Acute myocardial infarction associated with prostaglandin E2

Article Abstract:

Prostaglandin E2 (PGE2) is a fatty acid and product of arachidonic acid metabolism. It can be used to terminate pregnancy; prepare the cervix (opening of the uterus) for delivery; and induce labor. PGE2 usually causes mild side effects including nausea, vomiting, fever, diarrhea, and low blood pressure. A case is described of a 38-year-old woman who had a heart attack after being given PGE2 to terminate a pregnancy in the nineteenth week. The patient had a history of chronic high blood pressure (hypertension); impaired kidney function; and two miscarriages due to preeclampsia, a complication of pregnancy characterized by hypertension, headaches, protein in the urine, and accumulation of fluid in the legs. The woman had symptoms of congestive heart failure, the inability of the heart to pump blood leading to congestion of the lungs. After counselling, the patient decided to terminate the pregnancy, which was considered high risk. Thirty minutes after receiving PGE2, the patient developed a drop in blood pressure (hypotension), a slowed heart rate, cardiovascular collapse, and an abnormal heart rhythm. After defibrillation, drugs to improve blood flow and pressure and eliminate abnormal heart rhythms were administered and the woman was placed on artificial respiration. Examination of the electrical activity of the heart indicated a heart attack had occurred. The patient gradually improved, was taken off the respirator, and delivered the fetus eight hours after the heart attack. PGE2 rarely causes complications of the heart and circulatory system, but can dilate blood vessels and produce a drop in blood pressure. The combined effects of PGE2 and antihypertensive agents to lower blood pressure may have reduced blood flow to the heart leading to a heart attack. PGE2 should be used with caution in patients treated with antihypertensive agents. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Causes of, Heart attack, Drug interactions, Prostaglandins E

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Factors associated with preterm birth in Cardiff, Wales: indicated and spontaneous preterm birth

Article Abstract:

The risk factors for medically indicated preterm delivery versus spontaneous preterm birth appear to differ. Researchers analyzed the factors associated with preterm birth among residents of Cardiff, Wales who gave birth from 1970 through 1979. Overall, 25,071 women gave birth at term, 443 women had medically indicated preterm deliveries, and 691 women had spontaneous preterm births. Low maternal weight and early pregnancy bleeding were associated with both spontaneous and medically indicated preterm birth. Young age, history of previous abortion, smoking, and low social class were associated with spontaneous preterm birth but not medically indicated delivery. By contrast, older age, history of stillbirth, and urinary tract infection were associated with medically indicated preterm delivery but not spontaneous preterm birth.

Risk factors, Premature birth

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Misoprostol is more efficacious for labor induction than prostaglandin E2, but is it associated with more risk?

Article Abstract:

Misoprostol is more effective in inducing labor but it also has serious side effects. In a study of 159 women in labor, misoprostol significantly shortened delivery times. However, it was more likely to cause fetal distress and fetal heart rate abnormalities.

Labor, Induced (Obstetrics), Induced labor, Misoprostol, Synthetic prostaglandins E

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