Prostaglandin E1 Group Research Articles

Efficacy of controlled-release dinoprostone vaginal insert for elective induction of labor before due date.

The induction of labor before due date has recently been proved to reduce the rate of cesarean sections and is not associated with increased risk of adverse perinatal outcomes as compared to expectant management. Controlled-release dinoprostone (PGE2) vaginal insert has recently been approved for use in Japan. However, evidence regarding its efficacy in cervical ripening and labor induction before due date remains limited. We aimed to compare the efficacy of PGE2 vaginal inserts and mechanical dilation for labor induction before due date. This retrospective cohort study included 206 mothers at 37, 38, and 39 weeks' gestation delivered at our institution between January 2021 and October 2022. Perinatal outcomes, including the success rate of vaginal delivery, were compared between the PGE2 (n = 46) and metreurynter/laminaria tent (non-PGE2) (n = 160) groups. The success rate of vaginal delivery was defined as the proportion of women who delivered vaginally within 48 h of initiating oxytocin augmentation. The success rate of vaginal delivery was significantly higher in the PGE2 group (37/49, 80.4%) than in the non-PGE2 group (106/177, 66.2%). Emergency cesarean section related to non-reassuring fetal status was performed with none in the PGE2 group and with eight (5.0%) in the non-PGE2 group. The rate of vaginal delivery was significantly higher in the PGE2 group for elective labor induction between 37 and 39 weeks. The PGE2 vaginal insert could increase the success rate of vaginal delivery for elective induction of labor at 39 weeks.

Effect of intrafollicular administration of PGE2 or PGF2α in early estrus on ovulation, hemorrhagic anovulatory follicles formation, progesterone secretion and pregnancy outcome in the mare

This experiment was performed to evaluate whether intrafollicular treatment of PGE2 or PGF2α administered in early estrus would induce normal ovulation, progesterone production (Experiment 1) and pregnancy (Experiment 2). In Experiment 1, mares in estrus after 2 days of endometrial edema were injected in all largest dominant follicles (28–35 mm in diameter) with 0.5 mL of sterile water containing 500 μg PGE2 (n = 6), 125 μg PGF2α (n = 6) or placebo (n = 7) (Hour 0). Ultrasound examinations were performed daily, until ovulation or anovulation was detected, and daily blood samples were taken for 8 days. In Experiment 2, mares with a dominant follicle ≥35 mm after at least three days of slight-to-moderate endometrial edema, were injected with 500 μg PGE2 diluted in 0.5 mL of sterile water for injection in the follicle (PGE2 group; n = 9 mares and 11 dominant follicles). No puncture was performed in the control group (n = 9 mares and 11 dominant follicles). Mares from both groups were inseminated. In Experiment 1, all mares (6/6) in the PGE2 group ovulated within 24 h of treatment. The mean interval from intrafollicular injection to ovulation was shorter (P < 0.001) in PGE2 mares (24 ± 0 h) than in control mares (77 ± 9 h). Mares from the PGF2α group developed hemorrhagic anovulatory follicles (HAF) more often (7/7) than control mares (2/7); P < 0.05). The progesterone concentration in mares from the PGF2α group was lower (P < 0.004) than control mares in the early post-ovulatory period. The first significant increase in post-ovulatory progesterone concentration occurred earlier (P < 0.05) in mares from the control group than in mares from the PGF2α and PGE2 groups. In Experiment 2, more mares from the control group (7/9, 78 %) became pregnant than from the PGE2 group (2/9, 22 %) (P = 0.015). In conclusion, PGE2 alone induced follicle collapse in all treated mares within 24 h of administrations, while PGF2α blocked ovulation and induced formation of HAFs. However, the post-ovulatory rise in progesterone production was delayed and the fertility reduced in mares with ovulation induced by PGE2 compared to control mares.

Effects of Prostaglandin E1 and Balloon Atrial Septostomy on Cerebral Blood Flow and Oxygenation in Newborns Diagnosed with Transposition of the Great Arteries.

