dinoprost and Fetal-Membranes--Premature-Rupture

Topics: Arachidonic Acid; Arachidonic Acids; Chorion; Decidua; Dinoprost; Female; Fetal Membranes, Premature Rupture; Humans; Immunohistochemistry; Infant, Newborn; Interleukin-1; Platelet Activating Factor; Pregnancy; Uterine Contraction

Premature rupture of membranes is a normal occurrence of labor and can occur before or after the onset of contractions. The clinical factors associated with premature rupture of membranes include: low socioeconomic status, low body mass index, prior preterm pregnancies, smoking, sexually transmitted infections and urinary tract, conization, cervical cerclage and amniocentesis.. To evaluate whether prolonged release of the vaginal insert of PGE2 is superior to dinoprostone gel to achieve cervical ripening in patients with term pregnancy that occur with premature rupture of membranes.. Randomized clinical trial in the surgical unit of play in a period of 6 months, with an estimated sample of 50 patients was randomized by block table. After assessment confirming rupture of membranes, Bishop Score and meeting inclusion criteria, group A was applied PGE2 intracervical gel 0.5 mg with a maximum of 3 doses, every 6 hours. Group B was administered at vaginal insert of PGE2 single dose for 24 hours, the patient was left to sleep 30 minutes cardio toco-monitoring chart for at least 2 hours after application.. The average time to maturity was 310.59 minutes with a standard deviation of 198.7 and concluded that there was no significant difference between the onset of uterine activity and the onset of labor among the prolonged release dinoprostone and alternatives such as the gel cervical for cervical ripening.. Either this is a good choice to ripen the cervix in patients with term pregnancy and premature rupture of membranes.

Topics: Adolescent; Adult; Cervical Ripening; Cesarean Section; Dinoprost; Disease Susceptibility; Female; Fetal Membranes, Premature Rupture; Gels; Humans; Infant, Newborn; Infections; Middle Aged; Pregnancy; Suppositories; Term Birth; Young Adult

Intrauterine prostaglandin (PG) F2 alpha infusion and intravenous (IV) oxytocin infusion were compared to evaluate the effectiveness of the two methods for termination of pregnancies with second-trimester rupture of membranes. Twenty-two women with this complication were randomly allocated to receive either 20 mg PGF2 alpha, diluted in 500 mL of NaCl 0.9% and administered through a Foley catheter inserted through the cervix, or IV oxytocin infusion in increasing doses. All subjects in the PGF2 alpha group aborted after the first administration. Repeat infusion was necessary in three oxytocin-treated subjects. The mean (+/- SD) induction-abortion interval was significantly shorter in those receiving PGF2 alpha (6.7 +/- 1.2 hours) than in those receiving oxytocin (8.8 +/- 2.7 hours). Minor side effects, such as nausea and vomiting, were observed in three women during PGF2 alpha infusion and were treated symptomatically and by temporary interruption of the infusion. Uterine hypertonus, observed in one subject in each group, was treated by temporary cessation of the infusion. We conclude that intrauterine PGF2 alpha infusion seems more effective than IV oxytocin for termination of pregnancies with second-trimester rupture of membranes.

Topics: Abortion, Therapeutic; Dinoprost; Female; Fetal Membranes, Premature Rupture; Humans; Infusions, Intravenous; Infusions, Parenteral; Oxytocin; Pregnancy; Pregnancy Trimester, Second; Random Allocation; Uterus

One hundred consecutive women with singleton pregnancies and primary rupture of membranes (PROM) after 36 weeks of gestation were included in a prospective, randomized trial of intravenous infusion of oxytocin (up to 30 mIU/min) versus low-dose prostaglandin F2 alpha(PGF2 alpha, up to 6.0 micrograms/min). Cesarean section was performed in 12 patients because of suspected disproportion or intra-uterine asphyxia. Effective contractions or labor progress failed to become established within 8 hours in another 4 women stimulated with PGF2 alpha and 2 stimulated by oxytocin. The stimulation delivery time (hours) for the remaining 82 women treated with PGF2 alpha or oxytocin, respectively was 8.7 against 12.1 for initial Bishop score less than 5 (p less than 0.01), (Mann-Whitney test), 7.2 vs. 7.1 for Bishop score 5-8 and 5.7 vs. 4.2 for Bishop score greater than 8. Patients with initial Bishop score less than 5 seemed to need analgetics less often when treated with PGF2 alpha than with oxytocin. Frequencies of side effects and instrumental deliveries as well as the fetal outcome were similar for the two treatment schedules. The results of the study suggest that low-dose PGF2 alpha infusion may be the more appropriate treatment for women with an unfavorable initial Bishop score.

