使用缓释前列腺素E2阴道栓剂引产期间的血浆前列腺素E(2)代谢物水平

Plasma prostaglandin E(2) metabolite levels during labor induction with a sustained-release prostaglandin E(2) vaginal insert.

作者信息

Goharkhay N, Stanczyk F Z, Gentzschein E, Wing D A

机构信息

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

出版信息

J Soc Gynecol Investig. 2000 Nov-Dec;7(6):338-42.

PMID:11111068

Abstract

OBJECTIVE

To measure prostaglandin E(2) levels during labor induction with a sustained-release vaginal polymer insert (prostaglandin E(2) 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 E(2) 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 E(2) 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 E(2) 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 E(2) levels might cause tachysystole.

摘要

目的

测量使用缓释阴道聚合物栓剂（前列腺素E₂栓剂）引产期间的前列腺素E₂水平，并确定 Bishop 评分变化是否与子宫收缩过速相关。

方法

12 例初产妇和 12 例经产妇接受每小时 0.3 mg 的缓释聚合物阴道前列腺素E₂栓剂治疗，最长治疗 24 小时。在治疗开始和结束时评估 Bishop 评分，并每隔 4 小时采集血清样本。通过特异性酶免疫测定法测量前列腺素E₂代谢物（PGEM）水平。

结果

平均暴露时间为 13.5±7.2 小时。4 例患者（16.7%，3 例初产妇）出现子宫收缩过速。平均 PGEM 水平从基线时的 187±42 pg/mL 增加到 12 小时时的 548±110 pg/mL（P<.05），此后保持相对稳定。Bishop 评分变化 4 分或更多的初产妇增加幅度最大，平均峰值水平为 985±109 pg/mL，而其他所有患者为 452±58 pg/mL（P<.001）。出现子宫收缩过速的患者 PGEM 水平在 4 小时时（P<.01）和总体上（P<.04）升高幅度更大。取出栓剂后，PGEM 水平平均下降 335 pg/mL（P<.01）。这种下降与取出前测量的 PGEM 水平相关（r=.94，P<.0001），也与 PGEM 从基线的最大升高幅度相关（r=.94，P<.0001）。平均混合静脉脐血 PGEM 水平为 409±375 pg/mL。