Dextro-transposition of the great arteries (D-TGA) is a critical congenital heart defect that can impact neurodevelopment due to cerebral perfusion and oxygenation disorders followed by alterations in synaptogenesis, gyrification, sulcation, and the microstructure. Brain injuries can occur both pre-operatively and postoperatively, especially white matter injuries, neuronal loss, and stroke. Materials and Methods: In a retrospective study conducted at a tertiary center between 2016 and 2023, we investigated the early effects of Prostaglandin E1 (PGE1) administration and balloon atrial septostomy (BAS) on cerebral blood flow and oxygenation in inborn neonates with D-TGA. Cerebral Doppler Ultrasound in the anterior cerebral artery (ACA) was performed to assess the resistive index (RI), Peak Systolic Velocity (PSV), and End-Diastolic Velocity (EVD) before PGE1, before the BAS procedure, and 24 h after birth. Cerebral regional saturations of oxygen (crSO2) and cerebral fractional tissue oxygen extraction (cFTOE) were evaluated. D-TGA patients were divided into the PGE1 group and the PGE1 + BAS group. Age-matched healthy controls were used for comparison. Results: All 83 D-TGA newborns received PGE1 within two hours after delivery, of whom 46 (55.42%) underwent BAS. In addition, 77 newborns composed the control group. PGE1 administration increased crSO2 from 47% to 50% in the PGE1 group, but lower than in controls at 24 h of life, while cFTOE remained elevated. The RI increased 24 h after delivery (0.718 vs. 0.769; p = 0.000002) due to decreased EDV (10.71 vs. 8.74; p < 0.0001) following PGE1 treatment. The BAS procedure resulted in a significant increase in crSO2 from 42% to 51% at 24 h of life in the PGE1 + BAS group. Doppler parameters exhibited a similar trend as observed in the PGE1 group. Conclusions: PGE1 treatment and BAS are lifesaving interventions that may improve cerebral perfusion and oxygenation in newborns with D-TGA during the transition period, as reflected by increasing SpO2 and crSO2.

Effects of Prostaglandin E1 on Mastectomy Flap Necrosis in Immediate Implant-Based Breast Reconstruction.

Necrosis of a cutaneous flap including the nipple-areola complex is a common complication in immediate implant-based breast reconstruction following nipple-sparing mastectomy (NSM)/skin-sparing mastectomy (SSM). This study aimed to evaluate the efficacy of prostaglandin E1 (PGE1) in reducing such complications. A retrospective analysis of prospectively collected data was conducted at two centers, and the cohort consisted of patients undergoing NSM/SSM followed by immediate reconstruction with a prosthesis. Patients who were randomly allocated to the treatment group were administered daily intravenous PGE1 (10 μg/2 mL) beginning intraoperatively through postoperative day 6. Skin flap complications including nipple/skin necrosis, delayed wound healing, and postoperative wound revision were recorded. Complication rates were compared between the PGE1 and control groups. A total of 276 breasts in 259 patients were included for analysis (139 breasts in the treatment group and 137 breasts in the control group). There was no difference in patient demographics between the control and treatment groups. Reconstructed breasts receiving PGE1 had significantly lower rates of overall skin complications (21.6% versus 34.3%; P = 0.022) and wound revision (2.9% versus 9.5%; P = 0.025). Among NSM cases, the PGE1 group showed a significantly lower rate of nipple necrosis (15.5% versus 29.4%; P = 0.027). In the multivariate analysis, the use of PGE1 significantly reduced the risk of overall skin flap complications (OR, 0.491; P = 0.018) and wound revision (OR, 0.213; P = 0.018) in NSM/SSM cases, and nipple necrosis (OR, 0.357; P = 0.008) in NSM cases. PGE1 can be effective in reducing risk of mastectomy flap complications in immediate implant-based breast reconstructions. Therapeutic, III.

EVALUATION OF INDUCTION OF LABOUR IN TERM PREMATURE RUPTURE OF MEMBRANES BY PGE2 GEL VS INTRAVENOUS OXYTOCIN INFUSION

Premature rupture of membranes (PROM) refers to rupture of fetal membranes prior to onset of regular uterine contractions. It continues to be one of the most vexing issues of obstetrics due to increased maternal and fetal morbidity and mortality due to delayed intervention. A total of 240 women were divided into two equal groups to receive either i.v. oxytocin or intracervical PGE2 gel by odd-even method with the aim to compare induction to delivery interval and maternal and fetal outcome in both groups. They were followed from admission till discharge of the patient after delivery. Induction to delivery interval was found to be more in PGE2 group but maternal and fetal outcomes were comparable in both groups

Double-balloon catheter vs dinoprostone (PGE-2) insert for labour induction: A meta-analysis of 2493 pregnancies.

