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MoonDragon's Women's Health Procedures Information
PROSTAGLANDIN (PGE2) USE & CHILDBIRTH


For "Informational Use Only".
For more detailed information, contact your health care provider
about options that may be available for your specific situation.





  • Prostaglandin (PGE2) Description
  • PGE2 Use To Soften Cervix & Start Labor
  • PGE1 Abortion Technique




  • PROSTAGLANDIN (PGE2) DESCRIPTION

    The oxytocic action of prostaglandins can be made use of to terminate pregnancy at any stage.

    The name prostaglandin was given in 1935 to a substance found in human seminal fluid which caused smooth muscle contractions, and was thought to be a hormone secreted by the prostate. It is now known to consist of at least 13 related compounds which are synthesized from fatty acids by an enzyme system of prostaglandin synthesis found in all tissues. Prostaglandins act as "local hormones" at the site of formation, and are released during any tissue breakdown.



    The metabolizing of natural prostaglandins is rapid and begins at carbon atom 15. The attachment of a methyl group at 15 produces the analogue 15-methyl-PGF2alpha which is more resistant to degradation in lung and liver, and is therefore longer acting.





    PGE2 USE TO SOFTEN CERVIX & START LABOR

    Prostaglandin E2 tablets taken orally or PGE2 gel is often used on the cervix to soften and begin labor in a hospital setting. It should not be used at a homebirth to induce labor.


    DINOPROSTONE (Cervical/Vaginal)
    By HealthTouch.com

    SOME COMMON BRAND NAMES:
    • In the U.S.:
      • Cervidil
      • Prepidil
      • Prostin E2
    • In Canada:
      • Prepidil
      • Prostin E 2
    Other commonly used names are prostaglandin E2 or PGE 2.

    CATEGORY: Abortifacient; Antihemorrhagic, postabortion uterine bleeding; Antihemorrhagic, postpartum uterine bleeding; Oxytocic; Prostaglandin.

    DESCRIPTION: Dinoprostone (dye-noe-PROST-one) works by causing the cervix to thin and dilate (open) and the uterus to contract (cramp) the way it does during labor. Dinoprostone may also be used for other purposes as determined by your health care provider. Dinoprostone is to be administered only by or under the immediate care of your health care provider. It is available in the following dosage forms:
    • Cervical Gel (U.S. and Canada)
    • Vaginal Gel (Canada)
    • Suppositories (U.S.)
    • System (U.S.)
    BEFORE RECEIVING THIS MEDICATION

    In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your health care provider will make. For dinoprostone, the following should be considered:
    • Allergies: Tell your health care provider if you have ever had any unusual or allergic reaction to dinoprostone, misoprostol, oxytocin or other medicines that stimulate the uterus to contract.

    • Other Medicines: Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your health care provider may want to change the dose, or other precautions may be necessary. When you are receiving dinoprostone, it is especially important that your health care provider knows if you are using any other vaginal prescription or non-prescription (over-the-counter [OTC]) medicine.

    • Other Medical Problems: The presence of other medical problems may affect the use of dinoprostone. Make sure you tell your health care provider if you have any other medical problems, especially:
      • Anemia (or history of): Dinoprostone, when used in doses that stimulate the uterus to contract, may result in loss of blood in some patients that may require a blood transfusion.

      • Asthma (or history of, including childhood asthma) or Lung disease: Dinoprostone may cause narrowing of the blood vessels in the lungs or narrowing of the lung passages, especially when it is used in doses that stimulate the uterus to contract.

      • Epilepsy (or history of): Rarely, seizures have occurred with dinoprostone when it is used in doses that stimulate the uterus to contract.

      • Glaucoma: Rarely, the pressure within the eye has increased and constriction of the pupils has occurred during the use of medicines like dinoprostone; this may also be a problem with dinoprostone when it is used in doses that stimulate the uterus to contract.

      • Heart or blood vessel disease (or history of) or High blood pressure (or history of) or Low blood pressure (history of): Dinoprostone may cause changes in heart function or blood pressure changes; Patients with a history of heart disease have had heart attacks when dinoprostone was used in doses that stimulated the uterus to contract.

