Clinical applications of prostaglandins in Obstetrics and Gynaecology

Abstract

Although a number of potential practical uses of prostaglandins have been identified, these compounds have so far found clinical applications mainly in Obstetrics and Gynaecology. It is almost 15 years since a prostaglandin was first used for the induction of term labour and prostaglandin E2 is now commercially available for this purpose in many countries. For the termination of second trimester pregnancy, prostaglandins have almost completely replaced other methods previously in use. Other areas where prostaglandins are routinely used or where their uses are being developed, include menstrual induction, preevacuation dilatation of the cervix in the first trimester, termination of pregnancy in cases of missed abortion, intrauterine fetal death and other types of abnormal pregnancies, control of post-partum haemorrhage, treatment of post-partum or post surgical urine retention and ripening of the cervix prior to induction of labour at term. In early studies, prostaglandins E2 and F2 alpha were used for all the applications listed above. In order to increase efficacy and reduce side effects, a number of synthetic analogues were later evaluated for application in selected areas. Those with modification in the 15 and 16 positions of PGE2 and PGF2 alpha molecules have undergone extensive clinical trials and some of these analogues are now in routine use. The current status of the practical applications of prostaglandins in Obstetrics and Gynaecology is reviewed.

PIP: Although a number of potential practical uses of prostaglandins (PGs) have been identified, these compounds have thus far found clinical applications mainly in the areas of obstetrics and gynecology. It is almost 15 years since the 1st PG was used to induce term labor and PGE2 is now commercially available for this purpose in many countries. For the termination of 2nd trimester pregnancy, PGs have almost completely replaced other methods previously used. Other areas in which PGs are routinely used or where their use is being developed include menstrual induction, preevacuation dilatation of the cervix in the 1st trimester, termination of pregnancy in missed abortion, intrauterine fetal death and other types of abnormal pregnancies, control of postpartum hemorrhage, treatment of postpartum or postsurgical urine retention, and ripening of the cervix prior to the induction of labor at term. In early studies, PGE2 and PGF2alpha were used for all the applications mentioned above. In order to increase efficacy and reduce side effects, a number of synthetic analogues were later evaluated for application in selected areas. Those with modification in the 15 and 16 positions of PGE2 and PGF2alpha molecules have undergone extensive clinical trials and some of them are now used routinely. The current status of the practical application of PGs in obstetrics and gynecology is reviewed.