Induction of labor (IOL) is the stimulation of the uterus during pregnancy to begin the onset of labour. Nearly two of five pregnancies require IOL. We compared the effectiveness of double-balloon catheter (DBC) with dinoprostone (PGE-2) insert for labour induction from previous studies. We included randomized controlled trials (RCTs) that compared the safety and efficacy of DBC to PGE-2. To evaluate the studies, we utilized the Cochrane tool for risk of bias assessment. The rates of vaginal birth and cesarean section were the primary outcomes. We included ten RCTs in this meta-analysis with a total sample of 2493 singleton pregnancies. After 24 hours, there was no significant difference in the delivery rates between DBC and PGE-2 s [R.R=1.08, 95% CI, (0.77, 1.52), P.value=0.65], and the rate of cesarean delivery [R.R=1.03, 95% CI, (0.90; 1.18), P.value=0.65]. The DBC showed a significantly higher oxytocin use rate compared to the PGE-2 group [R.R=1.77, 95% CI, (1.41; 2.32), P.value<0.0001]. In the PGE-2 group, there was a significantly higher risk of uterine hyperstimulation, tachysystole, and umbilical artery PH levels below 7. There was no significant difference in the efficacy between the PGE-2 and DBC in terms of delivery rate in 24 hours and the rate of cesarean delivery except for a slight BISHOP score improvement with DBC. However, DBC showed a higher rate of oxytocin use compared to the PGE-2, the DBC seems to be safer with a lower risk of umbilical artery PH < 7, uterine hyperstimulation, and tachysystole incidence than PGE-2.

Comparison of Labour Induction between Intracervical PGE2 Gel and Intravaginal PGE1 Analogue Tablet among Patients with Intra Uterine Foetal Death- A Cross-Sectional Study

Introduction: In spite of modern medical advancement, there is some significant pregnancy loss during antepartum period. In majority of cases labour soon follows death of the foetus, but sometimes labour does not start for several weeks. So induction of labour is needed but the unfavourable cervix remains a well-recognized impediment to success of induction of labour in intrauterine foetal death. Prostaglandins in different Seems in different routes have been widely investigated to be used for induction of labour particularly when the cervix is unripe. Both Prostaglandin E1, and Prostaglandin E2 have been proved effective equally. Dinoprostone (PGE2), has been widely used for cervical ripening and labour induction. Misoprostol, a methyl ester of prostaglandin analogue, has been shown to be effective for cervical ripening and labour induction. Aim of the study: The aim of this study was to compare the effectiveness of vaginal misoprostol (PGE1 tablet) and prostaglandin (PGE2 gel) in order to induce labour among patients with intrauterine foetal death. Methods: This was a cross-sectional study and was conducted in the Department of Obstetrics and Gynaecology of Dhaka Medical College Hospital, Dhaka, Bangladesh during the period from July, 2004 to June, 2005. In our study we included 70 patients who were given and during labour induction. Our patients were equally divided into two groups – i) Group A (Patients were given Per- vaginal prostaglandin tablet) &amp; ii) Group B (Patients were given Intra-cervical prostaglandin gel). Result: In total 70 patients from both the groups completed the study. In our study we found the mean age was 23.94±4.19 and 24.46±2.44 years in group A and group B respectively and the mean induction to onset of labour time was less in prostaglandin E2 group (5.97±3.75) hours, than in prostaglandin E1 group (8.24±3.19) hour but induction to delivery interval time was not significantly different in most of the patients in both groups. With a .......

Dinoprostone Gel versus Intra-cervical Foley’s Catheter for Pre-induction Cervical Ripening: An audit

