S. Shaala

The relaxant property of local prostaglandin E2 on the non-pregnant uterus — A cyclic triphasic response

The response of the non-pregnant human uterus to intravenous (i.v.) injections and intra-uterine instillation of various doses of prostaglandin E-2 (PGE-2) was evaluated at the different phases of the menstrual cycle in 13 fertile regularly menstruating women who were neither lactating nor using any hormonal therapy. Uterine contractility was recorded by the microballoon technique in at least three sessions(proliferative, mid-cycle and secretory) in a single cycle with endometrial biopsy performed immediately following the last session to ascertain that the particular cycle was an ovulatory one. Single i.v. injections of PGE-I had a consistent stimulatory effect on the contractility throughout the cycle with a tendency towards a decreased uterine response at mid-cycle and luteal phase as compared to the proliferative part of the cycle. Intra-uterine instillation of the compound induced a peculiar and interesting type of response. In the proliferative and secretory phases of the cycle the response was one of stimulation; being more pronounced in the former period. However, around ovulation time, the local administration induced an evident uterine relaxation in most cases without any instance of stimulation. The possible implication of this triphasic response behaviour on the non-pregnant uterus within certain physiological events and pathological conditions is discussed.

In vivo inhibition of the human non-pregnant uterus by prostaglandin E2

Abstract The discrepancy between the effect of PGE 2 on the non-pregnant myometrium in vitro (relaxation) as compared to in vivo (stimulation) has not yet been solved. Nine women in the early post-menopause volunteered for the investigation. Prostaglandin (PG) F 2α or E 2 was administered either by single intravenous (i.v.) injection or by intra-uterine instillation and the uterine contractility was recorded by the microballoon technique. The response of the menopausal uterus to i.v. injections of PGF 2α or PGE 2 was characterized by rapid stimulation while intra-uterine instillation of PGF 2α induced gradual but sustained elevation of uterine tonus. However, the intra-uterine injection of PGE 2 caused inhibition of different components of uterine contractility. The fact that PGE 2 can also inhibit the in vivo motility of the menopausal non-pregnant uterus coincides with earlier in vitro results i.e. the discrepancy may not exist. Moreover, in one cycling patient (13–18th days of the menstrual cycle) similar results were also obtained. Two theories were offered to explain why PGE 2 stimulated the uterus when given as a single i.v. injection but inhibited the same organ when instilled locally into the uterine cavity.

Termination of pregnancy with fetal death in the second and third trimesters — the double balloon versus extra-amniotic prostaglandin

OBJECTIVES: To evaluate the use of a double balloon catheter in the termination of pregnancy with fetal death in the second and third trimesters, in comparison with the administration of extra‐amniotic PGF2‐α. METHODS: Twenty cases with IUFD at > 20 weeks of gestation were divided into two groups. Group I was subjected to the double balloon alone, while in Group II extraamniotic instillation of PGF2‐α via a Foleys catheter was used. RESULTS: There were no significant differences between the two groups with regard to induction‐expulsion time, inductiondelivery time and failure rate. CONCLUSIONS: The double balloon catheter proved to be an effective non‐pharmacological method. The technique was simple and well tolerated by the patients. The side‐effects of the prostaglandin and the cost of the medication were avoided.

Effect of Prostacyclin Infusion in Severe Pre-Eclampsia

Prostacyclin (PGI2) infusion was given in a dose of 7 ng/kg/min. to 20 pregnant women at gestational ages between 34–40 weeks; ten of them had severe preeclampsia and ten had normal pregnancies. The effects of prostacyclin were continuously monitored for 3–4 hours during infusion, and for up to 6 hours after stopping it. Prostacyclin reduced the systolic, diastolic and mean arterial blood pressure in pre-eclamptic cases much more than in normotensive subjects, who only showed a slight drop in diastolic pressure during the infusion phase. Post-infusion rebound rise in blood pressure to original values was also observed. It was accompanied by maternal tachycardia, caused non-significant changes in uterine activity, and did not alter the fetal heart rate in either group. Mild side effects such as facial flushing, headache, and nausea were recorded during the infusion period. After the end of infusion, all the effects and side effects of prostacyclin disappeared within 15–30 minutes. These data indicate a lim...

