ABSTRACT
In 7 primigravidae admitted for first trimester abortion by dilatation and evacuation, 0.5 mg PGE2 in viscous gel (5 patients) or placebo gel (2 patients) was applied intracervically 6 hours prior to the operation. Throughout the treatment period intrauterine pressure was recorded. Application of placebo gel induced no cervical ripening or myometrial activation. In all patients receiving active gel, a marked improvement of the cervical state was induced by the treatment. In three cases, this priming occurred in parallel to minimal changes in myometrial activity, without regular uterine contractions. In two patients, marked uterine activation was registered due to partly extraamniotic application. It is suggested, that the PGE2-gel has a direct effect on the cervical tissues. Further, the risk of partially applying the gel in the extraamniotic space, thus stimulating the myometrium, depends on the gel volume relative to the dimensions of the cervical canal and the application technique.
PIP: In 7 primigravidae admitted for 1st trimester abortion by dilatation and evacuation, 0.5 mg prostaglandin E2 (PGE2) in a viscous gel (5 patients) or placebo gel (2 patients) was applied intracervically 6 hours prior to the operation. Throughout the treatment period, intrauterine pressure was recorded. Application of placebo gel induced no cervical ripening or myometrial activation. In all patients receiving active gel, a marked improvement of the cervical state was induced by the treatment. In 3 cases, this priming occurred parallel to minimal changes in myometrial activity without regular uterine contractions. In 2 patients, marked uterine activation was registered due to partial extraamniotic application. It is suggested that the PGE2 gel has a direct effect on cervical tissue. Furthermore, the risk of partially applying the gel in the extraamniotic space, thus stimulating the myometrium, depends on gel volume relative to the dimensions of the cervical canal and the application technique.
Subject(s)
Abortion, Therapeutic/methods , Cervix Uteri/drug effects , Myometrium/drug effects , Prostaglandins E/pharmacology , Uterus/drug effects , Adolescent , Adult , Dinoprostone , Female , Gels , Humans , Pregnancy , Pregnancy Trimester, First , Prostaglandins E/administration & dosage , Uterine Contraction/drug effectsABSTRACT
Eight primigravid women with a mean gestational age of 9.4 weeks (9 to 10 weeks) who were admitted for first-trimester abortion by dilatation and evacuation were preoperatively treated for 6 hours with either intravenous infusion of oxytocin or a strictly intracervical application of prostaglandin E2 (PGE2) in viscous gel. Myometrial activity was monitored by intrauterine pressure recording throughout the treatment. Contractile activity was more pronounced in the oxytocin-treated group, whereas cervical priming occurred after the PGE2 treatment only. Intracervical PGE2-gel is suggested to have direct effects on the cervical tissues, independent of uterine contractile activity. Furthermore, myometrial stimulation induced by escape of gel into the extra-amniotic space can be avoided by adjusting the volume of gel and technique of application to the dimensions of the cervix.