Background One of the common practices in modern obstetrical care is labour induction when foetal and maternal complications arise. We endeavoured to compare the efficacy and safety of the inexpensive mechanical method of induction Foley’s catheter to the more established pharmacological agent Intracervical Prostaglandin E2 gel&#x0D; Method The present prospective randomised control study was carried out on 200 women with a term singleton pregnancy in cephalic presentation, with an unfavourable cervix and a valid indication for induction of labour. The patients were randomly allocated using the chit method to either Foley’s catheter [group A, n=100] or PGE2 gel [group B, n=100] . Augmentation with oxytocin was done if required and labor was closely monitored till delivery and the perinatal outcome and maternal side effects was recorded Quantitative variables were compared using unpaired t-test/Mann-Whitney Test and qualitative variables were compared using Chi-Square test /Fisher’s exact test. Analysis was done using Statistical Package for Social Sciences (SPSS) version 21.0&#x0D; &#x0D; RESULTThe caesarean section rate did not show a significant difference between the Foley’s group(18%) and PGE2 group(11%) The incidence of fetal distress, Meconium stained liquor and APGAR score &lt;7 at 5 minutes was significantly with PGE2 as compared to group A. (P&lt;.05) Incidence of hyperstimulation of uterus was reported in 6% women who received PGE2 as compared to none in Foley’s group. The induction delivery interval did not show any significant difference between the two groups.&#x0D; &#x0D; CONCLUSION In women undergoing induction of labour at term in resource constraint set ups like ours, Foley catheter is a good alternative to the more established prostaglandin E2 gel, with good efficacy and better neonatal and maternal safety profile.&#x0D; &#x0D; Keywords: cervical ripening; dinoprostone; obstetric labor, induced

Induction of Labour at Term: Comparison of Prostaglandin E2 with Foley Catheter

ABSTRACT Background: Induction of labour (IOL) or cervical ripening of an unfavourable cervix can be achieved by both pharmacological and surgical methods. When the cervix is unripe, Foley catheters and prostaglandins method of IOL is used. In this study, we aimed to compare the success rate and cost-effectiveness of vaginal prostaglandin E2 pessary with Foley catheter. Methods: This quasi-experimental study was conducted at the Gynaecological department of Ziauddin hospital from June-December 2019. A total of n=256 women at term were selected according to inclusion criteria. Group 1 was induced with Foley catheter and group 2 with Prostaglandins E2 vaginal pessary. The success rate to achieve delivery, the time interval between induction, delivery and the cost were recorded and compared between the two methods. Student’s t-test (continuous variables) and Chi-square (categories) were used for statistical analysis and p-value &lt; 0.05 was considered statistically significant. Results: The mean age of the females was 27.15 ± 5.5 years. The mean induction to the delivery time interval for PGE2 (group 2) was 15.77 ± 7.37 hours and Foley catheter (group 1) 17.31 ± 7.19 hours (p=0.02). The study did not find any statistically significant difference between the two methods of labour induction(p&gt;0.05). It was found that overall, 198 (77.3%) women delivered by spontaneous vaginal deliveries and 58 (22.7%) by lower Caesarean section (p=0.02, 0.04). However, the total cost of prostaglandins (Rs.1500/-) was higher than the cost of Foley catheter (Rs. 256/-) (p=0.00). Conclusion: Foley catheter to induce labour in an unfavourable cervix is an effective, safe, and inexpensive method of labour induction. Keywords: Foley Catheter; Prostaglandin E2; Induction of Labour; Cost.

Cervical histomorphology of successfully detorted uterine torsion affected buffaloes subjected to intracervical hyaluronidase or PgE1 treatment

Twenty-four buffaloes presented between 36-72 h of occurrence of uterine torsion were successfully detorted and equally divided to intracervical hyaluronidase enzyme or prostaglandin E1 (PgE1) treatment or control group for investigating the treatment effectiveness for complete cervical dilatation. Intracervical treatment was administered immediately after detorsion, and cervical biopsy was collected immediately before instituting treatment and at time of cervical dilatation or at 18 h post detorsion in case of non-dilated cervix. The doppler indices of middle uterine artery were evaluated at an hour before detorsion and 0.5 h after detorsion. In control group, none of the buffaloes exhibited cervical dilatation, whereas, 87.5% buffaloes of hyaluronidase group and 62.5% of PgE1 group exhibited cervical dilatation. Following intracervical treatment, lamina propria showed loosely arranged collagen fibres along with hemorrhages, polymorphonuclear (PMN) cells and intercollagen space filled by homogenous/ watery substance in case of dilated cervix. In non-dilated cervix, the collagen fibres were tightly arranged with lesser number of PMN cells and negligible haemorrhages at 18 h after treatment. The doppler indices of the middle uterine artery revealed improvement (P&lt;0.05) in blood supply towards cervix and uterus in buffaloes exhibiting complete cervical dilatation. In conclusion, intracervical hyaluronidase treatment in immediate post-detorsion period in uterine torsion affected buffaloes can be an effective strategy to ensure complete cervical dilatation and per-vaginal fetal delivery.