Reduced uterine response to PGF2α under oral contraceptives

Abstract The effect of prostaglandin F2α (PGF2α) on the non-pregnant human uterus was a evaluated in 35 patients. The compound was administered both by intra-uterine and intra-venous routes. Two groups of volunteers were studeid; fifteen cases who were under oral contraceptive and twenty women with normal ovulatory cycles. The uterus under the influence of oral contraceptives showed a reduced response to local and systemic administration fo PGF2α at all phases of the menstrual cycle. The implications of these findings in certain physiological and pathological conditions related to reproduction are discussed.

Aberrant Uterine Response to Prostaglandin E2 as a Possible Etiologic Factor in Functional Infertility

The clinical entity of functional infertility still remains unexplained and largely lacking a line of proper management. The uterine response to prostaglandin E2 (PGE2) and prostaglandin F2alpha (administered by intravenous and intrauterine routes) was evaluated during different phases of the menstrual cycle in five functionally infertile women. The results (quantitative and qualitative) were compared with those elicited among 20 fertile women. There were no apparent differences between the two groups with respect to either compound (systemic or local) when given during the proliferative or luteal phase of the cycle. However, at midcycle, about the time of ovulation (days 13 to 18), there was a salient deviation in the type of response following local instillation of PGE2; in the normal fertile group there was a definite inhibition of motility, while uteri in the functionally infertile group showed marked stimulation. The possible role of this aberrant uterine response in the etiology of functional infertility is discussed.

Cervical prostaglandin injection: a novel method of administration for ripening the cervix and induction of labor

Twenty pregnant women with ⩾36 weeks gestation and Bishop score of ⩽4 were subjected to either intracervical injection of PGE2 (0.25 mg) every 4 h to ripen the cervix and induce labor (study group n = 10) or injection of only the diluent (control group n = 10). PGE2 cases showed significant increase in Bishop score and were successfully induced. The mean induction‐establishment and induction‐delivery intervals were 4.3 ± 0.1 min and 6.07 ± 1.7 h, respectively. The control group showed no response. PGE2 cervical injection is a safe and effective method for cervical ripening and labor induction.

Uterine response to prostaglandin E2 under oral contraceptives

Abstract The effect of prostaglandin E 2 (PGE 2 ) on the non-pregnant human uterus was evaluated in 35 patients. The compound was administered both by the i.v. and intra-uterine routes. Two groups of volunteers were studied; fifteen cases who were under oral contraceptives and twenty women with normal ovulatory cycles. The latter group served as the control group. The uterus under the influence of oral contraceptives showed a markedly reduced response to i.v. injections of PGE 2 at all phases of the menstrual cycles. However, the response at mid-cycle to local instillation of the compound was contradictory in the two groups, i.e. local intra-uterine instillation of PGE 2 induced uterine stimulation in pill users as compared to the usually observed uterine inhibition in ovulatory (control) cases around mid-cycle. In the proliferative and luteal phases (early and late in the cycle), the response to intra-uterine injections was qualitatively similar in the two groups but greatly reduced quantitatively in the pill user group. The implications of these findings in certain physiological processes and pathological conditions related to reproduction are discussed.

Induction of labor by oral prostaglandin E2 in protracted pregnancy.

Induction of labor was performed in 20 pregnant females with postmaturity (> 294 days) using either oral PGE2 tablets (0.5 mg) or i.v. oxytocin drip (each group n = 10). The induction‐establishment interval was significantly shorter in the oxytocin group (P < 0.005). Moreover, the uterine activity (in Alexandria units) at 3 h post‐induction and at the end of the first stage of labor, was significantly higher with i.v. oxytocin (P < 0.005). However, the induction‐delivery interval did not differ in both groups. All cases delivered spontaneously with a satisfactory Apgar score.