Topics: Adolescent; Adult; Clinical Trials as Topic; Dinoprost; Female; Fetal Membranes, Premature Rupture; Humans; Infusions, Intravenous; Labor, Induced; Oxytocin; Pregnancy; Prospective Studies; Prostaglandins F; Random Allocation

Preterm premature rupture of membranes (PPROM) is associated with significant maternal and perinatal morbidity. This study examined maternal oxidative stress in PPROM.. This was a prospective cross-sectional study conducted in a university hospital. A total of 72 pregnant women were recruited into two groups, those with PPROM (38 cases) and those without PPROM (34 controls) matched for gestational age. Plasma interleukin-6, C-reactive protein, vitamins C, E and A, 8-isoprostane, total oxidant status (TOS) and antioxidant status (TAS) were determined for all study participants and the data were compared between the PPROM and control groups.. Both case and control groups were comparably matched in age, parity, gestational age and smoking status. There was a significant association between low 8-isoprostane, low vitamin C and high total oxidant status and the occurrence of PPROM (p < 0.001).. Plasma vitamin C and 8-isoprostane levels were lower and TOS higher in women with PPROM. Further research is needed to identify robust biological markers for the prevention and also prognosis of PPROM.

Topics: Ascorbic Acid; C-Reactive Protein; Cross-Sectional Studies; Dinoprost; Female; Fetal Membranes, Premature Rupture; Humans; Interleukin-6; Oxidants; Pregnancy; Prospective Studies; Vasoconstrictor Agents; Vitamin A; Vitamin E; Vitamins

Labor is characterized by "decidual activation" with production of inflammatory mediators. Recent data suggest that surfactant protein-A (SP-A) may be critical to the onset of labor in mice. Whether this is also true in humans is unclear.. The aim was to investigate: 1) the expression of SP-A at the maternal-fetal interface; 2) the effect of SP-A on the production of inflammatory mediators by human decidua; and 3) the association between single nucleotide polymorphisms in maternal SP-A genes and spontaneous preterm birth.. In situ expression of SP-A was investigated by immunohistochemistry and quantitative RT-PCR. Term decidual stromal cells were isolated, purified, and treated with/without SP-A (1-100 μg/ml), IL-1β, and/or thrombin. Levels of inflammatory mediators [IL-6, IL-8, TNFα, matrix metalloproteinase-3, monocyte chemotactic protein-1, IL-1β, PGE(2), prostaglandin F(2α) (PGF(2α))] and angiogenic factors (soluble fms-like tyrosine kinase-1, vascular endothelial growth factor) were measured in conditioned supernatant by ELISA and corrected for protein content. The effect of SP-A on eicosanoid gene expression was measured by quantitative RT-PCR.. SP-A localized to endometrium/decidua. High-dose SP-A (100 μg/ml) inhibited PGF(2α) by term decidual stromal cells without affecting the production of other inflammatory mediators, and this effect occurred at a posttranscriptional level. Decidual SP-A expression decreased significantly with labor. Single nucleotide polymorphisms in the SP-A genes do not appear to be associated with preterm birth.. SP-A is produced by human endometrium/decidua, where it significantly and selectively inhibits PGF(2α) production. Its expression decreases with labor. These novel observations suggest that decidual SP-A likely plays a critical role in regulating prostaglandin production within the uterus, culminating at term in decidual activation and the onset of labor.

Topics: Case-Control Studies; Cell Culture Techniques; Cells, Cultured; Decidua; Dinoprost; Dose-Response Relationship, Drug; Down-Regulation; Female; Fetal Membranes, Premature Rupture; Gene Expression Regulation, Enzymologic; Humans; Labor Onset; Polymorphism, Single Nucleotide; Pregnancy; Pulmonary Surfactant-Associated Protein A; Term Birth