      • Kidney disease (or history of) or Liver disease (or history of): The body may not remove dinoprostone from the blood stream at the usual rate, which may make the dinoprostone work longer or cause an increased chance of side effects, especially when dinoprostone is used in doses that stimulate the uterus to contract.

      • Problems during delivery, history of or Surgery of uterus (history of) or Unusual vaginal bleeding: There is an increased risk of problems occurring with dinoprostone when it is used in doses that stimulate the uterus to contract.

    PROPER MEDICAL USE

    After dinoprostone is given, you will need to lie down for 10 minutes to 2 hours so that the medicine can be absorbed. The length of time you must remain lying down will depend on what form of the medicine you are using.

    Dosing: The dose of dinoprostone will be different for different patients. The following information includes only the average doses for dinoprostone. Your health care provider will give you the dose of this medicine and follow your care in a hospital or other health care setting.

    For cervical dosage form (gel): For adults and teenagers, to thin and widen the opening of the cervix just before labor - your health care provider will insert 0.5 milligram (mg) (one application) of dinoprostone into the canal of your cervix. You should remain lying on your back for at least ten to thirty minutes after it has been applied.

    For vaginal dosage form (gel): For adults and teenagers, to cause the uterus to contract for labor - your health care provider will insert 1 milligram (mg) (one applicatorful) of dinoprostone into your vagina. You should remain lying on your back for at least thirty minutes after it has been applied. You may need another dose of 1 to 2 mg six hours after the first dose.

    For vaginal dosage form (suppositories): For adults and teenagers, to cause the uterus to contract to abort a pregnancy - your health care provider will insert 20 milligrams (mg) (one suppository) into your vagina every three to five hours as needed. You should remain lying on your back for at least ten minutes after it has been inserted.

    For vaginal dosage form (system): For adults and teenagers, to thin and widen the opening of the cervix just before labor - your health care provider will insert 10 milligrams (mg) (one system) into your vagina. You should remain lying on your back for at least two hours after it has been inserted.

    SIDE EFFECTS OF THIS MEDICATION

    Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention. Tell the health care professional immediately if any of the following side effects occur:

    Less common or rare: Fast or slow heartbeat; hives; increased pain of the uterus; pale, cool, blotchy skin on arms or legs; pressing or painful feeling in chest; shortness of breath; swelling of face, inside the nose, and eyelids; tightness in chest; trouble in breathing; weak or absent pulse in arms or legs; wheezing.

    Other side effects may occur that usually do not need medical attention. These side effects usually go away after the medicine is stopped. However, let the health care professional know if any of the following side effects continue or are bothersome:

    More common: Abdominal or stomach cramps; diarrhea; fever; nausea; vomiting.
    Less common or rare: Chills or shivering; constipation; flushing; headache; swelling of the genital area (vulva); tender or mildly bloated abdomen or stomach.

    This procedure may still result in some effects, which occur after the procedure is completed, that need medical attention. Check with your health care provider if any of the following side effects occur: Chills or shivering (continuing); fever (continuing); foul-smelling vaginal discharge; pain in lower abdomen; unusual increase in bleeding of the uterus.

    Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your health care professional.

    ADDITIONAL INFORMATION

    Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although these uses are not included in product labeling, dinoprostone is used in certain patients with the following medical condition: Unusual increase in bleeding of the uterus after delivery (postpartum hemorrhage).



    Cervidil (Generic Name: dinoprostone)
    By www.Drugs.com

    Dosage Form: Vaginal insert
    Rev. 5/06 Rx only

    CERVIDIL DESCRIPTION

    Dinoprostone vaginal insert is a thin, flat, polymeric slab which is rectangular in shape with rounded corners contained within the pouch of an off-white knitted polyester retrieval system. Each slab is buff colored, semitransparent and contains 10 mg of dinoprostone in a hydrogel insert. An integral part of the knitted polyester retrieval system is a long tape designed to aid retrieval at the end of the dosing interval or earlier if clinically indicated. The finished product is a controlled release formulation which has been found to release dinoprostone in vivo at a rate of approximately 0.3 mg/hr.

