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Plasma Prostaglandin E2 Metabolite Levels During Labor Induction With a Sustained-Release Prostaglandin E2 Vaginal Insert

F. Z. Stanczyk, PhD

E. Gentzschein, BS

Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California

D. A. Wing, MD

Department of Obstetrics and Gynecology, Keck Schook of Medicine, University of Southern California, Los Angeles, California dwing{at}hsc.usc.edu

Objective: To measure prostaglandin E₂ levels during labor induction with a sustained-release vaginal polymer insert (prostaglandin E₂ insert) and to determine whether Bishop score change correlated with tachysystole.

Methods: Twelve primiparas and 12 multiparas were treated with a 0.3 mg per hour sustained-release polymer vaginal prostaglandin E₂ insert for up to 24 hours. Bishop score was assessed at start and end of therapy, and serum samples were collected at 4-hour intervals. Prostaglandin E₂ metabolite (PGEM) levels were measured by specific enzyme immunoassay.

Results: Exposure averaged 13.5 ± 7.2 hours. Four patients (16.7%, three nulliparas) had tachysystole. Mean PGEM levels increased from 187 ± 42 pg/mL at baseline to 548 ± 110 pg/mL at 12 hours (P < .05) and remained relatively stable thereafter. Nulliparas with Bishop score changes of four points or more had the highest increase, with average peak levels of 985 ± 109 pg/mL, compared with 452 ± 58 pg/mL for all others (P < .001). Patients with tachysystole had higher 4-hour (P < .01) and overall (P < .04) increases in PGEM level. Removal of the insert led to an average decrease of 335 pg/mL in PGEM levels (P < .01). The decrease correlated with the PGEM level measured before removal (r = .94, P < .0001) and the maximum PGEM increase from baseline (r = .94, P < .0001). The mean mixed venous cord PGEM level was 409 ± 375 pg/mL.

Conclusion: Administration of the prostaglandin E₂ insert led to a sustained increase in circulating PGEM levels in women who had labor induction. Peak PGEM levels correlated with Bishop score improvement. Rapid increases in prostaglandin E₂ levels might cause tachysystole.

Key Words: Prostaglandin E2 • labor induction • plasma levels

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