Prostaglandin that can be used to induce labour at term is
Correct Answer: PGE2
Description: Ans. a. PGE2. (Katzung Clinical Pharmacology 11th edition./, Ch.l8/page 410)Dinoprostone, a synthetic prep of PGE2, is administered vaginally for oxytocic use. It is used for inducing abortion in the second trimester of pregnancy, for missed abortion, for benign hydatidiform mole, and for ripening of the cervix for induction of labor in patients at or near term. An analog of PGF2a (carboprost tromethamine) is also used in obstetrics - used to induce second-trimester abortions and to control PPH not responding to conventional methods of Rx.PROSTAGLANDINS# Have very short half-life.# Arachidonic acid is common precursor (acylic fatty acid derivatives).# The subscript numeral after the letter (e.g., PGE2) indicates degree of unsaturation.# PGF2 alpha acts predominantly on myometrium, while PGE2 on cervix due to its collagenolytic property. (Hint: F for fundus and E for effacement of cervix.).# Carboprost is effective in refractory cases of PPH.# Misoprostol is methyl ester of PGE1, rapidly absorbed and more effective than oxytocin and prostaglandins in induction of labour, also effective in treatment in NSAID induced peptic ulcer.# Inflammatory mediators from arachidonic are:- TxA2, PGD2, PGE2, PGF2 alpha, PGI2 (Cycloxygenase pathway) leukotrienes (Lipoxygenase)--LTB4 is a neutrophil chemotactic agent. LTC4, D4 and E4 (SRS-A) function in broncho-constriction, vasoconstriction, contractions of smooth muscle and increased vascular permeability.PgActionsPGE2Bronchoconstriction, platelet aggregation.PGE2Potent inducer of bone resorption and releases Ca++ from bones and cervical effacement.PGE2Bronchoconstriction, role in uterine and ovarian function (fundal contraction).PGI2Bronchodilation, vasoconstriction, and platelet aggregation.TXA2Bronchodilation, vasoconstriction, and platelet aggregation stimulation (Bradykinin and histamine are potent vasodilators)USES OF PROSTAGLANDINS IN OBSTETRICS# Induction of abortion (MTP and missed abortion); Antiprogestins (eg, mifepristone) have been combined with an oral oxytocic synthetic analog of PGE1 (misoprostol) to produce early abortion.# Induction of labour# Termination of molar pregnancy# Cervical ripening before induction of labour/abortion# Acceleration of labour# Management of atonic PPH# Management of tubal ectopic pregnancyActionArachidonic Acid Metabolites (Eicosanoids)VasodilationPGI2 (prostacyclin), PGE1, PGE2, PGD2VasoconstrictionThromboxane A2, leukotrienes C4, D4, E4Increased vascular permeabilityLeukotrienes C4, D4, E4Chemotaxis, leukocyte adhesionLeukotriene B4
Category:
Gynaecology & Obstetrics
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