Abstract

PIP: This review of prostaglandins (PGs) covers the following: PGs in obstetrics and gynecology (induction of labor, cervical priming, termination of pregnancies complicated by fetal death, use in 1st and 2nd trimester abortions, and potential contraceptive use); and PGs in other areas of medicine. The original work on the use of PGs in the induction of labor indicated that of the naturally occurring PGs only PGE2 and PGF2alpha are clinically important in reproduction. Ensuing clinical trials confirmed this observation but lead to the conclusion that intravenous PGs for routine labor induction provided no real benefit over intravenous oxytocin, and, in contrast to oxytocin, were associated with frequent gastrointestinal side effects and a pyrexia which could lead to confusion. A recent modification using a cross linked polymer pessary has been designed in an effort to provide a constant sustained release of the incorporated PGE2 for absorption by the vaginal surface. Further studies to assess this innovation are necessary. There was renewed interest in PGs in the mid 1970s when it was observed that they possibly enhanced the outcome of induced labor in patients with an unfavorable cervix. Recent research has established PGE2 as possibly the most efficient cervical priming agent available at this time. A cervical effect may be the reason why PGs are successful in evacuating pregnancies complicated by fetal death. The vaginal route has gained preference as a simple, nontraumatic means of stimulating uterine activity without increasing the chances of intrauterine infection. It seems unlikely that PGs will ever supersede routine aspiration termination of 1st trimester pregnancy. Longterm studies have not been reported yet to indicate that occult cervical damage will be avoided with preoperative PG treatment. Considerable research has been conducted into the safety of PGs for late abortion. Initial concerns of possible coagulopathy, encephalopathy and cardiopulmonary system disturbances have now been largely dismissed; the drugs have been confirmed as safe. The possibility of PGs becoming fertility controlling agents was initially explored in the early 1970s. Although abortion has been successfully induced in 80-90% of treated cases, in many reported series the observed side effects, particularly severe uterine effects, have thus far made the method untenable for routine management. Other uses of PGs include the treatment of spasmodic dysmenorrhea and dysfunctional uterine bleeding and the treatment of gastric ulcers.