    The chemical name for dinoprostone (commonly known as prostaglandin E2 or PGE2) is 11α, 15S-dihydroxy-9-oxo-prosta-5Z,13E-dien-1-oic acid and the structural formula is represented below:

    cervidil molecular chemical formula

    The molecular formula is C-20 H-32 O-5 and its molecular weight is 352.5. Dinoprostone occurs as a white to off-white crystalline powder. It has a melting point within the range of 65° to 69°C. Dinoprostone is soluble in ethanol and in 25 percent ethanol in water. Each insert contains 10 mg of dinoprostone in 241 mg of a cross-linked polyethylene oxide/urethane polymer which is a semi-opaque, beige colored, flat rectangular slab measuring 29 mm by 9.5 mm and 0.8 mm in thickness. The insert and its retrieval system, made of polyester yarn, are non-toxic and when placed in a moist environment, absorb water, swell, and release dinoprostone.

    CERVIDIL - CLINICAL PHARMACOLOGY

    Dinoprostone (PGE2) is a naturally-occurring biomolecule. It is found in low concentrations in most tissues of the body and functions as a local hormone (1-3). As with any local hormone, it is very rapidly metabolized in the tissues of synthesis (the half-life estimated to be 2.5-5 minutes). The rate limiting step for inactivation is regulated by the enzyme 15-hydroxyprostaglandin dehydrogenase (PGDH) (1,4). Any PGE2 that escapes local inactivation is rapidly cleared to the extent of 95 percent on the first pass through the pulmonary circulation (1,2).

    In pregnancy, PGE2 is secreted continuously by the fetal membranes and placenta and plays an important role in the final events leading to the initiation of labor (1,2). It is known that PGE2 stimulates the production of PGF2α which in turn sensitizes the myometrium to endogenous or exogenously administered oxytocin. Although PGE2 is capable of initiating uterine contractions and may interact with oxytocin to increase uterine contractility, the available evidence indicates that, in the concentrations found during the early part of labor, PGE2 plays an important role in cervical ripening without affecting uterine contractions (5-7). This distinction serves as the basis for considering cervical ripening and induction of labor, usually by the use of oxytocin (8-10), as two separate processes.

    PGE2 plays an important role in the complex set of biochemical and structural alterations involved in cervical ripening. Cervical ripening involves a marked relaxation of the cervical smooth muscle fibers of the uterine cervix which must be transformed from a rigid structure to a softened, yielding and dilated configuration to allow passage of the fetus through the birth canal (11-13). This process involves activation of the enzyme collagenase which is responsible for digestion of some of the structural collagen network of the cervix (1, 14). This is associated with a concomitant increase in the amount of hydrophilic glycosaminoglycan, hyaluronic acid and a decrease in dermatan sulfate (1). Failure of the cervix to undergo these natural physiologic changes, usually assessed by the method described by Bishop (15,16), prior to the onset of effective uterine contractions, results in an unfavorable outcome for successful vaginal delivery and may result in fetal compromise. It is estimated that in approximately 5 percent of pregnancies the cervix does not ripen normally (17). In an additional 10-11 percent of pregnancies, labor must be induced for medical or obstetric reasons prior to the time of cervical ripening (17).

    The delivery rate of PGE2 in vivo is about 0.3 mg/hour over a period of 12 hours. The controlled release of PGE2 from the hydrogel insert is an attempt to provide sufficient quantities of PGE2 to the local receptors to satisfy hormonal requirements. In the majority of patients, these local effects are manifested by changes in the consistency, dilatation and effacement of the cervix as measured by the Bishop score. Although some patients experience uterine hyperstimulation as a result of direct PGE2 - or PGF2α - mediated sensitization of the myometrium to oxytocin, systemic effects of PGE2 are rarely encountered. The insert is fitted with a biocompatible retrieval system which facilitates removal at the conclusion of therapy or in the event of an adverse reaction.

