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[Administration of prostaglandin E2 in premature rupture of the membranes]
1Frauenklinik Krankenhaus Köln-Porz/Rhein, Akademisches Lehrkrankenhaus, Universität Köln.
Insights
Prostaglandin E2 effectively reduces the duration of amnion infection syndrome, a severe perinatal complication. Early administration, particularly in cases of premature rupture of membranes, improves labor outcomes and fetal well-being.
Area of Science:
- Obstetrics and Gynecology
- Perinatal Medicine
- Reproductive Endocrinology
Context:
- Amnion infection syndrome (AIS) is a severe perinatal complication impacting both mother and neonate.
- Premature rupture of membranes (PROM) increases the risk of AIS, necessitating timely intervention.
- Prostaglandins are recognized for their efficacy in cervical ripening and labor induction.
Purpose:
- To evaluate the effectiveness of intracervical prostaglandin E2 gel and intravaginal prostaglandin E2 tablets in managing PROM and preventing AIS.
- To compare outcomes in patients with mature versus immature cervices receiving prostaglandin E2.
- To assess the impact of prostaglandin E2 on labor duration, delivery mode, and fetal well-being compared to controls.
Summary:
- Prostaglandin E2 administration resulted in delivery within 24 hours for approximately 80% of patients.
- Outcomes, including labor duration, cesarean rates, and fetal morbidity, were improved with prostaglandin E2, irrespective of cervical ripeness.
- Adverse effects like uterine hyperstimulation occurred in 7% of cases, with similar umbilical artery pH shifts across groups.
Impact:
- Prostaglandin E2 is a successful method for shortening the duration of amnion infection syndrome.
- Early cervical priming with prostaglandin E2 is recommended in the absence of spontaneous labor.
- This intervention can potentially reduce severe perinatal complications and improve neonatal outcomes.
Abstract:
The imminent amnion infection syndrome with or without premature rupture of the membranes is regarded as one of the most severe perinatal complications, especially for the baby. Early treatment or better, prevention of manifest intrauterine infection syndrome is thus a priority task in obstetrics. In recent years, administration of prostaglandin has proven to be a good choice to stimulate cervix maturation and to induce labor. The present study wanted to investigate the effect of prostaglandin application in PRM. Prostaglandin E2 was intracervically applied in the form of gel, and intravaginally in the form of a tablet. Its action was compared with controls. Patients with immature cervix were evaluated versus patients with mature cervix. Duration of labor and fetal outcome were compared to a group of non-primed patients. After application of prostaglandin E2, approximately 80% of patients started to deliver within 24 hours. Concerning the duration of labor, the rate of cesareans, incipient chorio-amnionitis and fetal morbidity, independent of cervical maturation, results after prostaglandin E2 administration were better among the primi- and pluriparae. Adverse effects such as uterine overstimulation or pathologic FHF in the CTG were seen in 7% of the cases. The incidence of pH-shifting in the umbilical artery was nearly equal in all groups. Our study confirmed that prostaglandin E2-application constitutes a successful method to shorten aminon infection syndrome. In absence of spontaneous labor, priming should be done early, e.g. within six to seven hours.