ABSTRACT
In a prospective, randomised dose-finding study involving 60 women scheduled for termination of 1st trimester pregnancy, 25 micrograms, 50 micrograms or 100 micrograms of a sulprostone gel with a constant injection volume of 2.5 ml were applied intracervically 6-8 hours before curettage. The gelatinising agent was Pluronic F 127, which is liquid at temperatures less than 20 degrees C but gelatinises immediately at body temperature. A sterile, ready-to-use gel can be produced within a minute by mixing the active substance with the gelatinising agent; this rules out any loss of activity due to storage of the substances. The priming effect was verified in 30 patients by means of comparative examinations with a special tonometer before application of the gel and immediately before the surgical procedure. The 100-micrograms dosage proved to be the most effective method in nulliparae, achieving a mean free patency (i.e. force less than 1 Newton) of 8.7 mm. In primiparae and multiparae, a comparable good effect was achieved with the 50-micrograms dose. After application of 25 micrograms sulprostone gel, the mean free patency was only 5.3 mm in the nulliparae and 8.5 mm in the primiparae and multiparae. The results of the tonometric studies agreed with the clinical documentation of the priming effect, which was assessed by means of a special score. The efficiency of the cervical priming correlated with the rate of vaginal bleeding and with the frequency of contraction-related lower abdominal pain. According to the present results, local application of this sulprostone gel represents a practicable and promising method for preoperative cervical priming because of its special electromechanical properties.
Subject(s)
Abortifacient Agents, Nonsteroidal , Abortifacient Agents , Abortion, Therapeutic/methods , Cervix Uteri , Dinoprostone/analogs & derivatives , Premedication , Prostaglandins E, Synthetic/therapeutic use , Adult , Cervix Uteri/drug effects , Dilatation , Dose-Response Relationship, Drug , Female , Gelatin , Humans , Pregnancy , Pregnancy Trimester, First , Vacuum CurettageABSTRACT
13 ,14 -Dihydro-15-keto-PGF2 alpha (PGFM) serum levels were determined by radioimmunoassay in 101 postpartum women who were treated with 200 micrograms methergin, 5 I.U. oxytocin and 500 micrograms sulprostone, respectively, 30 min after expulsion of placenta. All patients had normal deliveries. The present radioimmunoassay system did not show cross-reactivity with sulprostone. In addition, radioimmunoassayable sulprostone serum levels were monitored. Covariance analysis of area under PGFM serum levels between time zero and 180 min after application of oxytocics was performed. A higher but statistically not significantly PGFM serum level was maintained in subjects treated with sulprostone. Sulprostone serum levels are rapidly attained after application. Decrease of radioimmunoassayable sulprostone indicates a half-life of 75 min. These data corroborate clinical findings of an accompanying paper and combine to suggest that sulprostone may be a useful alternative therapy in high-risk patients with severe postpartum atony and hemorrhage in whom prior preventive measures have failed.
Subject(s)
Dinoprost/analogs & derivatives , Dinoprostone/analogs & derivatives , Postpartum Period , Prostaglandins E, Synthetic/blood , Prostaglandins F/blood , Female , Half-Life , Humans , Methylergonovine/analogs & derivatives , Methylergonovine/pharmacology , Oxytocin/pharmacology , Pregnancy , Prostaglandins E, Synthetic/pharmacology , RadioimmunoassayABSTRACT
UNLABELLED: With the introduction of prostaglandins to obstetrics another group of substances was known to influence uterine motility also post partum. It was interesting to study the effect of equal doses of synthetic prostaglandin E2 (sulprostone), methergin and synthetic oxytocin on the so-called puerperal model in humans. By transcervically introduced twin-catheters uterine motility was recorded after uncomplicated pregnancy and delivery in 101 volunteers. Uterine motility was recorded and evaluated according to the onset of the effect, its duration, motility pattern and uterine activity. Maternal heart-rate was additionally recorded similarly to the feto-maternal cardiotocogram. All substances were applied by intramuscular injection. The following observations could be made: 1. Onset: sulprostone is effective in the shortest time, followed by oxytocin and methergin. 2. DURATION: the most prolonged effect is noticed with methergin, followed by sulprostone and syntocinon. 3. Motility pattern: the strongest effect can be seen with sulprostone, followed by methergin and syntocinon. 4. Increase of uterine motility was highest with sulprostone, followed by methergin and oxytocin. 5. No side-effects on the maternal heart-rate could be found with any of the tested substances. As a conclusion, sulprostone is recommended in the treatment of severe bleeding post partum when an immediate and long-lasting effect is to be achieved with one single substance.