Cigarette smoking and bacterial infections are two major risk factors associated with preterm prelabor rupture of membranes (pPROM). We hypothesized that exposure of fetal membranes to cigarette smoke extracts might induce oxidative stress (OS) and fetal membrane apoptosis, culminating in an alternate pathway to that commonly activated by infection. To test this, we characterized the production of prostanoids and biomarkers of apoptosis in normal term human fetal membrane explant cultures. Fetal membrane explants collected at term (from cesarean deliveries, not in labor) were stimulated with cigarette smoke extract (CSE) for 24 h. Two classes of prostanoids, F2-Isoprostane (F2-IsoP), a marker of OS and PGF2α, a classical uterotonin, were measured by gas chromatography/mass spectrometry. Western blot analyses of tissue lysates were performed to quantify the anti-apoptotic protein Bcl2 and actin (as a control). Fetal membrane apoptosis was detected by immunohistochemistry for active caspase 3 and confirmed by TUNEL staining for nuclear fragmentation. CSE exposure resulted in significantly more F2-IsoP production from fetal membranes (242.8 ± 79.3 pg/ml/mg of total membrane protein) compared to unstimulated controls (131.5 ± 53.1 pg/ml/mg; p < 0.0001). By contrast, PGF2α was not different in CSE vs. controls (1083 ± 527 vs. 1136 ± 835 pg/ml/mg of protein; p = 0.80). CSE-exposed tissues demonstrated a dose-dependent decrease in Bcl2 expression and increases in active caspase 3 and nuclear fragmentation in both amnion and chorion cells compared to controls. In summary, fetal membranes exposed to CSE manifest evidence of OS and apoptosis. The differential pattern of prostanoid production observed in this study supports the hypothesis that an alternate non-inflammatory pathway mediated by OS and apoptosis in pPROM may promote proteolysis resulting in membrane weakening and rupture.

Topics: Apoptosis; bcl-Associated Death Protein; Caspase 3; Dinoprost; Extraembryonic Membranes; F2-Isoprostanes; Female; Fetal Membranes, Premature Rupture; Humans; Oxidative Stress; Pregnancy; Smoke; Smoking

To determine whether amniotic fluid (AF) concentration of prostaglandins (PGs) increases in patients with intra-amniotic inflammation and/or proven AF infection in preterm PROM, and can predict impending delivery.. AF PGF2a concentrations were determined by ELISA in 140 singleton pregnancies with preterm premature rupture of membranes (PROM) (< or =35 weeks). AF was cultured for aerobic and anaerobic bacteria, and genital mycoplasmas. Intra-amniotic inflammation was defined as an elevated AF matrix metalloproteinase-8 concentration (>23 ng/ml). Results. (1) Patients with intra-amniotic inflammation and a negative AF culture had a significantly higher median AF PGF2a than those without intra-amniotic inflammation and with a negative culture (p < 0.001); (2) However, there was no difference in the median AF PGF2a between patients with intra-amniotic inflammation with a negative culture and those with culture-proven AF infection (p > 0.1); (3) Patients with an elevated AF PGF2a had a significantly shorter interval-to-delivery than those with a low AF PGF2a (< or =170 pg/mL) (p < 0.001); (4) An elevated AF PGF2a (< or =170 pg/mL) concentration was a significant predictor of the duration of pregnancy after adjusting for gestational age and AF inflammation/infection (p < 0.005). Conclusions. AF PGF2a (> or =170 pg/mL) concentration increased in patients with intra-amniotic inflammation regardless of AF culture results. Moreover, an elevated AF PGF2a concentration was an independent predictor of impending delivery in preterm PROM.

Topics: Adult; Amniocentesis; Amniotic Fluid; Bacteriological Techniques; Chorioamnionitis; Delivery, Obstetric; Dinoprost; Female; Fetal Membranes, Premature Rupture; Humans; Middle Aged; Pregnancy; Pregnancy Complications, Infectious; Prognosis; Time Factors; Up-Regulation; Young Adult

To evaluate the total isoprostane 8-epi-PGF2alpha and neutrophil elastase (NE) concentrations in pregnancies complicated by premature rupture of membranes (PROM).. 128 pregnant women were divided into four groups: pregnancies complicated by PROM between 24.-36.(PPBP-N) and between 38 a 41 weeks of gestation (PPBP-D), uncomplicated pregnancies between 24-36 gestation weeks (K1) and pregnancies delivered by cesarean section (before uterine contractions had started) after 38 weeks (K2). The concentrations of NE and isoprostane 8-epi-PGF2alpha were measured in maternal serum, cord blood serum and in the amniotic fluid.. The following study revealed higher concentrations of NE in maternal serum and in the amniotic fluid than in the umbilical cord blood in PROM cases, and lower amniotic fluid than maternal serum concentrations in the control groups. Also, the levels of isoprostane differentiated between compartments in particular groups. In both groups complicated with PROM, higher maternal serum and amniotic fluid NE concentrations than in controls were found. There were no differences in isoprostane levels between the groups.. 1. Higher concentrations of NE in maternal blood serum and in the amniotic fluid than in the umbilical cord blood in PROM cases, as well as lower amniotic fluid than maternal serum concentrations in the controls, may be connected with pathogenesis of PROM. 2. Differentiated maternal serum, cord serum and amniotic fluid isoprostane concentrations may suggest various intensity of oxidative stress in particular compartments. 3. Lack of differences in maternal serum, cord serum and amniotic fluid isoprostane concentrations may suggest similar intensity of oxidative stress in cases with PROM and intact membranes.

