Uterine hyperstimulation after low-dose prostaglandin E2 therapy: tocolytic treatment in 181 cases

Article Abstract:

Prostaglandin E2 (PGE2, a fatty acid with many physiological actions) is often given to hasten ripening (softening and dilation) of the uterine cervix and to induce labor. But PGE2 can produce the unwanted side effect of excess uterine contractions (hyperstimulation). This, in turn, may lead to impairment of the circulation between the uterus and placenta. Descriptions of PGE2-induced uterine hyperstimulation in the medical literature appear rarely, so to add to the knowledge regarding the subject, the cases at two medical centers over a 51-month-long period were combined and evaluated. In this time, 3,099 women underwent treatment with PGE2 for cervical ripening as a result of postdate pregnancy, high blood pressure, diabetes, or possible fetal growth retardation. In all cases, fetal heart rate was normal, and regular uterine contractions were not present. The drug was administered three ways: as a vaginal tablet, an intravaginal gel, or an intracervical gel. Results showed that 181 women (5.8 percent) developed uterine hyperstimulation. More specifically, uterine hyperstimulation was observed in 7.3 percent of the women who received the intravaginal tablet, 2.9 percent of those who received the intravaginal gel, and less than 1 percent of those treated with the intracervical gel. In slightly over 98 percent of the cases, administration of another drug (a beta-2-adrenergic drug) reversed the hyperstimulation. Three cases required cesarean section. The effect was not associated with any complications of delivery, nor did any catastrophic side effects occur. The results indicate that therapy with PGE2 rarely leads to uterine hyperstimulation, and when it does, the effects can easily be reversed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Uterus, Uterine contractions, Tocolytic agents

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Uterine and fetal Doppler flow changes after intravaginal prostaglandin E-2 therapy for cervical ripening

Article Abstract:

Prostaglandins are physiologically active substances that have a variety of effects, including uterine stimulation. Prostaglandin E-2 (PGE-2) in gel form is sometimes given to pregnant women experiencing complications of labor to stimulate cervical ripening. Some studies have shown that this gel may have adverse effects on hemodynamics (blood flow), causing constriction or narrowing of vessels in the placenta, decreasing umbilical cord blood flow, and increasing fetal arterial pressure. This study examined fetal and uterine hemodynamic changes that occur when PGE-2 is given at various doses to induce cervical ripening. Nineteen women who had reached term and in whom induction of pregnancy was required because an unfavorable cervix was present were enrolled in the study. They were divided into three groups, 7 receiving PGE-2 in gel form, 5 in a chip form, and 7 in a controlled-release pessary form. Doppler (ultrasound) blood flow measurements and various aspects of uterine hemodynamics were evaluated before and after treatment to assess the effects of PGE-2. Flow measurements were expressed in ratios of peak systolic blood velocity to least diastolic flow (S/D; basically, the ratio between blood flow during the contraction of the heart and during the rest, or filling, phase). Results showed that PGE-2 treatments did not significantly affect any of the variables measured. These results indicate that short-term use of PGE-2 does not adversely affect fetal or uterine circulation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Usage, Abnormalities, Doppler ultrasonography, Uterine circulation, Blood circulation

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Double-blind comparison of intravaginal prostaglandin E2 gel and "chip" for preinduction cervical ripening

Article Abstract:

Ripening (softening and dilation) of the uterine cervix is a necessary occurrence before the onset of labor, and low doses of prostaglandin E2 (PGE2, a drug with many physiological actions) are often administered to hasten the process. PGE2 in such cases is usually given as a gel, but another preparation is the PGE2 'chip', made by cutting a standard PGE2 suppository into six equal parts. To evaluate the effectiveness of these two methods for promoting cervical ripening, a randomized study of 69 patients with 'unfavorable' cervixes (cervixes that did not ripen properly) was carried out. Thirty-four women received the gel form, and 35, the 'chip'. Although the rates of cesarean section and successful induction of labor, and the doses of oxytocin (to stimulate uterine contractions) were comparable for both groups, more women who received 'chips' (20 percent) than gel (2.9 percent) developed uterine hyperstimulation, defined as excessive uterine contractions, possibly associated with fetal or maternal distress. No differences were noted in infant birth weight or Apgar scores (a measure of physical functioning in newborns). The results indicate that the gel form of PGE2 is preferable to the 'chip' form for promoting cervical ripening. (Consumer Summary produced by Reliance Medical Information, Inc.)

Dosage and administration

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