1. prostaglandins in labour dr rabi

prostaglandin, labour, pregnancy, obstetrics, delivery, normal labour, normal delivery, first stage of labour, induction of labour, pph, post partum haemorrhage, bleeding in pregnancy, abortion

1. PROSTAGLANDINS IN
LABOUR
DR. RABI NARAYAN SATAPATHY
ASST.PROFESSOR
DEPT. OF OBST.& GYNAECOLOGY
SCB MEDICAL COLLEGE, CUTTACK
MOB-09861281510
[email protected]

2. The role of all technological advances is to reduce
human suffering.
In relation to obstetrics it can be achieved by:
•Reducing Maternal morbidity and mortality.
•Reducing perinatal mortality and morbidity
•Relievingpain of a parturient mother and thereby
reducing her suffering

3. Historical developments in the development
of Prostaglandins
1930 – KURZORK & LEIB DISCOVERED BIOLOGICAL
ASPECTS OF PG’S
1935 – VON EULER COINED THE TERM PROSTAGLANDIN
BELIEVING IT TO ORIGINATE FROM THE PROSTATE
1959 – ELAISON PROVED THAT PG ORIGINATED IN THE
SEMINAL VESICLE
1964 – BERGSTRON ELUCIDATED THE STRUCTURE
1966 – DR. SULTAN KARIM REPORTED PRESENCE OF PG IN
THE AMNIOTIC FLUID
- USED SEMEN TO AUGMENT LABOUR
1970 – DR. KARIM I.V. PGF
2
α FOR 1
ST
AND 2
ND
TRIMESTER
ABORTIONS

4. Prostaglandins in Reproduction
Parturition
Birth
Ovulation
Fertilization &
implantation
Pregnancy
Fetal placental
hemodynamics
PPH
Lactation
Toxaemia
Ductus
Aretriosus
patency
Spontaneous
abortion
Preterm labour
Sperm
transport
PDA closure
Umbilical
cord
closure
dysmenorrhoea
Leutolysis
menstruation

5. Prostaglandin
Release
Rupture of
membranes
Stretching of
cervix
Vaginal
examination
Oxytocin
Estrogen

6. OXYTOCIN INDUCED
High amplitude
Higher frequency
Higher intensity
Quicker onset
Stops when infusion discontinued
PROSTAGLANDIN INDUCED
Low amplitude
Low frequency
Lower intensity
Continues even after
discontinuing treatment
UTERINE
CONTRACTIONS

7. PROSTAGLANDINS
Membrane Phospholipids
Arachidonic acid (AA)
NSAID
PGE
2
PGH
2
Cyclooxygenese
PGI
2
PGD
2
PGE
2
PGF
2
αThromboxanes
A
2
& B
2
(TXA
2
,TXB
2
)
GlucocorticoidsPhospholipase A
2

8. PG synthesis

10. 0
2
4
6
8
10
Non pregnantmid pregnancyterm pregnancy
not in labour
term preg in
labour
area under the curve (sq cm)
Uterine sensitivity to
oxytocin

11. 10
50
90
not in
labour
early
stage 1
late
stage 1
II stageIII stage
oxytocin
pg/ml

12. 0
12
24
2 cm 4 cm 6 cm 8 cm 10 cm
PGF2
PGE2
Amniotic fluid PG
during labour

13. Indicatons for the use of Cerviprime gel
•Post term
•Hypertension / Toxaemia
•Chronic hypertension
•Oligohydramnios
•Intrauterine growth restriction
•Diabetes
•Reduced fetal movements
•Suspected placental insufficiency

14. MUSCLE
MUCOSA
PROTEOGLYCAN
FIBROBLASTS

16. Instillation of PGE
2 Gel

17. Cervical priming
COLLAGEN DEGRADATION
COLLAGEN IS RESISTANT TO MOST PROTEINASES
I COLLAGENASE
II LEUCOCYTE ELASTASE

18. Fibroblast activation
Vasacular permiability
Tissue hydration
Destabilization of
Proteoglycans
Collagen dsegradation
PGE2
Cervical
ripening

19. PGE
2
FIBROBLAST
VASCULATURE
Relaxin, Collagenase
Leucocyte
infiltration
Tissue
hydration
Collagen
Collagen breakdown
Cervical ripening
Proteoglycans
Expression,
production
Increased vascular
permiability

20. Progressive cervical dilatation

21. Cervical changes during labour
Nulliparous cervix near term
During labour - effacement
Fully dilated

22. Cerviprime to improve Bishop score
Authors yearNo. of
Pts
Bishop score
Before After
Bernstein1987 42 3.2 7.7
ICMR
study
1988 221 <3.0 >6.0
Bhide 1992 68 2.8 8.5
Patki &
Daftary
1992 80 2.7 6.0

23. Cerviprime for labour outcome
Authors Year No. of PtsVaginal
delivery
(%)
Legarht 1988 57 84.2
ICMR
Study
1988 221 80.5
Bhide 1991 40 97.0
Patki &
Daftary
1992 80 92.5

