Prostaglandin E2 Suppositories Research Articles

A control study on the COOK balloon catheter, prostaglandin E2 Suppositories and misoprostol in induction of labor at term

Objective To evaluate the effectiveness and safety of Misoprostol,Prostaglandin E2 suppositories and COOK balloon catheter in induction of labor at term.Methods 91 women of full-term pregnancy with indications of induced abortion,and cervical Bishop score ＜6 were randomly divided into Misoprostol group (31 cases),Prostaglandin E2 group (32 cases) and COOK balloon group (28 women).The improvement of cervical conditions was compared before and after the application.The uterine contraction,labor time,fetus delivery method,situation of maternal and newborn were determined.Results The obvious effective rate in Prostaglandin E2 suppositories was 78.6％,in COOK balloon group it was 75.0％,both were significantly higher than those in Misoprostol group.However,the side effect such as placental abruption was found in Prostaglandin E2 group.The cesarean section ratios in the COOK balloon group and the prostaglandin E2 group were much the same,but both were lower than those of the Misoprostol group.Conclusion Although the efficacy of Misoprostol is much weak,it is convenient and cheap.COOK balloon catheter method is the same as prostaglandin E2 in induced labor at term,it is safe and has less side effect. Key words: Misoprostol; Prostaglandin E2; COOK balloon catheter; Induction of labor at term

Second Trimester Abortion Using Prostaglandin E2 Suppositories With or Without Intracervical Laminaria japonica

In Brief Objective To compare the abortifacient efficacy of vaginal prostaglandin (PG) E2 suppositories with and without pretreatment with intracervical PGE2 gel and Laminaria japonica. Methods One hundred seventy-five women between 16 and 20 weeks' gestation requesting abortion were divided randomly into three groups. Forty-one received PGE2 vaginal suppositories alone to induce abortion, 72 had Laminaria placed 24 hours before vaginal PGE2, and 62 were given intracervical 0.5 mg PGE2 gel plus Laminaria 24 hours before vaginal PGE2. Maternal demographic characteristics, induction to delivery time, number of suppositories required, and complications were analyzed. Results The mean maternal age, gravidity, parity, race, and gestational age were similar among groups. Ninety-five percent of all women delivered within 24 hours. The induction to delivery time was significantly longer in the PGE2-only women (mean ± standard deviation 689 ± 319 minutes) compared with that of those receiving PGE2 plus Laminaria (487 ± 321 minutes) and PGE2 plus Laminaria plus gel (547 ± 374 minutes, P = .01). There was a statistically significant difference in the number of suppositories needed to complete the abortion process. The PGE2-only group required more suppositories (median three, range 1-8) compared with PGE2 plus Laminaria (median 3, range 1-3) and PGE2 plus Laminaria plus gel (median 2.5, range 1-9; P = .001). Patients in the PGE2 plus Laminaria plus gel group reported more pain associated with placement (median pain score 4, range 0-10) compared with PGE2 plus Laminaria (median 2, range 0-9; P = .003). There was a lower incidence of febrile episodes in the PGE2-only group (29%) compared with PGE2 plus Laminaria (68%) and PGE2 plus Laminaria plus gel (54%, P = .002). Conclusion Placement of Laminaria japonica 24 hours before PGE2 vaginal suppository-induced abortion resulted in a significantly shorter induction-to-delivery time, and pretreatment with Laminaria japonica decreased the number of suppositories required to complete abortion. Pretreatment with intracervical PGE2 gel increased pain associated with Laminaria placement and did not improve the efficacy of the procedure. Pretreatment with Laminaria japonica improves the induction to delivery time in patients undergoing second trimester abortions with prostaglandin E2.

Intraurethral prostaglandin E-2 cream: A possible alternative treatment for erectile dysfunction

Prostaglandin E-2 (PGE-2) is an oxytocic agent in suppository form with vasodilatory effects similar to prostaglandin E-1 (PGE-1). Because some men find intracavernosal injections disagreeable, we investigated whether intraurethral PGE-2 may provide an alternative method for treating erectile dysfunction. A PGE-2 cream was made using PGE-2 suppositories (20 mg or 40 mg), 10 cc of 2% lidocaine (Xylocaine) jelly, and 40 cc of surgical lubrication. Two cc of the cream was instilled into the urethral meatus using a syringe, the cream was massaged down the urethra, and the urethra was occluded for five minutes. Treatment response was rated as no penile tumescence, partial tumescence, and full tumescence. Overall, 70 percent showed a response and 30 percent had full penile tumescence. Two of 4 men who had no tumescence using PGE-2 had a subsequent full tumescence using intracavernosal PGE-1 (15 mg), while 3 of 4 men with a partial tumescence with PGE-2 had a subsequent full tumescence using intracavernosal PGE-1 (15 mg). These data demonstrate that full penile tumescence may be achieved in impotent men using intraurethral PGE-2 cream. This pilot study supports the necessity for further investigations in a randomized double-blind manner in the use of intraurethral PGE-2 cream as a less invasive treatment alternative for erectile dysfunction.

