 slightly increased basal diastolic pressure in the non-pregnant subjects (P<0.05) and increased heart rate by a similar amount (8.4 ± 1.8 bpm, P<0.01). Again, the overall pressor response to AII was sanewhat diminished in the majority of these subjects. The pregnant patients exhibiting the greatest initial pressor response to AII were those in whom the greatest decrease in response was seen; this correlation achieved statistical significance at 8 and 16 ng kg^?1 min^?1 AII (P<0.01, P(0.002 respectively). A similar trend was apparent in the non-pregnant subjects.     

Regional variations in contractile responses to prostaglandins and prostanoid receptor messenger ribonucleic acid in pregnant baboon uterus

Objectives: The aims of this study were to compare (1) the contractile responses of the lower uterine segment and fundus to prostaglandins, (2) expression of genes encoding prostanoid receptors in myo-metrium from different regions of the uterus, and (3) the distribution of expression of genes encoding prostanoid receptors (P receptors) in key intrauterine tissues. Study Design: Cesarean hysterectomy was performed in 8 pregnant baboons, not in labor, in the last third of pregnancy. Contractile responses of fresh tissue were quantified in a superfusion system. Polyadenylated ribonucleic acid was extracted from frozen tissue and gene expression was quantified by Northern blot analysis with complementary deoxyribonucleic acid probes. Results: Prostaglandin E₂ contracted strips of myometrium from the fundus but had no significant effect on strips from lower uterine segment. Prostaglandin F_2α contracted myometrium from both regions equally. Compared with fundus tissue, lower uterine segment tissue had greater expression of EP₂ receptor messenger ribonucleic acid, less expression of EP₃ receptor messenger ribonucleic acid, but similar levels of EP₄ receptor and FP receptor messenger ribonucleic acid. EP₂ receptor, EP₃receptor, and EP₄ receptor messenger ribonucleic acids were also detected in cervix, decidua, and chorion. EP₂ receptor messenger ribonucleic acid was most abundant in the cervix, EP₃ receptor messenger ribonucleic acid was most abundant in the myometrium, and EP₄ receptor messenger ribonucleic acid was most abundant in the decidua. Conclusions: The reduced contractile response of lower uterine segment tissue to prostaglandin E₂ is paralleled by greater inhibitory EP₂ receptor expression and less contractile EP₃ receptor expression, a pattern similar to that seen in the cervix. Drugs with selective activity at prostanoid receptor types and subtypes are likely to allow safer and more effective control of the uterus and cervix than native prostaglandins. (Am J Obstet Gynecol 1998;179:1545-52.)     

Polygonum hydropiper crude root extract mimics estrogenic properties in females: Evidence of uterine protein profiles studied by sodium dodecyl sulfate polyacrylamide gel electrophoresis

Polygonum hydropiper is a widely grown weed in the north-eastern states of India. In the present study, estrogenic effects of the crude root extract (CRE) ofPolygonum hydropiper on uterine protein was tested in ovary-intact and ovariectomized (OVX) female albino rats. The methanolic crude extract ofPolygonum hydropiper was given to adult ovary-intact and OVX female albino rat in a dose of 1000 mg/kg bodyweight per day. Oral administration of the CRE was carried out for a period of 12 days from the onset of proestrus and for a similar period of time for the OVX female. To study the estrogenic effect, OVX females were subcutaneously injected with 0.1 μg of estradiol-17β (E2). E2 was injected at the interval of 24 h for a total period of 72 h. The uterine protein of ovary-intact and OVX females was studied by single dimensional sodium dodecyl sulfate polyacrylamide gel electrophoresis. The results showed similar protein bands in OVX females treated with E2 and CRE. In addition, treatment with CRE stimulated expression of more proteins in the uterus. The results showed that CRE ofPolygonum hydropiper mimics the effect of estradiol-17β in the uterine protein profiles of adult female albino rats.     

Susceptibility to Toxoplasma gondii proliferation in BeWo human trophoblast cells is dose-dependent of macrophage migration inhibitory factor (MIF), via ERK1/2 phosphorylation and prostaglandin E2 production

Introduction

Macrophage migration inhibitory factor (MIF) participates in the immune response to Toxoplasma gondii, triggers ERK1/2 and prostaglandin E₂ (PGE₂) activation, but there is limited information on these mechanisms in human trophoblast. The present study aimed to verify the role of MIF in the ERK1/2 phosphorylation and PGE₂ production, as well as its effect on the susceptibility to T. gondii in BeWo cells.

