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Role of prostaglandin in the management of prelabor rupture of the membranes at term
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Citations from the Literature
Role of prostaglandinin the management of prelabor rupture of the membraoes at term Mahwood TA; Dick MJW; Smith NC; Templeton AA Department of Obstetrics and Gynaecology, Aberdeen Maternity Hospital, Comhill Road, Aberdeen GBR
BR J OBSTET GYNAECOL 1992 99/2 (112-117) Objective: To compare conservative versus prostaglandin management of prelabor rupture of the membranes (PROM) in healthy primigravid women at term. Design: A prospective randomized study. Setting: Labor Ward, Aberdeen Maternity Hospital. Subjects: 230 primigravidas at term with PROM, 115 allocated to be treated conservatively and 115 to be managed with prostaglandin treatment. Interventions: In the conservatively managed group the women were observed for up to 24 h after hospital adminission with PROM. The actively managed group had PGE, gel (2 mg) instilled into the posterior fornix and if contractions had not commenced, a further dose of PGEz gel (1 mg) was instilled 6 h later. In both groups, if labor had not established 24 h after adminission, intravenous oxytotin was given in escalating doses. Main outcome measures: PROM to delivery interval, oxytocin augmentation, mode of delivery, maternal and neonatal infective morbidity. Results: There was a significant reduction in the PROM to delivery interval in the women managed actively with PGE, gel and fewer women in the PGE2 group required oxytocin augmentation (31% vs. 51%). The two managements groups were comparable for intrapartum analgesia, antibiotic treatment, babies requiring admission to the special care nursery unit and delivery by cesatean section. Conclusion: The early use of prostaglandin is associated with a significant reduction in PROM to delivery interval without a significant increase in infective morbidity or cesarean section rate. However, the advantages of the conservative approach should not be overlooked. More work is still needed in the management of those women where uterine activity fails to establish within 24 h after PROM.
Cboriodecidual production of interleukin-tl and mechanism of partViti00 Kelly RW; Leask R; Calder AA Medical Research Council Reproductive Biology Unit, University of Edinburgh Centre for Reproductive Biology, 37 Chalmers Street, Edinburgh EH3 9EW, GBR
LANCET 1992 33918796(776-777) Both prostaglandins and antiprogestagens can induce labour and ripen the cervix, but the mechanisms are unclear. The collagenases that bring about cervical ripening are neutrophil derived. We examined the potential of uterine tissues to control neutrophil attraction by measuring interleukin-8 production. Choriodecidual cells in culture produced substantial amounts of interleukin-8; release was inhibited by progesterone and stimulated by the antiprogestagen mifepristone. Interleukin-8 production was similar in cells from spontaneously delivered placentas and from those obtained at cesarean section. Since prostaglandin E and interleukin-8 have synergistic effects, we suggest that interleukin-8 activity is the final common step of prostaglandin and antiprogestagen action in parturition. Int J Gynecol Obstet 39
Preterm prematurerupture of membranes: Results of expectant managementin patients with cervical cultures positive for group B streptococcus or Neisseria gonorrhoeae Maxwell GL; Watson WJ Division of Maternal-Fetal Medicine, Depariment of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
AM J OBSTET GYNECOL 1992 166/3 (945-949) Objective: The antepartum course and short-term neonatal outcome for patients with premature rupture of membranes between 26 and 33 weeks’ gestation with positive cervical cultures for group B streptococcus or Neisseria gonorrhoeae were reviewed. Study design: A retrospective analysis of 182 patients managed expectantly over a 3-year period was done. Thirtyfour patients had cervical cultures positive for group B streptococcus, 11 had positive cultures for Neisseria gonorrhoeae and 137 had negative cultures. Prophylactic antibiotics were routinely given and antibiotic therapy was continued in patients with positive cultures. Results: There was no difference between groups in latent phase or maternal morbidity. The incidence of neonatal pneumonia was increased in those with positive cervical cultures (P = 0.009, odds ratio 6.9, 90% confidence interval 2.1-22.8), but there was no difference in neonatal sepsis, respiratory distress, or neonatal mortality. Conclusion: These data support the conservative or expectant management of premature rupture of membranes between 26 and 33 weeks in patients with positive cervical cultures who are given prophylactic antibiotic therapy.
Plasma endothelin levels in preeclampsia: Elevation and correlation with uric acid levels and renal impairment Clark BA; Halvorson L; Sachs B; Epstein FH Department of Medicine, Beth Israel Hospital, Harvard Medical School, 330 Brookline Ave., Boston, MA 02215, USA
AM J OBSTET GYNECOL 1992 166/3 (962-968) Objective: The purpose of this study was to determine if endothelin levels are elevated in women with preeclampsia and if these levels correlated with other laboratory features of disease severity. Study design: Parameters were compared in four groups of women volunteers by means of analysis of variance: (1) 16 women with preeclamptic pregnancies, (2) 11 pregnant women without preeclampsia, of similar lengths of gestation, (3) six otherwise normal women with pregnancies at term or beyond (> 38 weeks) and (4) 22 normotensive young women. Results: Endothelin levels were elevated in women with preeclampsia as compared with those of gestationmatched pregnant and nonpregnant controls (22.6 * 2.0 vs. 12.0 f 1.0 vs. 10.4 f 1.3 pmolfl, P < 0.005, preeclampsia vs. controls) and also were increased in late gestation (17.7 f 2.0 pmohl). Endothelin correlated positively with plasma levels of uric acid (r = 0.698, P < 0.005) and inversely with creatinine clearance (r = -0.659, P c 0.05). Conclusion: Circulating endothelin levels are elevated in women with preeclampsia and correlate closely with serum uric acid levels and measures of renal dysfunction. These observations suggest that endothelin may contribute to renal vasoconstriction in preeclampsia.
