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Prostaglandin E2 preparations for preinduction cervical ripening. Pharmacy considerations

F Y Nishioka1

  • 1Department of Pharmacy, Lucile Salter Packard Children's Hospital, Stanford University Medical Center, Palo Alto, California 94304.

The Journal of Reproductive Medicine
|January 1, 1993
PubMed
Summary

Locally applied prostaglandin E2 (PGE2) aids cervical ripening in term pregnancy. Evidence supports low-dose PGE2 for labor induction, minimizing systemic effects and potential complications.

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Area of Science:

  • Obstetrics and Gynecology
  • Reproductive Medicine
  • Pharmacology

Background:

  • Locally applied prostaglandin E2 (PGE2) is widely used for cervical ripening in term pregnancies.
  • Extemporaneously prepared PGE2 vaginal gels are common in the US but lack standardization and large-scale trials.
  • Current efficacy and safety assessments rely on anecdotal reports due to lack of standardized products.

Purpose of the Study:

  • To review the evidence supporting the use of locally applied PGE2 for cervical ripening.
  • To discuss the pharmacokinetic limitations and safety considerations of PGE2 administration.
  • To outline factors for a cost-benefit analysis of commercially prepared PGE2 gels.

Main Methods:

  • Review of existing clinical evidence and pharmacokinetic data on prostaglandin E2.

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  • Analysis of safety and efficacy based on available literature and clinical reports.
  • Consideration of cost-benefit factors for commercial PGE2 gel use.

    • Main Results:

    • Available evidence supports the use of low-dose, locally applied PGE2 for cervical ripening.
    • Local application appears to minimize systemic side effects and uterine hypertonus.
    • Plasma levels of PGE2 are not reliable indicators of clinical efficacy due to rapid metabolism.

    Conclusions:

    • Low-dose local prostaglandin E2 application is supported for cervical ripening prior to labor induction.
    • Minimizing systemic exposure may reduce adverse effects like uterine hypertonus.
    • Cost-benefit analyses should include procedural savings and risk mitigation.