Methods

BeWo cells were treated with increasing concentrations of recombinant MIF (rMIF) and/or T. gondii-soluble tachyzoite antigen (STAg) and analyzed for ERK1/2 phosphorylation and PGE₂ production by Western blotting and ELISA, respectively. Cells were also treated with increasing concentrations of rMIF, rPGE₂, or ERK1/2 inhibitor and tested for T. gondii proliferation. The supernatants of cells treated with rPGE₂ were assayed for cytokine production by ELISA or CBA.

Results

ERK1/2 phosphorylation and PGE₂ production increased when the cells were treated with low MIF concentrations while the parasitism control occurred only at high MIF concentrations. STAg was unable to change ERK1/2 phosphorylation or PGE₂ release. BeWo cells demonstrated increased T. gondii proliferation and reduced production of pro-inflammatory cytokines when treated with PGE₂, while PD98059 diminished the parasite proliferation.

Discussion

The intracellular mechanisms triggered by MIF are dose-dependent in BeWo cells, and PGE₂ is an important factor for the persistence of T. gondii at the maternal fetal interface.

Conclusion

MIF was unable to control T. gondii infection in BeWo cells at low concentrations since ERK1/2 and PGE₂ expression were activated, demonstrating a critical effect of these mediators favoring parasite proliferation.     

Ripening of the uterine cervix in a post-Cesarean parturient: prostaglandin E2 versus Foley catheter

Objective: To compare the success and complication rates of prostaglandin E₂ tablets (PGE₂) and a Foley catheter for the ripening of the uterine cervix in post-Cesarean section parturients. Study design: The study population in this retrospective cohort study consisted of parturients in their second pregnancy who had undergone Cesarean section in their previous delivery and who underwent ripening of the uterine cervix by using PGE₂ (n = 55) or Foley catheter (n = 161) in the current pregnancy. The control group consisted of 1432 post-Cesarean section parturients without induction of labor. We compared the rates of placental abruption, non-reassuring fetal heart rate patterns, intrapartum fetal deaths (IPFD), uterine rupture, Apgar scores, labor dystocia, severe birth canal lacerations, vacuum deliveries and repeated Cesarean section rates in the three groups by using ANOVA, χ² analysis and Fisher's exact test when appropriate. Results: A significant increase in the rates of labor dystocia during the first stage (30.4% vs. 11.6%, p < 0.01) and repeated Cesarean deliveries (49.1% vs. 35.2%, p < 0.01) were observed in women in whom the Foley catheter was used as compared to controls, respectively. No such changes were demonstrated in the PGE₂ group as compared to the controls. No significant differences were found between the PGE₂ group and Foley catheter group as compared to the controls in rates of placental abruption, IPFD, uterine rupture, fetal distress, birth canal lacerations, vacuum deliveries and Apgar scores. Conclusions: PGE₂ was found to be superior to the Foley catheter for ripening of the uterine cervix in a post-Cesarean parturient, as demonstrated by a lower repeated Cesarean delivery rate.     

Comparison of Prostaglandins E2 and F2α Blood Levels in Pre-Eclampsia with Normal Pregnancy

Levels of prostaglandins (PGs) E₂ and F₂α in the peripheral plasma of women in pre-eclampsia and in normal pregnancy have been compared. Two types of comparisons were made. In one, all the cases of pre-eclampsia were grouped together irrespective of the severity of the condition and comparisons with the normal pregnancy were made on the basis of gestation period. The results showed that there was no significant difference in PG levels in the two groups.

In the second comparison, pre-eclampsia subjects were grouped as moderate and severe cases irrespective of their gestation length. The levels of PGs in these groups were compared with those in the 3rd trimester of normal pregnancy. The results showed that the values of the two PGs in moderate pre-eclampsia were similar to those in the normal pregnancy. In contrast, however, the subjects with severe pre-eclampsia had higher PGE₂ and lower PGF₂α. levels compared with either normal pregnancy or moderate pre-eclampsia. In addition the PGE₂:PGF₂α ratio in severe pre-eclampsia was significantly higher than the ratio found in either normal pregnancy or moderate pre-eclampsia. It is possible that the change in PGE₂:PGF₂α in severe pre-eclampsia occurs as a consequence of the prevailing condition and is not the cause of pre-eclampsia.     