    No correlation could be established between PGE2 release and plasma concentrations of PGEm. The relative contributions of endogenously and exogenously released PGE2 to the plasma levels of the metabolite PGEm could not be determined. Moreover, it is uncertain as to whether the measured concentrations of PGEm reflect the natural progression of PGEm concentrations in blood as birth approaches or to what extent the measured concentrations following PGE2 administration represent an increase over basal levels that might be measured in control patients.

    INDICATIONS & USAGE FOR CERVIDIL

    Cervidil Vaginal Insert (dinoprostone, 10 mg) is indicated for the initiation and/or continuation of cervical ripening in patients at or near term in whom there is a medical or obstetrical indication for the induction of labor.

    CONTRAINDICATIONS

    Cervidil is contraindicated in:
    • Patients with known hypersensitivity to prostaglandins.
    • Patients in whom there is clinical suspicion or definite evidence of fetal distress where delivery is not imminent.
    • Patients with unexplained vaginal bleeding during this pregnancy.
    • Patients in whom there is evidence or strong suspicion of marked cephalopelvic disproportion.
    • Patients in whom oxytocic drugs are contraindicated or when prolonged contraction of the uterus may be detrimental to fetal safety or uterine integrity, such as previous cesarean section or major uterine surgery (see PRECAUTIONS and ADVERSE REACTIONS).
    • Patients already receiving intravenous oxytocic drugs.
    • Multipara with 6 or more previous term pregnancies.

    WARNINGS

    For hospital use only.

    Cervidil should be administered only by trained obstetrical personnel in a hospital setting with appropriate obstetrical care facilities.

    PRECAUTIONS

    1. General Precautions: Since prostaglandins potentiate the effect of oxytocin, Cervidil must be removed before oxytocin administration is initiated and the patient's uterine activity carefully monitored for uterine hyperstimulation. If uterine hyperstimulation is encountered or if labor commences, the vaginal insert should be removed. Cervidil should also be removed prior to amniotomy.

    Cervidil is contraindicated when prolonged contraction of the uterus may be detrimental to fetal safety and uterine integrity. Therefore, Cervidil should not be administered to patients with a history of previous cesarean section or uterine surgery given the potential risk for uterine rupture and associated obstetrical complications.

    Caution should be exercised in the administration of Cervidil for cervical ripening in patients with ruptured membranes, in cases of non-vertex or non-singleton presentation, and in patients with a history of previous uterine hypertony, glaucoma, or a history of childhood asthma, even though there have been no asthma attacks in adulthood.

    Uterine activity, fetal status and the progression of cervical dilatation and effacement should be carefully monitored whenever the dinoprostone vaginal insert is in place. Any evidence of uterine hyperstimulation, sustained uterine contractions, fetal distress, or other fetal or maternal adverse reactions, should be a cause for consideration of removal of the insert.

    2. Drug Interactions: Cervidil may augment the activity of oxytocic agents and their concomitant use is not recommended. A dosing interval of at least 30 minutes is recommended for the sequential use of oxytocin following the removal of the dinoprostone vaginal insert. No other drug interactions have been identified.

    3. Carcinogenesis, Mutagenesis, Impairment of Fertility: Long-term carcinogenicity and fertility studies have not been conducted with Cervidil (dinoprostone) Vaginal Insert. No evidence of mutagenicity has been observed with prostaglandin E2 in the Unscheduled DNA Synthesis Assay, the Micronucleus Test, or Ames Assay.

    4. Pregnancy, Teratogenic Effects: Pregnancy Category C. Prostaglandin E2 has produced an increase in skeletal anomalies in rats and rabbits. No effect would be expected clinically, when used as indicated, since Cervidil (dinoprostone) Vaginal Insert is administered after the period of organogenesis. Prostaglandin E2 has been shown to be embryotoxic in rats and rabbits, and any dose that produces sustained increased uterine tone could put the embryo or fetus at risk.