Topics: Adult; Amniotic Fluid; Case-Control Studies; Dinoprost; Female; Fetal Blood; Fetal Membranes, Premature Rupture; Humans; Leukocyte Elastase; Obstetric Labor, Premature; Oxidative Stress; Poland; Pregnancy; Risk Factors

Many authors consider that using prostaglandins is the best way of obtaining adequate maturation of the cervix uteri before induction of labour; however, in case of premature rupture of the membranes the conventional methods can seldom be used. An original technique for this relatively rare situation is presented, consisting of an intracervical infusion of prostaglandin F2-alpha at the initial rate of 0.3 mg/hour. Details are given of the technique as well as of the results obtained in a preliminary study of 10 patients. With a mean 7.5 mg total dose of prostaglandin F2-alpha, the mean durations of maturation and delivery were 15 and 20 hours respectively. No infection developed and the procedure was well tolerated by the patients. Nevertheless, this technique should be reserved to those cases where conventional methods cannot be used.

Topics: Cervix Uteri; Dinoprost; Female; Fetal Membranes, Premature Rupture; Humans; Labor, Induced; Perfusion; Pregnancy

Rupture of membranes at term, whether spontaneous or artificial, causes rapid and sustained increase in prostaglandin F2 alpha (PGF2 alpha) metabolite (PGFM) levels and is associated with augmentation of uterine contractions. To investigate why premature rupture of membranes (PROM) often fails to initiate uterine contractions, we measured plasma concentrations of PGFM and oxytocin (OT) in patients with PROM near term. Serial blood samples were taken before and after PROM as well as before and after local PGE2 gel application for cervical ripening. For comparison, patients with similar criteria with intact membranes were also studied, as were patients in spontaneous labor at term with and without spontaneous rupture of membranes. PROM was always associated with an initial, marked increase in plasma PGFM. Whether or not this increased PGF2 alpha production was maintained was related to the cervical status at the time of PROM. In patients with unripe cervix PGFM levels returned to initial levels within 2 hours and no contractions were elicited; when the cervix was 3 cm or more dilated, PGFM levels remained high and contractions began within 1 to 3 hours. PROM had no significant effect on plasma OT levels. When PGE2 gel was applied to ripen the cervix, PGFM levels increased moderately within 30 minutes in all patients regardless of the status of the membranes. In patients with intact membranes the concentration of PGFM in plasma declined to initial levels within 4 hours, whereas in patients with PROM, PGFM levels remained increased throughout the study period.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Cervix Uteri; Dinoprost; Dinoprostone; Female; Fetal Membranes, Premature Rupture; Humans; Labor Onset; Labor, Obstetric; Oxytocin; Pregnancy; Uterine Contraction

This study was undertaken to examine the effects of intrauterine infection and preterm labor on the amniotic fluid concentrations of prostaglandins in women with premature rupture of the membranes. Amniotic fluid was obtained from four groups of patients with premature rupture of the membranes: group 1, patients without labor or infection; group 2, patients with labor but without infection; group 3, patients with an intra-amniotic infection but without labor; group 4, patients with both infection and labor. Prostaglandins E2 and F2a were measured by radioimmunoassays. Preterm labor, in the absence of infection, was not associated with significant increases in amniotic fluid concentrations of prostaglandins. Women with preterm labor and intra-amniotic infections had higher amniotic fluid concentrations of prostaglandins than women with preterm labor in the absence of infection or women with intra-amniotic infection in the absence of labor. These observations are compatible with the participation of prostaglandins in the mechanisms of onset of preterm labor associated with intra-amniotic infection.

Topics: Adult; Amniotic Fluid; Bacterial Infections; Dinoprost; Dinoprostone; Female; Fetal Membranes, Premature Rupture; Humans; Obstetric Labor, Premature; Pregnancy; Pregnancy Complications, Infectious; Prostaglandins; Prostaglandins E; Prostaglandins F

To suppress uterine contractions during cervical ripening induced by prostaglandin E2 (PGE2) gel, beta-mimetic drugs were given orally 30 minutes before PGE2 application to 17 patients with unripe cervix. This prevented the increase in contraction frequency observed during the first four hours after PGE2 application in 17 controls. Nevertheless, cervical ripening proceeded at a similar rate and the clinical outcome was comparable in both groups. Prostaglandin E2 application caused a transient rise in plasma levels of the PGE2 alpha metabolite (13,14-dihydro-15-keto), which was not prevented by pretreatment with beta-mimetics. Patients with premature rupture of the membranes had higher initial plasma PGF2 alpha metabolite levels than those with intact membranes but cervical ripening proceeded with the same rate, and the effect of beta-mimetics was the same in both groups. Thus, cervical ripening induced by PGE2 does not depend on uterine contractions, and increased production of PGF2 alpha is unrelated to the ripening process. There was no difference between the three beta-mimetic agents in the present study.