Abortion

In 1991, the abortion literature was characterized by articles relating to 1) epidemiologic issues in abortion care, 2) advances in knowledge and experience with medical abortifacients such as mifepristone (RU 486), and 3) cervical ripening prior to abortion with the use of both mifepristone and prostaglandins. Technical methods of achieving termination of pregnancy continue to be similar in the United States, the United Kingdom, and Europe, although induction-abortion times are generally slower in Europe than in the United States. Surgically, dilatation and evacuation procedures continue to be more common in the United States than in other countries. The effectiveness of mifepristone is undisputed, and the recommended dose for early first-trimester termination is being compared with lower dose alternative regimens. There is additional evidence that at least in the short term, the negative psychological sequelae of abortion are infrequent and are inconsequential as a public health issue.

Mid-Second-Trimester Labor Induction: Concentrated Oxytocin Compared With Prostaglandin E2 Vaginal Suppositories

A concentrated oxytocin infusion and prostaglandin E2 (PGE2) vaginal suppositories were compared in a retrospective analysis for indicated abortion in the mid-second trimester (17-24 weeks' gestation). Eighty-one women underwent second-trimester pregnancy termination, 59 by PGE2 suppositories and 22 by concentrated oxytocin infusion. Success was achieved by PGE2 in 93% (55 of 59) and oxytocin in 91% (20 of 22). The mean duration of labor was 13.1 hours with PGE2 and 8.2 hours with oxytocin. The mean dose of PGE2 was 65.2 mg; of oxytocin, 200 units. Women who received PGE2 experienced nausea (46%), vomiting (37%), fever (64%), and diarrhea (20%) despite appropriate premedication. Few side effects occurred in the women who were treated with oxytocin. We conclude that concentrated oxytocin infusion seems to be a reasonable alternative to PGE2 vaginal suppositories for induction of labor in the mid-second trimester.

Management of the third stage of labor in pregnancies terminated by prostaglandin E 2

In the management of second-trimester medical terminations of pregnancy, it is a commonly accepted practice to allow 2 hours for the third stage of labor. This practice is based on data from terminations with saline solution as the abortifacient. Herein we report our experience with the use of prostaglandin E2 vaginal suppositories for midtrimester terminations, with particular regard to placental delivery rates and associated complications. Ninety-six patients underwent prostaglandin E2 vaginal suppository terminations. Fifty-eight percent of patients had spontaneous placental delivery within 2 hours of the passage of the fetus; approximately two thirds of these were expelled within 30 minutes. Previous work involving elective saline solution-induced terminations suggested the 2-hour time limit for the third stage of labor. This was based on an unacceptable complication rate of greater than 4% beyond 2 hours. The present study of the use of prostaglandin E2 suppositories for a variety of indications demonstrated a similar complication rate of 4% at 30 minutes. These findings suggest expectant management beyond this time limit may produce unacceptably high complication rates.

Cardiac output response to prostaglandin E2-induced abortion in the second trimester

Maternal cardiac output changes were evaluated in 10 patients undergoing second-trimester abortion induced by prostaglandin E2 suppositories. The peak cardiac output increased by an average of 64.5% above preinduction values. This is similar to the percent increase described during oxytocin-induced labor at term. Inasmuch as resting cardiac output tends to be higher in midpregnancy than at term, absolute values during prostaglandin E2 induction were higher than those observed in laboring term patients.

Uterine Rupture Associated with the Use of Vaginal Prostaglandin E2 Suppositories

Uterine Rupture Associated with the Use of Vaginal Prostaglandin E2 Suppositories

Uterine Rupture Associated with the Use of Vaginal Prostaglandin E2 Suppositories

The authors present an obstetrical case of silent uterine rupture due to prostaglandin E2 vaginal suppositories. Although this complication has been reported in the obstetrical literature, lack of attention to it in the anaesthesia literature, causes us to call this problem to the attention of anaesthetists.

Pregnancy termination in patients with pregnancy-induced hypertension or eclampsia at less than 22 weeks' gestation

3 patients with fetal death, 2 of whom had pregnancy-induced hypertension and a third with eclampsia had pregnancy termination before 22 weeks' gestation with vaginal prostaglandin E2 (PGE2) suppositories, without complication. PGE2 has a hypotensive action, decreasing blood pressure by arteriolar dilation and blocking the angiotensin-induced rise in blood pressure in the pregnant rhesus monkey and should be useful abortifacient in patients with hypertension including preeclampsia and eclampsia. One patient received magnesium sulfate and the other 2 received hydralazine and methyldopa during PGE2 administration which could alter mean arterial pressure (MAP). MAPs remained stable and dropped slightly after PGE2 administration in the 2nd and 3rd patients. These outcomes suggest that PGE2 suppositories can be used to terminate 2nd trimester pregnancy in cases of hypertension and eclampsia when routine medical management is ineffective or when fetal death occurs although caution is advised since severe hypotension can occur with PGE2 administration.

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.

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.

