Vaginal and Intracervical Prostaglandin E₂For Cervical Ripening: A Doppler Study of Hemodynamic Effects

Abstract

The hemodynamic effects of vaginally and intracervically administered prostaglandin E2 gel were evaluated by pulsed wave color Doppler ultrasound. Twenty term pregnant mothers were recruited. Mothers were randomized to receive either vaginal or intracervical prostaglandin E2 gel. The hemodynamics was assessed by repeated color Doppler velocimetry of the uterine artery and fetal umbilical and middle cerebral arteries; analysis of variance was used to test statistical significance. In the uterine artery a statistically significant rise (P < or = 0.001) of the pulsatility index (PI) was observed. A slightly higher rise of the PI was observed after intracervical administration, but the difference between the groups was not statistically significant (P = 0.4). The fetal PI remained unchanged both in the umbilical and cerebral vessels throughout the study. The rise in the uterine artery PI is probably caused by an increase in the uterine tone as prostaglandins of the E series usually cause vasodilation. No detectable fetal effects were evident.

Fetal Doppler hemodynamic changes in spontaneous versus prostaglandin E1-induced active labor

“…It has been shown that the S/D ratio did not change significantly for the fetal aorta and UA circulation after a single intravaginal dose of prostaglandin E 2 for cervical ripening (15). It has been also demonstrated that the fetal PI remained unchanged both in the umbilical and cerebral vessels after prostaglandin E 2 application (14). In addition, misoprostol, a synthetic analogue of naturally occurring PGE 1 , is being studied for obstetric-and abortion-related uses with its better success rate and less cost (16,17).…”

“…There were, however, only a few reports studying the relationship between induction and hemodynamic changes of fetuses. It has been demonstrated that the fetal pulsatility index in the UA and fetal MCA remained unchanged after administration of prostglandin E 2 (12)(13)(14)(15). Recently, prostaglandin E 1 (PGE 1 ) was studied extensively for its better success rate of induction and decreased cost (16,17).…”

Is there any relation between development of persistent non‐reassuring fetal heart rate pattern and acutely increased uterine artery vascular flow resistance during dinoprostone use in prolonged pregnancies?

“…We observed a significant increase in the uterine artery resistance after dinoprostone application among those who underwent emergency cesarean delivery for persistent non‐reassuring FHR pattern. There have been a few studies showing increased uterine artery Doppler velocities due to Prostaglandin E2 use, but none of the studies included data about the assessment of abnormal outcome during follow‐up (19–21). Rotmensch et al studied the effect of dinoprostone in post‐term pregnancies on Doppler flow of the umbilical, MCA, and the uterine arteries and they found an increase of only uterine artery RI after dinoprostone (20).…”