Topics: Adrenergic beta-Agonists; Adult; Cervix Uteri; Dinoprost; Dinoprostone; Female; Fetal Membranes, Premature Rupture; Gels; Humans; Labor, Induced; Pregnancy; Premedication; Prostaglandins E; Prostaglandins F; Uterine Contraction

Topics: Adolescent; Adult; Dinoprost; Female; Fetal Membranes, Premature Rupture; Humans; Infusions, Parenteral; Labor, Induced; Labor, Obstetric; Pregnancy; Pregnancy, Prolonged; Prostaglandins F; Stimulation, Chemical; Time Factors

Premature rupture (= PR) of the amnion is a serious complication even for the mature child if it occurs earlier than 24 hours before birth. To keep the interval as short as possible, the authors induce labour from week 35/0 in case of PR, provided the Bishop score is greater than 7. If the bishop score is lower, they conduct intracervical priming of the cervix with 0.4 mg PGE2 gel before induction of labour. This has proved clinically superior to intravenous procedures. In the study presented here, the authors attempted to find out whether intracervical administration of PGE2 gel would result in changes in the maternal and foetal plasma concentrations of oxytocin, PGFM, or PGEM when comparing conditions in case of ruptured amnion with those if the amnion remained intact. If the amnion is intact and the cervix immature (less than 2 cm), intracervical administration of 0.4 mg PGE2 gel produces a significant OT increase within 30 minutes. From a cervical width of 2 cm onwards, the OT levels are already primarily enhanced and will hardly change even after PGE2 gel administration. Similar conditions obtain in PR. PGFM plasma levels will rise only slightly within an hour after intracervical PGE2 gel administration, independent of whether there has been a rupture or not, or whether the cervix is dilated less than 2 cm or 2 cm and more.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Administration, Topical; Cervix Uteri; Dinoprost; Dinoprostone; Female; Fetal Membranes, Premature Rupture; Humans; Maternal-Fetal Exchange; Oxytocin; Pregnancy; Prostaglandins E; Prostaglandins F

The plasma concentrations of oxytocin and 13,14-dihydro-15-keto-prostaglandin F2 alpha (PGFM) were measured in serial samples collected during the first stage of spontaneous and oxytocin-induced labor in 17 and 15 women, respectively. Four women in late pregnancy served as control subjects, with serial samples collected at similar intervals as during labor. During spontaneous labor, mean plasma oxytocin levels were consistently raised over the levels observed 1 to 2 weeks before the onset of labor and were higher than the levels in the control patients (mean, 19.9 +/- 3.1 pg/ml) and the initial levels in the oxytocin-induced group of women (mean, 17.4 +/- 4.8 pg/ml). The mean plasma oxytocin levels during spontaneous labor (45 +/- 3.9 pg/ml) were similar to those observed during infusion of 4 to 6 mU/min of synthetic oxytocin (49.1 +/- 10.9 pg/ml). Plasma oxytocin levels increased progressively with stepwise increments of the infusion. Plasma PGFM levels also rose during labor, but, in contrast to the oxytocin levels which increased in early labor, plasma PGFM levels did not increase significantly until relatively late in labor, provided the membranes were intact. The state of the membranes had a marked influence on plasma PGFM; patients with spontaneous rupture of membranes had significantly increased PGFM levels when admitted early in labor or when membranes ruptured during labor. This increase in prostaglandin F2 alpha (PGF2 alpha) production does not by itself suffice to initiate labor, as evidenced by the failure of premature rupture of the membranes to initiate labor in a number of patients with elevated PGFM levels in whom labor was then induced with oxytocin. Conversely, oxytocin induction was successful only when PGFM levels increased during the infusion of oxytocin; in the absence of a rise in plasma PGFM, oxytocin induction failed. These data add support to the view that both oxytocin and PGF2 alpha are required for adequate stimulation of the human uterus during labor. In addition, the data suggest that oxytocin rather than PGF2 alpha may be the major stimulus that initiates labor, whereas PGF2 alpha appears responsible for the progress of labor.

Topics: Cervix Uteri; Dinoprost; Extraembryonic Membranes; Female; Fetal Membranes, Premature Rupture; Humans; Infusions, Parenteral; Labor, Induced; Labor, Obstetric; Oxytocin; Pregnancy; Prostaglandins F; Time Factors