ASPECTS ON RIPENING OF THE CERVIX AND INDUCTION OF LABOR BY INTRACERVICAL APPLICATION OF PGE₂ IN VISCOUS GEL

Abstract

Abstract. In this survey the effect of intracervically applied prostaglandin E2 (PGE2) on the pregnant uterus is outlined. It is concluded that PGE2 decreases cervical resistance and stimulates the myometrium to contract. In small doses (0.25 mg and 0.5 mg) PGE2 produces a rapid and prominent ripening of the cervix without systemic side effects and independent of prominent uterine contractions. Prostaglandin E2 applied intracervically in viscous gel seems to be superior to previously used methods for treatment of patients with an unfavorable cervical state.

An In vitro Study on Spontaneous Cervical Contractility in the Cow During Oestrus and Diestrus

“…Mechanical extensibility of cervical specimens after stunning of these animals increased significantly when compared with saline‐treated control animals (Ledger et al., 1983). In human beings, spontaneous and drug‐induced contractility of cervical specimens was studied in vitro (Najak and Hillier, 1970) and in vivo (Ulmsten, 1979). Isolated cervical smooth muscle specimens exhibited spontaneous contractility.…”

“…PGE 2 caused marked relaxation, whereas oxytocin and adrenaline caused contractions of the specimens (Najak and Hillier, 1970). Intracervical application of PGE 2 in human beings produced rapid ripening of the cervix independent of uterine contractions (Ulmsten, 1979).…”

Long Chain Polyunsaturated Fatty Acids Alter Oxytocin Signaling and Receptor Density in Cultured Pregnant Human Myometrial Smooth Muscle Cells

“…Both PG and leukotrienes (LT), such as PGE 2 , PGF 2α , LTC 4 , and LTB 4 increase prior to the onset of labor. Exogenous PGE 2 or PGF 2α provision induces cervical ripening and uterine contractions in both full-term and preterm labor [22] – [25] . Selective inhibitors of cyclooxygenase-2 are effective in decreasing PGE 2 in amniotic tissues and have been explored for preventing preterm deliveries, although there are many complicating issues.…”

“…Evidence indicates that prostaglandins (PGs) play a key role in initiating and maintaining normal labor [16] . PGE 2 and PGF 2α increase at term in laboring women compared with nonlaboring women [17] , [18] , can activate tissue remodeling matrix metalloproteinases [19] – [21] , mediate cervical ripening [22] , [23] , and induce uterine contractions [24] , [25] . These PG 2 -mediated actions coupled with markedly elevated arachidonic acid (AA) in maternal erythrocytes of women delivering prematurely [26] , apparent LC n-3 PUFA deficiency in these women [26] , and the opposing effects of LC n-3 PUFAs and AA on PG 2 biosynthesis [27] – [29] have pointed investigators toward a mechanism in which LC n-3 PUFAs prolong pregnancy by suppressing the AA cascade [8] , [9] , [12] .…”

Distribution of prostaglandin E2 and prostaglandin F2α receptors in human myometrium

“…From clinical studies (Ulmsten 1979) it is known that local application of PGE2 decreases cervical resistance. In our study however, free PGE2 re¬ ceptors were almost undetectable in the cervical region.…”