Histomorphometry evaluation of bone anabolism promoted by prostaglandin E1 and its relation to hypercalcemia.

At present, parathyroid hormone is the only existing anabolic bone therapy but produces hypercalcemia. Prostaglandin E1 (PGE1) has been suggested as a bone anabolic agent that allows bone modeling formation without producing hypercalcemia. This study aimed to corroborate these PGE1 properties. For 22 days, rabbits (n = 30) were divided into three groups (n = 10 each group) and received intravenous solutions: vehicle (control group), palate disjunction + vehicle (sham group), and palate disjunction + 50 μg of PGE1 (PGE1 group). On days 1, 3, and 22, palatine suture X-rays weretaken. On day 22, bone formation markers were analyzed, and the rabbits were sacrificed. Bone palate undecalcified samples were processed. Histomorphometry software was used to analyze bone parameters, and the mineralization front was stained with toluidine blue. Scalloped lines reflect remodeling-based bone formation (RBF), and smooth lines reflect modeling-based formation (MBF). X-rays showed more significant palatal disjunction in the PGE1 group; this group exhibited significant calcitriol serum increments. Hypercalciuria was observed in the PGE1 group, and resorption markers (N-telopeptides) remained stable. Sutural bones in the PGE1 group exhibited significant anabolism in structural parameters. RBF was 20%, and MBF was 6% in the sham group; in the PGE1 group, RBF was 8.6%, and MBF was 17%. In the PGE1 group, mineralization was significantly accelerated, but resorption remained stable. This model suggests that PGE1 favors palate disjunction, calcitriol synthesis, and shortens the mineralization. Therefore, PGE1 is an important bone anabolic molecule predominantly of modeling-based form and no hypercalcemia.

Dinoprostone pessary for labor induction in Chinese patients with premature rupture of membranes at term: A retrospective cohort.

Whether the use of dinoprostone pessary increased the vaginal delivery rate of labor induction in Chinese nulliparous women with term premature rupture of membranes (PROM) and unfavorable cervices? PROM women at term with singleton pregnancies and Bishop scores ≤4 who needed labor induction were enrolled in this retrospective study. They received either the dinoprostone pessary followed by oxytocin infusion if necessary (n= 102, PGE2 group) or oxytocin infusion alone (n= 103, oxytocin group). Compared with oxytocin infusion alone, vaginal delivery within 12 h and total vaginal delivery were higher in the PGE2 group (28.4% vs 7.8%, p= 0.0001; 79.4% vs 62.1%, p= 0.009, respectively). There were no statistical differences between the two groups in terms of maternal and neonatal outcomes, such as postpartum hemorrhage, endometritis, third- and fourth-degree vaginal lacerations and neonatal weight, 1- and 5-min Apgar score ≤7, neonatal jaundice, and neonatal unit admission (p> 0.05). However, there was a higher rate of uterine hyperstimulation in the PGE2 group (20.6% vs 3.9%, p< 0.0001). The effective rate of cervical ripening increased in the PGE2 group at 8 and 12 h of labor induction (p< 0.001). Despite higher rates of uterine hyperstimulation, the use of dinoprostone was associated with higher rates of vaginal deliveries in Chinese nulliparous women with term PROM and Bishop scores ≤4, compared with use of oxytocin only.

475 Comparison between medical and mechanical cervical ripening in obese nulliparous women-A randomized controlled trial

Obesity has been associated with adverse maternal and neonatal outcomes. Data regarding the optimal method of induction in this population is limited with contradicting results. In the current study we aimed to compare between medical and mechanical methods of induction in obese pregnant women. A randomized controlled trial conducted from June 2016 to July 2020. Nulliparous women with a pre-pregnancy BMI>30, singleton term pregnancies and a bishop score<5 with an indication for induction of labor were eligible for the study. Exclusion criteria included a previous cesarean section (CS), multiple pregnancy or non-cephalic presentation. Participants were randomized to either mechanical induction with a cervical ripening balloon (CRB) or a 10 mg vaginal Dinoprostone insert. The primary outcome was delivery rate within 24 hours. Secondary outcomes included time to delivery, CS rate, and 2 composites of maternal and neonatal outcomes. A total of 164 women participated in the study, 83 in the CRB group and 81 in the PGE2 group. There was a significant difference in the rate of deliveries within 24 hours, the time to delivery and the rate of need for additional induction between the PGE2 and CRB groups (45% vs. 71%, p=0.017 and 49.3±6.8 hours vs. 23.5±5.9 hours, p=0.003 and 59.2% vs. 14.4%, p<0.0001 respectively). There were no differences in the rate of vaginal delivery or other secondary outcomes (Table 2). CRB leads to expeditious delivery compared to PGE2 in obese nulliparous women without affecting other obstetric outcomes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