Citations from the Literature
Role of prostaglandinin the management of prelabor rupture of the membraoes at term Mahwood TA; Dick MJW; Smith NC; Templeton AA Department of Obstetrics and Gynaecology, Aberdeen Maternity Hospital, Comhill Road, Aberdeen GBR
BR J OBSTET GYNAECOL 1992 99/2 (112-117) Objective: To compare conservative versus prostaglandin management of prelabor rupture of the membranes (PROM) in healthy primigravid women at term. Design: A prospective randomized study. Setting: Labor Ward, Aberdeen Maternity Hospital. Subjects: 230 primigravidas at term with PROM, 115 allocated to be treated conservatively and 115 to be managed with prostaglandin treatment. Interventions: In the conservatively managed group the women were observed for up to 24 h after hospital adminission with PROM. The actively managed group had PGE, gel (2 mg) instilled into the posterior fornix and if contractions had not commenced, a further dose of PGEz gel (1 mg) was instilled 6 h later. In both groups, if labor had not established 24 h after adminission, intravenous oxytotin was given in escalating doses. Main outcome measures: PROM to delivery interval, oxytocin augmentation, mode of delivery, maternal and neonatal infective morbidity. Results: There was a significant reduction in the PROM to delivery interval in the women managed actively with PGE, gel and fewer women in the PGE2 group required oxytocin augmentation (31% vs. 51%). The two managements groups were comparable for intrapartum analgesia, antibiotic treatment, babies requiring admission to the special care nursery unit and delivery by cesatean section. Conclusion: The early use of prostaglandin is associated with a significant reduction in PROM to delivery interval without a significant increase in infective morbidity or cesarean section rate. However, the advantages of the conservative approach should not be overlooked. More work is still needed in the management of those women where uterine activity fails to establish within 24 h after PROM.
Cboriodecidual production of interleukin-tl and mechanism of partViti00 Kelly RW; Leask R; Calder AA Medical Research Council Reproductive Biology Unit, University of Edinburgh Centre for Reproductive Biology, 37 Chalmers Street, Edinburgh EH3 9EW, GBR
LANCET 1992 33918796(776-777) Both prostaglandins and antiprogestagens can induce labour and ripen the cervix, but the mechanisms are unclear. The collagenases that bring about cervical ripening are neutrophil derived. We examined the potential of uterine tissues to control neutrophil attraction by measuring interleukin-8 production. Choriodecidual cells in culture produced substantial amounts of interleukin-8; release was inhibited by progesterone and stimulated by the antiprogestagen mifepristone. Interleukin-8 production was similar in cells from spontaneously delivered placentas and from those obtained at cesarean section. Since prostaglandin E and interleukin-8 have synergistic effects, we suggest that interleukin-8 activity is the final common step of prostaglandin and antiprogestagen action in parturition. Int J Gynecol Obstet 39
Preterm prematurerupture of membranes: Results of expectant managementin patients with cervical cultures positive for group B streptococcus or Neisseria gonorrhoeae Maxwell GL; Watson WJ Division of Maternal-Fetal Medicine, Depariment of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
AM J OBSTET GYNECOL 1992 166/3 (945-949) Objective: The antepartum course and short-term neonatal outcome for patients with premature rupture of membranes between 26 and 33 weeks’ gestation with positive cervical cultures for group B streptococcus or Neisseria gonorrhoeae were reviewed. Study design: A retrospective analysis of 182 patients managed expectantly over a 3-year period was done. Thirtyfour patients had cervical cultures positive for group B streptococcus, 11 had positive cultures for Neisseria gonorrhoeae and 137 had negative cultures. Prophylactic antibiotics were routinely given and antibiotic therapy was continued in patients with positive cultures. Results: There was no difference between groups in latent phase or maternal morbidity. The incidence of neonatal pneumonia was increased in those with positive cervical cultures (P = 0.009, odds ratio 6.9, 90% confidence interval 2.1-22.8), but there was no difference in neonatal sepsis, respiratory distress, or neonatal mortality. Conclusion: These data support the conservative or expectant management of premature rupture of membranes between 26 and 33 weeks in patients with positive cervical cultures who are given prophylactic antibiotic therapy.
Plasma endothelin levels in preeclampsia: Elevation and correlation with uric acid levels and renal impairment Clark BA; Halvorson L; Sachs B; Epstein FH Department of Medicine, Beth Israel Hospital, Harvard Medical School, 330 Brookline Ave., Boston, MA 02215, USA
AM J OBSTET GYNECOL 1992 166/3 (962-968) Objective: The purpose of this study was to determine if endothelin levels are elevated in women with preeclampsia and if these levels correlated with other laboratory features of disease severity. Study design: Parameters were compared in four groups of women volunteers by means of analysis of variance: (1) 16 women with preeclamptic pregnancies, (2) 11 pregnant women without preeclampsia, of similar lengths of gestation, (3) six otherwise normal women with pregnancies at term or beyond (> 38 weeks) and (4) 22 normotensive young women. Results: Endothelin levels were elevated in women with preeclampsia as compared with those of gestationmatched pregnant and nonpregnant controls (22.6 * 2.0 vs. 12.0 f 1.0 vs. 10.4 f 1.3 pmolfl, P < 0.005, preeclampsia vs. controls) and also were increased in late gestation (17.7 f 2.0 pmohl). Endothelin correlated positively with plasma levels of uric acid (r = 0.698, P < 0.005) and inversely with creatinine clearance (r = -0.659, P c 0.05). Conclusion: Circulating endothelin levels are elevated in women with preeclampsia and correlate closely with serum uric acid levels and measures of renal dysfunction. These observations suggest that endothelin may contribute to renal vasoconstriction in preeclampsia.