Gemeprost for first trimester missed abortion

In 87 patients with a missed abortion prior to 13 weeks, the application of a prostaglandin (PG) E₁ derivative (1 mg gemeprost, Cergem®) was compared to conventional surgical termination of pregnancy by cervical dilatation and curettage. In 33 patients with PGE₁ application, complete expulsion of the abnormal pregnancy occurred after an average of 2.8 ± 1.5 vaginal suppositories. PGE₁ treatment was effective in 76.7%, and surgical management was effective in 90.9% of patients. Sixty percent of the patients in the PGE₁ group required analgesia because of uterine pain in comparison to 4.5% in the surgical group. The possibility of medical termination with synthetic PG derivatives should be further investigated.     

Induction of Labour With Prostaglandin Gel in Grand Multipara with a Previous Caesarean Delivery

ObjectiveThis study sought to evaluate the safety of induction of labour with prostaglandin E₂ (PGE₂) gel in grand multiparous (GMP) women and to compare the labour outcome of GMP women who have undergone one previous Caesarean section (CS) with that of GMP women who never had a previous CS.MethodsThis prospective cohort study (Canadian Task Force Classification II-2) evaluated induction of labour with 1 mg of PGE₂ gel in 96 GMP women with one previous CS (study group) and in 104 GMP women without previous CS (control group).ResultsOne uterine rupture occurred in the study group (1%), and another occurred in the control group (0.9%). Additional oxytocin was used in seven patients (7.3%) in the study group and in 28 others (26.9%) in the control group (P = 0.002). Both uterine ruptures occurred with oxytocin augmentation. One case of uterine scar dehiscence was found in the study group. There was no significant difference between the study group and the control group regarding the rate of vaginal delivery (74 [77.1%] vs. 78 [75%]) or the rate of CS (21 [21.9%] vs. 24 [23.1%]), respectively. There was no significant difference between the groups in 5-minute Apgar scores ≤7. There was no neonatal death in either group.ConclusionA low dose (1.0 mg) of PGE₂ gel for induction of labour in GMP women with one previous CS is appropriate and appears to be safe for both mother and baby. Augmentation by oxytocin should be used judiciously.     

Retrospective Comparison of PGE2 Vaginal Insert and Foley Catheter for Outpatient Cervical Ripening

ObjectiveTo compare the efficacy of two methods of outpatient cervical ripening (CR): an intracervical Foley catheter and a prostaglandin E₂ (PGE)₂ slow-release vaginal insert.MethodsAll records of women receiving outpatient CR at a tertiary care hospital from January 2017 to June 2018 were retrospectively reviewed. We compared time from insertion of first CR agent until delivery between groups using a Cox proportional hazards (CPH) model. Exclusion criteria included age <18 years, multiple gestation, or contraindication to either CR method. Secondary outcomes included time from removal of agent and time from admission until delivery, additional CR used, uterine tachysystole, labour and delivery complications, type of delivery, and adverse neonatal outcomes.ResultsA total of 153 patients were included (82 Foley; 71 PGE₂). Baseline characteristics were comparable except for lower dilation in the PGE₂ group (16% vs. 38% <1cm dilated; P < 0.05). In the CPH model, time from insertion to delivery was not different between PGE₂ and Foley catheter groups (median 27 vs. 33 h), controlling for parity, gestational age, initial dilation, and use of oxytocin (HR 1.13, 95% confidence interval 0.77–1.68). Patients in the PGE₂ group were more likely to experience uterine tachysystole (9% vs. 0%; P < 0.01) and require another method of CR (34% vs. 1%; P < 0.001). There were no differences in neonatal or maternal adverse outcomes between groups.ConclusionOur results suggest that outpatient Foley catheter and PGE₂ CR are comparable in time from insertion to delivery; however, PGE₂ inserts are associated with higher rates of tachysystole and the need for second CR method. A prospective study is warranted to further investigate these findings.