Application Of Prostaglandin E2 Gel Research Articles

PG E2 gel supplemented with oral PG E2 for induction of labour in high risk pregnancy

INTRODUCTION: The risks to the fetus-infant increase substantively in high risk pregnancies. The efforts are always to ensure a vaginal rather than a caesarian delivery. The present study aims to assess the safety and efficacy of Prostaglandin E2( PGE2) intracervical gel and oral PGE2 in inducing and augmenting labour in such patients. METHODS: PGE2 intracervical gel was used for induction oflabour in 100 high risk pregnancies. PGE2 gel was supplemented by oral PGE2 afterARM. RESULTS: PGE2 successfully induced labour in 60% of women while it improved the Bishop's score in the rest of the cases. L.S.C.S. was needed in only 7% of women. CONCLUSION: Intracervical PGE2 gel application is a safe and efficacious method of inducing labour, which can be augmented with oral PGE2 when needed. DOI: http://dx.doi.org/10.3126/jucms.v1i4.9568 Journal of Universal College of Medical Sciences (2013) Vol.1 No.04: 22-25

Coagulación intravascular diseminada: una complicación de la inducción del parto con prostaglandinas

ObjectivesWe studied 12 cases of disseminated intravascular coagulation (DIC) associated with the use of intracervical prostaglandin E2 (PgE2) for labor induction. Subjects and methodsFrom September 1995 to March 2003, PgE2 gel was applied to 4,013 term pregnancies for labor induction. Clinical data and blood coagulation analysis were conclusive in the diagnosis of DIC. ResultsThe frequency of this complication was relatively low (3 x 1000 inductions) but maternal morbidity was high (50% of the patients required hysterectomy). The most significant marker of the coagulation disorder consisted of blood levels of D dimmer, which in most cases were greater than 8,000 µg/L. In all patients, pathological reports showed epithelial damage of the cervical channel with vascular compromise. We found no evidence that the intravascular passage of amniotic fluid was the trigger mechanism for DIC. ConclusionThese 12 cases of DIC, which appeared after intracervical application of PgE2 gel, can be attributed to the intravascular passage of tissue factor from the cervical channel, or even to an immunologic response to the direct passage of PgE2 through the cervical epithelial tissue. The possibility that DIC is caused by amniotic fluid seems highly improbable. The success of hysterectomy (in six patients) as a last resort to control bleeding provides further evidence against an amniotic fluid embolism as the trigger mechanism for DIC.

COMPARISON OF INTRACERVICAL PROSTAGLANDIN E2 AND INTRAVENOUS OXYTOCIN IN INDUCTION OF LABOUR

154 patients requiring induction with unfavourable cervix at varying period of gestation were studied. Patients were distributed into two groups. 76 patients were induced with 0.5 mgm single dose intracervical application of Prostaglandin E2 gel and remaining 78 patients with Oxytocin and efficacy of the two methods of induction was compared. Labour was established within 24 hours in 71.4% of primigravidas and 91.7% of multigravidas in the prostaglandin treated group compared to 65.6% of primigravidas and 89.1% of multigravidas in the oxytocin group. The study found substantial improvement in cervical score 12 hours after application of intracervical prostaglandin E2 gel and decrease in Caesarean section rate with no major adverse effect to mother or neonate.

Uterine rupture at term pregnancy with the use of intracervical prostaglandin E 2, gel for induction of labor

Prostaglandin E2 is a powerful oxytocic agent that reliably initiates labor, even in the presence of an unripe cervix. The low incidence of fetomaternal complication contributes to its universal use. We report a rare case of uterine rupture after intracervical application of prostaglandin E2 gel. Thus far no prostaglandin compound or method of administration seems to be exempt from such a complication.

Effect of intravaginal application of prostaglandin E2 gel on the mechanical properties of the ovine cervix uteri at term

The extensibility (“creep” or strain per minute) and the stretch modulus (stress per unit strain) of strips of cervical tissue were measured in vitro. Intravaginal application of prostaglandin E2 gel led to a fourfold increase in the extensibility (mean ± SE, 15.45 ± 0.26 versus 4.23 ± 0.86 min−1; p < 0.05) and a twofold reduction in the stretch modulus (mean ± SE, 0.66 ± 0.03 versus 1.28 ± 0.12 N · mm2; p < 0.0005). This marked increase in the degree of softening occurred in the absence of an increase in uterine activity or changes in plasma progesterone concentrations.

Cervical repening and labor induction with prostaglandin E2 gel: A placebo-controlled study

A randomized double-blind, placebo-controlled study was undertaken to evaluate the effect of a single intracervical application of prostaglandin E2 gel on the ripening of the cervix and on the subsequent induction of labor with oxytocin in patients with low Bishop scores (≤4). Compared to controls receiving gel only, the group receiving prostaglandin E2 gel had significant increases in their cervical Bishop scores, shorter induction-to-delivery intervals, shorter time requiring use of oxytocin, and more successful labor induction without oxytocin. Systemic side effects were minimal and fetal outcomes were comparable, as were the routes of delivery.

Avoiding cesarean deliveries by intravenous prostaglandin E2 administration (PGE2)

The study reported here was prompted by the question whether caesarean deliveries which would otherwise be necessary can be avoided by intravenous infusion of prostaglandin E2 (PGE2). The authors consider intravenous administration of PGE2 during delivery to be indicated in cases which fail to respond to therapy after three local cervical maturation attempts and in standstills where oxytocin has no effect. Out of a total of 5835 women who gave birth at the Obstetrics Department of the Berlin-Neukölln Gynecological Clinic between 1980 and 1981, those who had been given intravenous infusions of PGE2 were identified and a check was made to establish whether this treatment offers any advantages. PGE2 infusion after unsuccessful intracervical application of PGE2 gel: Out of 1122 risk patients in whom cervical maturation prior to induction of birth appeared desirable, 43 (3.8%) still had a Bishop Score of less than or equal to 7 after three local applications of PGE2 gel. Attempts to achieve a vaginal delivery in spite of this, by means of PGE2 infusion, were successful in 60% of the cases. The mean rate of PGE2 infusion was 1.1 +/- 0.3 microgram/min. Four women were given oxytocin in addition, in an average dose of 9.3 +/- 1.1 mU/min. The average duration of labour was 10 hours 30 min. Complications in mother and child occurred no more frequently than in other risk births. PGE2 infusion in cases with standstill not responding to oxytocin treatment: In 82 parturients (1.4%) a standstill occurred during labour after initially normal dilation of the cervix, and could not be overcome by administration of oxytocin.(ABSTRACT TRUNCATED AT 250 WORDS)