Uterine Hypertonus during Labour Induced by Prostaglandins

Roberts, G.; Turnbull, A. C.

doi:10.1136/bmj.1.5751.702

Cited by 35 publications

(11 citation statements)

References 10 publications

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“…Although several authors have stated that uterine contractility following oral administration of PGE2 tablets is essentially comparable to that induced by intravenous oxytocin (4,5,17,28), there is at least theoretically a higher risk for hyperstimulation when an oxytocic compound is administered orally rather than intravenously (7,19,22,24,26,27,29,31). In our study signs of overstimulation, uncoordinated uterine contractility and/or uterine hypertonus were mainly seen when the PGE2 dose had been stepped up to 2.0 mg. Other studies have shown an increased frequency of gastrointestinal side effects with an individual dose of 1.5 mg or more (4,7,30,32).…”

Section: Discussionmentioning

confidence: 49%

Induction of Labor by Oral PGE₂ Administration—Evaluation of Different Dose Schedules

Bremme

Kindahl

Svanborg

1980

Acta Obstet Gynecol Scand

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The efficacy and safety of different oral doses of PGE, in tablet form were evaluated in 30 women admitted to the hospital for labor induction at or near term. The aim was to select a recommendable dose schedule based on recording of uterine contractility, clinical outcome and measurement of the resulting plasma levels of the two prostaglandin metabolites 15-keto-13.14-dihydro-PGE, and 15-keto-l3,14-dihydro-PGF, by gas-chromatography-mass spectrometry and by radio-immunoassay.Measurements of uterine contractility and of plasma levels of the PGE, metabolite both showed that the preferable interval between oral doses of PGE, tablets is one hour. Following 1 .O mg PGE,, the plasma concentra-7 42 40-43 4.1 3-6 c 15 6 42 40-43 5.0 2-1 *A=5, B = l O Acta Obstet Gynecol &and Suppl92

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Section: Discussionmentioning

confidence: 49%

Induction of Labor by Oral PGE₂ Administration—Evaluation of Different Dose Schedules

Bremme

Kindahl

Svanborg

1980

Acta Obstet Gynecol Scand

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“…We feel, however, that there are possible dangers of pursuing a similar policy of increasing the dose of prostaglandins above that required to induce optimum contractions. Besides maternal disturbance caused by possible vomiting and soreness of the arm it is our impression that fetal distress may be provoked, for contractions of excessive frequency or strength may result or uterine hypertonus may occur, as recently reported by Roberts and Turnbull (1971).In this study the necessity for performing fetal blood sampling to establish the significance of fetal heart variations was noticeably different in the two groups, though a pH of <7-20 was found in only one instance. It is possible that these findings could have been minimized had the infusion rates been reduced after spontaneous rupture of the membranes.…”

supporting

confidence: 55%

mentioning

confidence: 67%

Vesico-ureteric Reflux after Renal Transplantation

Powis¹,

Barnes²,

Dawson-Edwards³

1971

BMJ

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BRITISH MEDICAL JOURNAL 31 JULY 1971 279 that prostaglandin E2 is more effective in inducing labour must be considered with caution, for though the patients were selected at random the groups were not identically matched. The differences found in these studies may be partly explained by essential differences in the plan of each investigation and the exact protocol undertaken. Beazley and Gillespie (1971) started the infusion of prostaglandin E, at 0-21 [Lg/min and oxytocin at 2 1 mU/min. These rates were doubled every hour until contractions were effective and then usually maintained at a fixed rate. In addition some patients' membranes were ruptured artificially when labour was established. Our approach was basically different in that rapid titration regimens were used to induce an early onset of regular contractions in each group, as we considered it was impossible to know that the stimulatory effect of doubling the infusion rates of prostaglandin E2 was quantitatively equivalent to doing the same with oxytocin. It is therefore not surprising that the results were different.By using the titration regimens an initial uterine response occurred at a comparable time with both substances, though regular contractions of similar amplitude generally occurred earlier with oxytocin. Despite this fact prostaglandin E2 was more effective in dilating the cervix, and it is our impression that this substance had a greater stimulatory effect on the uterus than oxytocin in the dose range used. One feature tending to confirm this impression was the finding that while prostaglandin E2 invariably resulted in spontaneous rupture of the membranes, this occurred before dilatation of the cervix had reached 6 cm in eight out of 15 patients. With oxytocin this was so in only two out of the nine successes. With both agents basically two types of response were elicited. One resembled normal labour in that progressive cervical dilatation occurred with time, while in the other little or no change in dilatation resulted for many hours, usually until the onset of spontaneous membrane rupture. About one-third of the successes in each group were in this latter category.With regard to the practicality of using oxytocin to induce labour in the presence of intact membranes, we feel that a greater success rate could probably be achieved if the infusion rate were increased above that required to induce contractions which appear "optimum" on an external tocograph. In effect oxytocin titration would be against cervical dilatation rather than contractions. The limitation of such a policy is a possibility of causing uterine hypertonus, though oxytocin infusions in doses ranging from 2 to 128 mU/min. We feel, however, that there are possible dangers of pursuing a similar policy of increasing the dose of prostaglandins above that required to induce optimum contractions. Besides maternal disturbance caused by possible vomiting and soreness of the arm it is our impression that fetal distress may be provoked, for contractions of excessive frequency or str...

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“…Some basic design features of each study are summarized in Table V. Similar results were obtained in a study in which amniotomy was performed prior to drug infusion where PGEl and PGE, could effectively induce labor in smaller doses than PGFza (268). Many other differences in the studies reported to date preclude any meaningful comparison between studies, but some qualitative results are emerging.…”

Section: Biologymentioning

confidence: 75%

“…In most studies, no effects on blood pressure, pulse rate, or the GI tract were observed (259,267,269,272,275), whereas about half of the patients receiving PGE, vomited during labor in the study reported by Craft et al (270). One response that seems t o be specific to PGE, is a mild erythema which occurs along the course of the infusion vein (268,270,272). A tendency toward uterine incoordination or prolonged contractions was observed in some cases with PGE, and PGE, (267,276) and PGF,, (267,273).…”

Section: Biologymentioning

confidence: 99%

Prostaglandins

Oesterling¹,

Morozowich

Roseman

1972

Journal of Pharmaceutical Sciences

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Uterine Hypertonus during Labour Induced by Prostaglandins

Cited by 35 publications

References 10 publications

Induction of Labor by Oral PGE₂ Administration—Evaluation of Different Dose Schedules

Induction of Labor by Oral PGE₂ Administration—Evaluation of Different Dose Schedules

Vesico-ureteric Reflux after Renal Transplantation

Prostaglandins

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Uterine Hypertonus during Labour Induced by Prostaglandins

Cited by 35 publications

References 10 publications

Induction of Labor by Oral PGE2 Administration—Evaluation of Different Dose Schedules

Induction of Labor by Oral PGE2 Administration—Evaluation of Different Dose Schedules

Vesico-ureteric Reflux after Renal Transplantation

Prostaglandins

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Induction of Labor by Oral PGE₂ Administration—Evaluation of Different Dose Schedules

Induction of Labor by Oral PGE₂ Administration—Evaluation of Different Dose Schedules