1020: The consequences of balloon induction on the risk for concomitant preterm birth

The prevalence of elective inductions is anticipated to increase in the years to come due to growing body of evidence demonstrating improved birth outcomes. Nevertheless, concerns have been raised regarding mechanical iatrogenic disruption of the cervical stroma due to induction of labor, with possible increased risk for preterm birth. Therefore, the aim of this study is to evaluate subsequent pregnancy outcomes following balloon induction. A retrospective case control study including all women who underwent induction of labor at a single tertiary care center, between December 2011 to August 2018. Study group included women after elective balloon induction (n=737) were compared to women induced by slow release vaginal PGE2 (Propess) (n=112). Inclusion criteria included: ≥37 weeks of gestation, concomitant spontaneous labor and singleton pregnancy. Women after cesarean delivery and multiple gestational pregnancy were excluded. Demographics, obstetrical characteristics and pregnancy outcomes were compered between groups. Data were analyzed using non-parametric tests. Age, gravidity and parity were comparable between the groups. No differences were observed in the concomitant gestational age at birth [40.3 (39.1-40.4) vs. 39.3 (38.1-40.5), balloon and slow release vaginal PGE2 respectively; p=0.12]. Furthermore, delta between concomitant to previous delivery week was comparable between groups (p=0.73). Normal vaginal delivery was reported in 91.9% (n=679) and in 93.8% (n=105) of the balloon and slow release vaginal PGE2 groups, respectively (p=0.49). Cervical dynamics was not seen in any of the patients in both groups. Balloon induction of labor was not associated with earlier gestation in concomitant delivery.

A CLINICAL COMPARATIVE STUDY BETWEEN MISOPROSTOL (PGE1) AND DINOPROSTONE (PGE2) FOR INDUCTION OF LABOUR AT TERM - A PROSPECTIVE RANDOMISED CONTROLLED TRIAL

Background: Comparative study beween misoprostol and dinoprostone for induction of labour at term has been done at various centres which showed misoprostol to be more effective. This study was done, 18 years back in 2001, when the most common method of induction was dinoprostone. Since then both the drugs has been used equally for induction of labour at term. But in recent past, PGE1 is not being used widely because of fear of untoward effect. Hence, the importance this article which shows misoprostol to be more effective with less side effects, easy for storage and low cost. This study is to compare the effectiveness between the two molecules of prostaglandins PGE1 and PGE2 for induction of labour in term. The complication can be reduced by proper selection, 1 to 1 and continuous fetal monitoring.&#x0D; Methods: It was a prospective RCT. 200 Women at term in whom induction of labour was indicated with no contraindications for the use of prostaglandin attending labor room in a tertiary care centre (SAT Hospital Government Medical College Trivandrum) for a period of five months, from September 1St 2000 to January 31st 2001 was chosen to compare the effectiveness of Misoprostol and Dinoprostone for induction of labour at term. Both the groups were comparable in age, parity and bishop score.&#x0D; Results: Among 200, 123(61%) were primigravida and 146 (73%) were in the age group of 21 – 30 yrs. Median induction delivery interval was about 9 hrs shorter in PGE1 group. Only14.14% required oxytocin augmentation in PGE1 Group compared to 50.54% in PGE2 group. There was 8 failures in PGE2 and there was one case of hyper stimulation in PGEI group for which LSCS was done. PGE2 costs 10 times more than PGE1.&#x0D; Conclusion: Misoprostol is faster acting with low induction delivery interval and requirement for oxytoccin augmentation. Misoprostol is low cost drug, affordable to most of our patient from low socio economic status.&#x0D; Keywords: Term pregnancy, Tab Misoprostol, PGE1, Dinoprostone gel, PGE2, Induction of labour.

