Prostaglandin E2 in induction of labour: a pharmacokinetic study of dose and treatment protocols

A fetal cyclooxygenase-2 gene polymorphism is associated with placental malperfusion

Prostaglandin levels vary during pregnancy, mostly under the control of the inducible enzyme cyclooxygenase-2 (COX-2). The expression of COX-2 has been associated with ischemic events in the heart and brain, but its direct effect on human placental perfusion has not been previously examined. The purpose of this study was to investigate whether a functional polymorphism in the COX-2 gene that controls enzyme expression levels is associated with placental histopathologic lesions. Maternal and neonatal DNA from twin gestations were analyzed by a polymerase chain reaction-based assay for a single G to C nucleotide polymorphism at position -765 in the COX-2 gene promoter. Placental histopathology was evaluated in 6 major categories: meconium, malperfusion, inflammation, umbilical cord problems, villitis, and thrombosis. There was no significant association between placental histopathologic findings and polymorphisms of the COX-2 gene in the mother. In the fetus, carriage of the COX-2 C allele, which is correlated with decreased COX-2 gene expression, was negatively associated with lesions of placental ischemia/malperfusion (P = 0.02). Placental ischemic lesions were positively associated with intrauterine growth restriction (IUGR; P < 0.001). No other group of histopathologic lesions was associated with fetal polymorphisms in the COX-2 gene or with IUGR. Thus, a fetal polymorphism in the COX-2 gene influences the occurrence of placental malperfusion and ischemia, which may be of sufficient severity to promote or allow the development of IUGR.

Prostaglandin E2 (PGE2) vaginal gel for cervical ripening

Cervical ripening prior to oxytocin stimulation is highly desirable to ensure a successful induction. Prostaglandin E2 has been administered by intracervical, intravaginal and extra-amniotic routes with successful ripening of the cervix. The dose of PGE2 administered is under investigation. Use of 3 or 4 mg of PGE2, although effective, has been reported to be accompanied by uterine hypertonus or fetal heart changes. Lower dose of PGE2 at 0.2 mg and 0.4 mg do not have the above-mentioned side effects but necessitate multiple applications. This randomized double-blinded study incorporated the use of 2 mg of PGE2 administered by intravaginal route in a hydroxyethyl cellulose gel medium. A significant increase in Bishop score (40% higher) was achieved in patients receiving PGE2 as compared to placebo patients. There were no adverse side effects, indicating application of 2 mg of PGE2 as a safe method of cervical ripening prior to induction of labor.

The effect of chlamydial infection on the initiation of premature labour: serial measurements of intrauterine prostaglandin E2 in amniotic fluid, allantoic fluid and utero-ovarian vein, using catheterised sheep experimentally infected with an ovine abortion strain of Chlamydia psittaci

The initiation of premature labour by an ovine abortion strain of Chlamydia psittaci was studied in relation to Prostaglandin E2 (PGE2), which plays a major role in parturition. The local intrauterine concentration of PGE2 was monitored after experimental infection with C. psittaci, during late gestation, using a catheterised sheep model. Indwelling catheters were implanted into the amniotic and allantoic cavities of six control sheep, and into six sheep infected with an ovine abortion of C. psittaci. The release of PGE2 into the utero-ovarian vein of these sheep was also monitored. Infection with C. psittaci was associated with a premature rise in PGE2 in the amniotic fluid between days 122 and 135 of gestation (P less than 0.01). A premature increase in PGE2 was defected between days 127 and 136 of gestation (P less than 0.05) in the allantoic fluid of sheep infected with C. psittaci, but not in the control uninfected sheep. Chlamydial infection significantly decreased the secretion of PGE2 into the utero-ovarian vein. The mean concentration of PGE2 in the utero-ovarian vein of infected sheep was 68.8 +/- 5.2% of the PGE2 concentration of control sheep between days 122 to 141 of gestation (P less than 0.01). The release of PGE2 into the utero-ovarian vein increased between days 126 to 136 of gestation in infected and control sheep (P less than 0.01). The results from the catheterised sheep model indicated that C. psittaci infection is associated with a local intrauterine release of PGE2. The magnitude of this release was similar to the PGE2 release in control sheep prior to parturition.(ABSTRACT TRUNCATED AT 250 WORDS)