24. Prostaglandin induction of Labour (1993-94)
S
No.
Author Place % Vag
Del.
% C
sec.
Avg Dur of lab(hrs)
Primi Multi
1Patki Mumbai 92.5 7.5 7.3 7.3
2Bhide Mumbai 90 10 16.4
3Dubey Kanpur 92.2 7.1 14.6 8.2
4Mehta Jaipur 100 - 8.0 6.0
5R. Jina Gorakhpur 95 5 8.13 7.06
6Sasikala Pondicherry 91.4 8.6 7.4 7.4
7Daftary G. S.Mumbai 80 20 10.6 8.4
8Handa P.R.Jamshedpur 85.7 14.3 12 10

25. Prostaglandin induction of Labour (1995-96)
S
No.
Author Place % Vag
Del.
% C
sec.
Avg Dur of lab(hrs)
Primi Multi
1S. Gupta Jaipur 79.7 21.3 12.6
2S. BhattacharyaCalcutta 62.4 37.6 8.2 8.2
3Sandhu Amritsar 85 15 10.35 6.08
4S. Kore Mumbai 88 12 11.4 7.6
5Mukherjee Allhabad 84 16 16.3 10.3
6Vaneetkuma Jammu 81 19 12.0 -
7A. Sone Simla 93 7 10 7.4

26. Contraindicatons for the use of
Cerviprime gel
1.Patients hypersensitive to PG’S
2.Patients in whom Oxytocics are contraindicated
•Previous LSCS
•Major CPD
•Pre-existing fetal distress
•Grande multipara
•Previous difficult or traumatic labour
1.Patients with ruptured membranes
2.Non-vertex presentation

27. Oxytocin PGE
2
FUNDUS + +
ISTHMUS + -
+ STIMULATION - INHIBITION

28. Comparison of PG vs. Pitocin
for Induction of labour
Distribution of cases
OxytocinPGE2
Total cases 200 200
Indications
Post datism 25 60
P.R.O.M. 75 80
P.I.H. 40 30
Meconium stained
liquor
50 15
I.U.G.R 10 15

29. Effect on Bishop score after single
Intracervical Gel or oxytocin drip after 4 hours
Oxytocin PGE2
Initial Bishop score2.71± 0.962.65± 1.04
Follow up Bishop score3.86± 1.455.02± 1.58
Mean change in Bishop
score
1.15 2.37

30. Mean duration of stages of labour
Oxytocin PGE2
1
ST
STAGE 10.4
(2-14 HRS)
7.3
(1.5-12 HRS)
2
ND
STAGE 25.5 MIN 26.7 MIN
3
RD
STAGE 5 MIN 7 MIN

31. Comparison of PG vs. Pitocin
Mode of delivery
OxytocinPGE2
Normal vaginal
delivery
70 (35%)125 (62.5%)
Instrumental
vaginal
delivery
90 (45%) 60 (30%)
L.S.C.S. 40 (20%) 15 (7.5%)

32. Prostaglandins – Induction of labour
SUMMARY:
•A survey of 15 Indian studies 1993 – 1996
•Parts of the country covered – 12 cities
•Average incidence of vaginal delivery 86.6%
•Average incidence of C. sections – 13.4%
•Average induction – Del. Interval – Primi 10.8
hrs
•Average induction – Del. Interval – multi 7.6 hrs

33. Pitocin induction of labour
Summary:
•Survey of six Indian studies
•Average incidence of vaginal deliveries – 72.8%
•Average incidence of C. section – 27.2%
•Average induction – delivery time: 16.2 hrs in
primi
•Average induction – delivery time: 9.6 hrs in
Multi
•Incidence of low APGAR scores 1.5 – 2 times
higher

34. Comparison of PG vs. Pitocin for Induction
S
no
Authors drug%
success
LSCS %
incidence
Ind-Del
interval
hrs
Perinatal
outcome
low apgar
1Gupta et al,
Jaipur, 1995
PG
O
73.3
55.5
13.3
44.4
16.4
27.9
4.4%
13.3%
2Muhkerjee,
Allhabad,1996
PG
O
72.7
50
16.3
40
16.3
22.5
-
-
3Sandhu et al,
Amritsar,1995
PG
O
10
15
9.5
10.4
-
-
4Patki et al,
Mumbai,1993
PG
O
75
20
7.8
10.9
5%
7.5%
5Dubey,
kanpur, 1994
PG
O
7.1
12.5
14.6
16.2
NIL
4.7%
6k. Gupta,
Agra, 1994
PG
O
12%
20%
5.6
6.3
8.3%
8.3%

35. Time lag due to oral
administration leads to longer
induction – delivery interval as
compared to I.V. Oxytocin
(Lange 1986)

36. Oral PGE
2
– less GI symptoms
& more effective than PGF
2
α and
has become the standard for
induction and acceleration of
labour

37. PG’S are effective even in unripe
cervices due to the direct
softening effect on the cervix as
compared to Oxytocin

38. Prostaglandins in the induction of
labour have been shown to be
devoid of deleterious effects on
the physical and psychomotor
development of the Neonate

39. Prostaglandin formulations in Obstetric practice
PROSTAGLANDINS
CERVICAL RIPENING
Cerviprime gel
FETAL DEATH
Prostodin injection
Cerviprime Gel +
Oxytocic
LABOUR
INDUCTION
Primiprost tablet
LABOUR
AUGMENTATION
Primiprost Tablets
THIRD STAGE
COMPLICATIONS
Prostodin injections