Pathogenetic justification and clinical significance of using arginine for prevention of critical ischemia of lower extremities and fatal manifestations of multifocal atherosclerosis

The aim — to investigate the results of treatment with L‑arginine of patients with intermittent claudication for prevention of critical stages of limb ischemia.Materials and methods. 86 patients with intermittent claudication were randomly divided into two groups of 43 patients each. Patients of the first group received 8 g of L‑arginine (Tivortin) twice a day, patients of the second group — 40 mg of prostaglandin E1 (PGE1) twice a day.Results and discussion. Administration of L‑arginine contributed to an increase in the distance of painless walk by 230 ± 63 %, the absolute walk distance — by 155 ± 48 % (p < 0.05), the administration of PGE1 — by 209 ± 63 % and 144 ± 28 %, respectively (p < 0.05). Treatment with L‑arginine increased the value of the coefficient of L‑arginine/asymmetric dimethylarginine in plasma and the excretion of nitrates and cGMP in the urine, which indicated the normalization of the biosynthesis of endogenous NO. PGE1 therapy did not significantly affect endothelium‑dependent vasodilation parameters. The coefficient of quality of life, estimated in an analog scale, increased from 3.51 ± 0.18 to 8.3 ± 0.4 in the arginine group and to 7.0 ± 0.5 in the PGE1 group (all p < 0.05).Conclusions. Arginine is a drug of choice to prevention of severe forms of lower limbs ischemia and other manifestations of multifocal atherosclerosis.

Prevention of contrast-induced nephropathy with prostaglandin E1 in patients undergoing percutaneous coronary procedures: A meta-analysis of 24 randomized controlled trials .

Contrast-induced nephropathy (CIN) is the third most common cause of acute kidney injury in hospitalized patients. There have been many conflicting results across trials that have evaluated the prophylactic efficacy of prostaglandin E1 (PGE1) for prevention of CIN in patients undergoing percutaneous coronary procedures. PGE1 may have renal-protective effects due to its pleiotropic properties. The aim of this study was to evaluate the efficacy of PGE1 in preventing CIN. We searched PubMed, Embase, Cochrane Library, Chinese Biomedical Literature, China National Knowledge Infrastructure, VIP Information/Chinese Scientific Journals, and WANFANG databases for randomized controlled trials (RCTs) comparing the preventive effects of PGE1 versus controls (conventional hydration, no PGE1, or placebo) on CIN in patients undergoing percutaneous coronary procedures from January 1999 to June 2016. Study characteristics and outcome data were abstracted by two independent reviewers; the risk of bias was also assessed by two reviewers. 24 RCTs involving 3,915 patients were included. Compared with controls, PGE1 reduced the risk of CIN (risk ratio: 0.40, 95% confidence interval (CI): 0.33, 0.48; p < 0.01). Serum creatinine levels in the PGE1 groups were significantly lower than in the control groups at 24, 48, and 72hours after operation (mean difference (MD): -10.06, 95% CI: -16.94, -3.19; MD: -15.47, 95% CI: -21.75, -9.18; and MD: -11.15, 95% CI: -14.40, -7.91, respectively). Cystatin C was significantly lower for the PGE1 group than the control groups at 24, 48, and 72 hours after operation (MD: -0.24, 95% CI: -0.40, -0.07; MD: -0.34, 95% CI: -0.53, -0.14; and MD: -0.32, 95% CI: -0.49, -0.15, respectively). PGE1 may play an important role in reducing the incidence of CIN in patients undergoing percutaneous coronary procedures. .

Effect of intracoronary prostaglandin E1 injection prior to percutaneous coronary intervention on myocardial microcirculation perfusion and clinical outcome in acute non-ST segment elevation myocardial infarction

Objective To discuss the clinical effects and the major adverse cardiac events of intracoronary prostaglandin E1 injection prior to percutaneous coronary intervention(PCI) in early(within 24h of symptom onset) interventional treatment for patients with acute non-ST segment elevation myocardial infarction(NSTEMI). Methods 122 patients with NSTEMI who underwent early interventional treatment were divided into three groups according to the digital table: 41 cases in prostaglandin E1 group, 41 cases in nitroglycerin group, 40 cases in control group. The TIMI blood flow was compared among the three groups after PCI. All patients were followed up during 6 months about major adverse cardiac events(MACE) and the cardiac structure and function by echocardiography. Results After primary PCI, the corrected TIMI frame count(CTFC) was significantly better in the prostaglandin E1 group[(20.22±6.82)] than in the nitroglycerin group[(26.35±8.71)] and the control group[(27.02±9.65), t=6.451, 6.763, all P 0.05). All patients were followed up for 6 months, the LVDd in the prostaglandin E1 group[(46.8±3.7)mm] was significantly lower than that in the nitroglycerin group[(49.5±5.8)mm] and the control group[(50.2±4.9)mm, t=6.312, 5.893, all P 0.05). Conclusion Intracoronary administration of prostaglandin E1 injection prior to balloon dilation can significantly improve the myocardial microcirculation perfusion, and can decrease MACE in patients with NSTEMI who underwent early interventional treatment. Key words: Myocardial infarction; Myocardial perfusion imaging; Prostaglandin E1