Uterine rupture with the use of vaginal prostaglandin E2 suppositories

Uterine rupture with the use of vaginal prostaglandin E2 suppositories

Serum relaxin levels in prostaglandin E 2 induced abortions

Relaxin, a peptide hormone produced only by the corpus luteum of pregnancy, can be used as a marker of luteal function in human pregnancy. Serum immunoreactive relaxin levels were measured serially in six women having second trimester abortions induced with intravaginal prostaglandin E2 (PGE 2) suppositories. All patients aborted within 17 hours of the first suppository. No significant changes were detectable in serum relaxin levels in any of the patients. It is concluded that PGE 2 does not interfere with the corpus luteum's ability to secrete relaxin in the second trimester of human pregnancy.

Vaginal prostaglandin E2 for missed abortion and intrauterine fetal death

Vaginal suppositories containing 20 mg. of prostaglandin E2 (PGE2) were given to 50 patients with a diagnosis of either missed abortion or fetal death. A total of 94 per cent of the patients (47/50) expelled products of conception, and 84 per cent of these expulsions (42/50) were complete. The mean time to expulsion of the fetus was 11.3 hours with a mean dose of 3.6 suppositories. A total of 60 per cent of the patients experienced vomiting, diarrhea, and pyrexia. Four patients had a blood loss in excess of 500 ml., and two of these patients required blood transfusion. Vaginal administration of PGE2 suppositories appeared to be a rapid, safe, and reliable means of managing missed abortion and intrauterine fetal death.

Induction of labor in patients with missed abortion and fetal death in utero with prostaglandin E2 suppositories

Labor was successfully induced in 20 patients with a diagnosis of missed abortion or intrauterine fetal death (IUFD) by intravaginal administration of prostaglandin E2 suppositories. Fifteen patients delivered with the prostaglandin alone while a concomitant oxytocin infusion was employed to augment contractions in the other five patients. The mean induction-delivery time was 9.80 hours; nulliparous patients delivered in a mean time of 7.78 hours, parous patients in a mean time of 12.29 hours. The uterus appeared to be sensitive to the PGE2 stimulation in all patients and all were delivered completely without the need for surgical intervention. Fifty per cent of patients were delivered within 8 hours and 80 per cent by 12 hours. The side effects associated with prostaglandin administration—vomiting, diarrhea, and temperature elevation—were well tolerated and therapy did not have to be terminated in any patient. The administration of PGE2 vaginal suppositories offers an effective and safe technique for the induction of labor in patients with IUFD. Labor can be induced with PGE2 suppositories as soon as the diagnosis of IUFD is confirmed, which climinates the need for waiting until spontaneous labor occurs.

Mid-trimester abortion induced by intravaginal administration of prostaglandin E2 suppositories

Mid-trimester abortion was successfully induced in 70 of 71 patients by administration of vaginal PGE2 suppositories. The one patient who failed to abort with this method was pregnant in the blind horn of a duplex uterus. The mean abortion time for the successful inductions was 11.88 hours. Multiparous patients aborted somewhat faster than nulliparous patients, but the difference was not significant. Among the 70 successful inductions 42 patients aborted in 12 hours or less and only one patient had an abortion time of more than 24 hours. The drug appeared effective throughout the stages of gestation included in this series—from 8 to 27 weeks. Eight patients were monitored throughout the abortion procedure and uterine activity was calculated and analyzed. The development of uterine activity was gradual without the sudden rise in frequency of contractions and intrauterine baseline tonus that characterized prostaglandin administered by other methods. The most frequently encountered side effect of vaginal PGE2 suppositories was a temperature elevation, which returned to normal within a few hours of the last dose of the drug. Gastrointestinal disturbances—vomiting and diarrhea—were also common, despite a low initial dose of PGE2 and premedication with antiemetic and antidiarrheal agents. These side effects were in general well tolerated by the patients and never required termination of therapy. The cardiovascular effects of PGE2 in this series could be considered minimal. In a single patient surgical intervention was required to remove the placenta. In seven patients the placenta was removed by sponge forceps and in five patients the placenta was removed manually. There was an estimated blood loss exceeding 250 ml. in 10 patients, but transfusion was not required. Although white blood cell count rose significantly during the abortion period there were no significant changes in hematocrit or platelet count. Mid-trimester abortion with intravaginal administration of PGE2 suppositories appears to offer a valid alternative to the presently available techniques, with a rapid abortion time, high success rate, and low incidence of complications.

Reduction of cervical resistance by prostaglandin suppositories prior to dilatation for induced abortion

Several recent reports citing increased rates of prematurity among women who have had induced first-trimester abortion suggest that forceful cervical dilatation may result in cervical incompetence in future pregnancy. There appear to be conflicting clinical impressions regarding the effectiveness on cervical softening and the reduction of cervical resistance produced by various prostaglandins. The development of the Electronic Force Monitor which is capable of precise measurement of the forces encoutered in overcoming resistance during dilatation provided objective evidence with which to evaluate the effects of vaginally administered prostaglandin E2 and F2α suppositories. Suppositories were administered 3 hours prior to cervical dilatation, after which suction curettage was performed. Compared to the nonmedicated control group, patients receiving PGF2α suppositories exhibited greatly reduced cervical resistance, in some cases permitting direct introduction of the suction curette without need for any preliminary dilatation. Those patients receiving PGE2 suppositories showed an intermediate degree of cervical softening.