    5. Pediatric Use: The safety and efficacy of Cervidil has been established in women of a reproductive age and women who are pregnant. Although safety and efficacy has not been established in pediatric patients, safety and efficacy are expected to be the same for adolescents.

    ADVERSE REACTIONS

    Cervidil is well tolerated. In placebo-controlled trials in which 658 women were entered and 320 received active therapy (218 without retrieval system, 102 with retrieval system), the following events were reported.

    Table 1 Total Cervidil – Treated Drug Related Adverse Events


    1Controlled Studies (with and without retrieval system)


    2Controlled Study (with retrieval system)
    Controlled Studies1
    Active Placebo
    Uterine hyperstimulation
    with fetal distress
    2.8% 0.3%
    Uterine hyperstimulation
    without fetal distress
    4.7% 0%
    Fetal Distress without
    uterine hyperstimulation
    3.8% 1.2%
    N    320 338
    STUDY 101-8012
    Active Placebo
    Uterine hyperstimulation
    with fetal distress
    2.9% 0%
    Uterine hyperstimulation
    without fetal distress
    2.0% 0%
    Fetal Distress without
    uterine hyperstimulation
    2.9% 1.0%
    N    102

    104


    In Postmarketing Experience Reports, uterine rupture has been reported in association with the use of Cervidil.

    Drug related fever, nausea, vomiting, diarrhea, and abdominal pain were noted in less than 1 percent of patients who received Cervidil.

    In study 101-801 (with the retrieval system) cases of hyperstimulation reversed within 2 to 13 minutes of removal of the product. Tocolytics were required in one of the five cases.

    In cases of fetal distress, when product removal was thought advisable there was a return to normal rhythm and no neonatal sequelae.

    Five minute Apgar scores were 7 or above in 98.2 percent (646/658) of studied neonates whose mothers received Cervidil. In a report of a 3 year pediatric follow-up study in 121 infants, 51 of whose mothers received Cervidil, there were no deleterious effects on physical examination or psychomotor evaluation (18).

    DRUG ABUSE & DEPENDENCE

    No drug abuse or dependence has been seen with the use of Cervidil.

    OVERDOSAGE

    Cervidil is used as a single dosage in a single application. Overdosage is usually manifested by uterine hyperstimulation which may be accompanied by fetal distress and is responsive to removal of the insert. Other treatment must be symptomatic since, to date, clinical experience with prostaglandin antagonists is insufficient.

    The use of beta-adrenergic agents should be considered in the event of undesirable increased uterine activity.

    CERVIDIL DOSAGE & ADMINISTRATION

    The dosage of dinoprostone in the vaginal insert is 10 mg designed to be released at approximately 0.3 mg/hour over a 12 hour period. Cervidil should be removed upon onset of active labor or 12 hours after insertion.

    Cervidil is supplied in an individually wrapped aluminum/polyethylene package with a "tear mark" on one side of the package. The package should only be opened by tearing the aluminum package along the tear mark. The package should never be opened with scissors or other sharp objects which may compromise or cut the knitted polyester pouch that serves as the retrieval system for the polymeric slab.

    Cervidil must be kept frozen until use, and is administered by placing one unit transversely in the posterior fornix of the vagina immediately after removal from its foil package. The insertion of the vaginal insert does not require sterile conditions. The vaginal insert must not be used without its retrieval system. There is no need for previous warming of the product. A minimal amount of water-miscible lubricant may be used to assist insertion of Cervidil. Care should be taken not to permit excess contact or coating with the lubricant which could prevent optimal swelling and release of dinoprostone from the vaginal insert. Patients should remain in the recumbent position for 2 hours following insertion, but thereafter may be ambulatory. If the patient is ambulatory, care should be taken to ensure the vaginal insert remains in place. If uterine hyperstimulation is encountered or if labor commences, the vaginal insert should be removed. Cervidil should also be removed prior to amniotomy.

    Upon removal of Cervidil, it is essential to ensure that the slab has been removed, as it will continue delivering the active ingredient. This is accomplished by visualizing the knitted polyester retrieval system and confirming that it contains the slab. In the rare instance that the slab is not contained within the polyester retrieval system, a vaginal exam should be performed to remove the slab.

