Labor induction with prostaglandins

The authors commented that induction with prostaglandins in women with a previous lower segment cesarean scar is associated with a risk of symptomatic scar rupture no greater than 0.6%, and the vaginal delivery rate is about 75%, that is similar to rates quoted for spontaneous labor in women with a cesarean scar. At present, faced with the lack of... 

The incidence of neonatal jaundice was not increased after induction of labor with prostaglandins (47). 

Stampe Sorensen, S. Palmgren Colov, N. Andreasson, B. Bock, J. Berget, A. Schmidt, T. Induction of labor by vaginal prostaglandin E2. A randomized study comparing pessaries with vaginal tablets. Acta. Obstet. Gyn. Scand. 

Once the cervix has been ripened, or in patients who present with a favorable, soft cervix, labor induction can proceed with IV oxytocin (Pitocin ). This is a synthesized form of the same peptide composed of nine amino acids that is synthesized by the hypothalamus and secreted by the posterior pituitary. Although it will cause contractions beyond the late second trimester of pregnancy, these contractions do not always lead to labor. Labor also can be initiated or augmented by rupture of the amniotic and chorionic membranes, which is thought to up-regulate oxytocin receptors on the uterus and release prostaglandins. Nipple stimulation causes the increased release of oxytocin from the posterior pituitary and can be used to initiate corrtractions as well. 

Misoprostol has several therapeutic uses, including the treatment of gastroduodenal ulceration and labor induction and has the advantage of being relatively inexpensive and stable enough to be stored at room temperature. Prostaglandin therapy for the induction of labor is a well-established practice, and misoprostol has been compared with dinoprostone and also oxytocin. It was found to be equieffective with oxytocin (325)and more effective than dinoprostone (326). It was also shown to be effective in 92% of women in combination with tamoxifen (327). However, mi-... 

Prostaglandins have been used intravenously, both for induction of mid-trimester abortion and for induction of labor in cases of intrauterine death. The same adverse effects as described above occur, and are usually very pronounced. Routine premedication with an antiemetic and an antidiarrheal agent significantly reduces gastrointestinal adverse effects. 

Maymon R, Shulman A, Pomeranz M, Holtzinger M, Haimovich L, Bahary C. Uterine rupture at term pregnancy with the use of intracervical prostaglandin E2 gel for induction of labor. Am J Obstet Gynecol 1991 165(2) 368-70. 

Misoprostol, an analogue of PGE1 is licensed for use in the management of gastroduodenal ulceration. It is an effective myometrial stimulant of the pregnant uterus and is used for the induction of labor and as abortifacient, both alone and in combination with other substances (for example mifepristone). It provides an effective alternative to gemeprost, the most widely used prostaglandin pessaries in combination with mifepristone. 

Prostaglandins are found in all body tissues and are responsible for regulating a variety of physiological responses, such as inflammation, blood pressure, blood clotting, fever, pain, the induction of labor, and the sleep-wake cycle. All prostaglandins have a five-membered ring with a seven-carbon carboxylic acid substituent and an eight-carbon hydrocarbon substituent. The two substituents are trans to each other. 

Induction of term labor with intravenous prostaglandin F(2a). (A comparison of two dosage schedules). Prostaglandins 10, 1019. 

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