Abstract

PIP: In this discussion of the clinical application of prostaglandins (PGs) in human reproduction, attention is directed to indications for PG administration, potential therapeutic applications, PG drugs, routes and schedules of PG administration, contraindications to PG administration, and side effects and complications. Termination of pregnancy is the most common reason for using PGs. Induction of early abortion by PGs up to 8 weeks following the 1st day of the last menstrual period offers many advantages that make this approach competitive with vacuum aspiration. Being a nonsurgical method that can be self-administered, it presents an attractive clinical potential. The preferred routes of administration are the vaginal route and to a lesser extent the intramuscular injection route. From the 8th week of gestation up to the 12th week, vacuum aspiration and conventional curettage are the most efficient abortion methods. PGs, hypertonic saline, and vaginal surgical evacuation are the most popular methods for performing 2nd trimester abortions. In abnormal pregnancies with fetal death or molar changes, PGs appear to be most valuable and to be a logical primary choice, particularly in uterine sizes exceeding 12 weeks. Induction of labor by PGs continues to be a controversial issue, but the consensus is that although these compounds may be more efficient than oxytocin, they probably are more risky at labor inducing doses from the danger of uterine hyperstimulation. Intramyometrial injection of PGF2alpha has been shown to be a valuable method for treatment of atonic postpartum hemorrhage. More recently, intramuscular administration of 15-methyl-PGF2alpha has been reported to be highly effective and life saving in severe uncontrollable atonic postpartum hemorrhage when all other nonsurgical lines of treatment already have failed. Toxemia of pregnancy is 1 area in which PGs may prove to be of clinical value in management, especially because recent reports implicate these compounds in the pathogenesis of this serious disorder. At least 3 generations of PGs have thus far developed: the classic PGE2 and PGF2alpha represent the 1st generation, and only PGE2 still is used clinically; 15-methyl-PGF2alpha, representing the 2nd generation; and the 3rd generation of PGs, the one with the greatest clinical potential for induction of abortion, made up totally of E analogues. PGs have been used by every possible route of administration, including systemic routes and locally. Recently, PGE2 was administered intranasally. The contraindications to PG administration differ according to the type of PG, the indication for use, and the mode of administration. In general terms, the absolute contraindications include glaucoma and cardiac disease. Side effects include gastrointestinal side effects.