93: Induction of labor at term with a live fetus: is 25μg of vaginal misoprostol non inferior to slow release 10mg PGE2 Pessary? CYTOPRO, A french multicentre randomized controlled trial, (NCT01765881)

To test whether 25μg vaginal misoprostol is non-inferior to slow release PGE2 pessary for induction of labor with unfavorable cervix at term. This is an open-label multicenter randomized controlled trial conducted in 4 hospitals of the Research Group in Obstetrics and Gynecology (GROG). We included women necessitating induction of labor with an unfavorable cervix at term (≥ 36 weeks) with a singleton pregnancy in cephalic presentation without prior cesarean section (CS). Women were randomly allocated to 25μg vaginal misoprostol 4-hourly or PGE2 pessary. Primary outcome was total CS rate. Secondary outcome was drug tolerance. Analyses were done both by intention-to-treat and per protocol. In this non-inferiority trial, the non-inferiority margin was 5% of the absolute difference in the CS rate. We randomized 836 women to vaginal misoprostol and 838 women to PGE2 pessary between September 2013 and June 2015. Total CS rate was 22.0% in the misoprostol and 19.8% in the PGE2 groups. The absolute difference in CS rates between misoprostol and PGE2 groups was 2.2% with an upper 95% confidence limit of 5.5% that exceeded the non-inferiority margin (5%) in the intention-to treat and per protocol analysis sets. Rate of deliveries ≤ 24 hours was significantly higher in the misoprostol group (72.9% vs. 55.9%; p< 0.001). Neonatal morbidity was comparable between groups in terms of arterial umbilical cord pH < 7.05 (1.3% vs. 1.6%, p=0.6), 5-minute Apgar score < 7 (3.6% vs. 4.8.5%, p=0.2) and meconium-stained amniotic fluid (4.2% vs. 3.9%, p=0.8). Rates of uterine hyperstimulation with and without FHR changes were not different between groups. Non-inferiority of 25μg vaginal misoprostol 4-hourly to PEG2 pessary on CS rate for induction of labor at term was not demonstrated in our multicenter RCT. However, as neonatal morbidity was comparable and CS rates very close, both drugs could be considered.

PGE1 improves diabetic peripheral neuropathy in patients with type 2 diabetes

BackgroundDiabetic peripheral neuropathy (DPN) is the most common chronic complication of diabetes. We aim to investigate the efficacy of Prostaglandin E1 (PGE1) treatment in addition to intensive insulin therapy on DPN in patients with type 2 diabetes. MethodsSeventy-seven patients with DPN received daily intravenous injection of Prostaglandin E1 (PGE1) in lipid microspheres (Lipo-PGE1) for 10days as an additional therapy to standard glucose control therapy (PGE1 group). Another 42 patients with DPN receiving only standard glucose control therapy (intensive insulin therapy) acted as a control group. Michigan neuropathy screening instrument (MNSI) score, neurophysiology examination, transcutaneous oxygen sensory threshold, and ankle-brachial index (ABI) were measured to evaluate the efficacy of PGE1 treatment as compared with control group. ResultsStandard glucose control therapy decreased plasma glucose to a similar level in both PGE1 and control groups. Compare to control group, PGE1 group displayed improvement in several nerve electrophysiological indexes. MNSI score was significantly improved in patients who received PGE1 treatment compared with the control group (p<0.001) after 10days of PGE1 treatment. Similarly, nerve conduction velocity and foot sensory thresholds (p<0.05 for all) also significantly improved compared with the control group after 10days of PGE1 treatment. However, only intensive insulin therapy did not improve any neural function. ConclusionsLipo-PGE1 can effectively improve neural function of patients with DPN.