Prostaglandins labor induction

Misoprostol (Cytotec) is a prostaglandin Ej analogue that is being evaluated as a cervical ripening agent. It also is used in the treatment and prevention of peptic ulcer disease (see Chapter 40). Clinical trials show that misoprostol is an effective agent for both cervical ripening and labor induction. It appears to be as effective as dinoprostone and is much less expensive. 

Maymon R, Haimovich L, Shulman A, Pomeranz M, Holtzinger M, Bahary C. Third-trimester uterine rupture after prostaglandin E2 use for labor induction. J Reprod... 

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-... 

There are a number of nonpharmacologic methods for cervical ripening. Castor oil, hot baths, sexual intercourse, and nipple stimulation all have been recommended for labor induction. However, there is minimal evidence to support the efficacy of these methods. The use of a Foley catheter placed in an unfavorable cervix for ripening has been found as effective as prostaglandin E2. A safe and inexpensive method, membrane stripping, is particularly of value. ... 

For labor induction, all of the aforementioned modes of administration of prostaglandins have been used successfully ° . In addition, orally administered PGEg and PGFaa are effective for labor induction , whereas the larger doses required for orally induced therapeutic abortion produce marked levels of gastrointestinal side effects . Karim showed that the action of prostaglandins on the human uterus is not mediated throvigh the release of oxytocin . 

F. Role in therapy According to Micromedex, oxytocin is routinely used for the induction of labor at term and postpartum for the control of uterine bleeding. Oxytocin is not the drug of choice for induction of labor for abortion. Oxytocin infusion has been used following prostaglandin or hypertonic abortifacients to shorten the induction to abortion time when inducing second-trimester abortion, inducing abortion when a patient has failed to respond to the abortifacient, or to induce abortion after membranes have ruptured. 

Contraction of the non-pregnant uterus Induction of abortion and labor Prostaglandin F series... 

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

When PGE2 and PGF2a are used for induction of labor and abortion, the following contraindications must be respected and (until proven otherwise) also apply to the methyl analogues of these two prostaglandins ... 

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. 

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... 

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 have been found to be involved in a number of important physiological functions, including the inflammatory response, the production of pain and fever, the regulation of blood pressure, the induction of blood clotting, and the induction of labor. 

Prostaglandin E2 (PGE2) is an agent used to ripen the cervix for the induction of labor (it is also used for second-trimester abortion) and shows various beneficial effects ... 

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