    HOW IS CERVIDIL SUPPLIED

    Cervidil (NDC 0456-4123-63) contains 10 mg dinoprostone. The product is wound and enclosed in an aluminum/polyethylene pack. Cervidil is stored in a freezer: between -20°C and -10°C (-4°F and 14°F). Cervidil is packed in foil and is stable when stored in a freezer for a period of three years. Vaginal inserts exposed to high humidity will absorb moisture from the air and thereby alter the release characteristics of dinoprostone. Once used, the vaginal insert should be discarded.

    CLINICAL STUDIES
    Table 2 Efficacy of Cervidil in Double Blind Studies
    Primip/Nullip Multip
    Parameter Study # Cervidil Placebo Cervidil Placebo P-Value


  • Treatment success was defined as Bishop score increase at 12 hours of ≥ 3, vaginal delivery within 12 hours or Bishop score at 12 hours ≥ 6. These studies were not designed with the power to show differences in cesarean section rates between Cervidil and placebo groups and none were noted.
  • Treatment Success* 101-103 (N=81) 65% 28% 87% 29% <0.001
    101-003
    (N=371)
    68% 24% 77% 24% <0.001
    101-801
    (N=206)
    72% 48% 55% 41% 0.003
    Time to Delivery (hours)
    Average Median 101-103 (N=81) 33.7
    25.7
    48.6
    34.5
    14.0
    12.3
    28.6
    24.6

    0.001
    Average Median 101-801
    (N=206)
    31.1
    25.5
    51.8
    37.2
    52.3
    20.8
    45.9
    27.4

    <0.001
    Time to Onset of Labor (hrs)
    Average Median 101-103 (N=81) 19.9
    12.0
    39.4
    19.2
    6.8
    6.9
    22.4
    18.3

    <0.001


    References
    1. Physiology of Labor In: Williams Obstetrics. Eds. Pritchard, J. A., MacDonald, P. C., and Gant, N.F. Appleton-Century-Crofts, Conn, Pp 295-321, (1985).
    2. Rall, T. W. and Schliefer, L. S. Oxytocin, prostaglandin, ergot alkaloids, and other drugs; tocolytics agents, In: The Pharmacological Basis of Therapeutics. Eds. Gilman, A.G., Goodman, L.S., Rall, T.W., and Murad, F. MacMillan, Publ. Co., New York, Pp. 926-945, (1985).
    3. Casey, M.L. and MacDonald, P.C. The initiation of labor in women: Regulation of phospholipid and arachidonic acid metabolism and of prostaglandin production. Semin. Perinat. 10:270-275, (1986).
    4. Casey, M.L., MacDonald, P.C. and Mitchell, M.D. Stimulation of Prostaglandin E2 production in amnion cells in culture by a substance(s) in human fetal urine. Biochem. Biophys. Res. Comm. 114:1056, (1983).
    5. Olson, C.M., Lye, S.J., Skinner, K. and Challis, J.R.G. Prostanoid concentrations in maternal/fetal plasma and amniotic fluid and intrauterine tissue prostanoid output in relation to myometrial contractility during the onset of Endocrinology, 116: 389-397, (1985).
    6. Ledger, W.L., Ellwood, D.A., and Taylor, M.J. Cervical softening in late pregnant sheep by infusion of Prostaglandin E2 into cervical artery. J. Reprod. Fert. 69, 511-515, (1983).
    7. Olson, D.M., Lye, S.J., Skinner, K. and Challis, J.R.G. Early changes in prostaglandin concentrations in ovine maternal and fetal plasma, amniotic fluid and from dispersed cells of intrauterine tissues before the onset of ACTH-induced pre-term labor. J. Reprod. Fert., 71: 45-55, (1984).
    8. Caldero-Garcia, R. and Posiero, J. Oxytocin and the contractility of the human uterus, Ann, N. Y. Acad. Sci. 75:813, (1959).
    9. Posiero, J. and Noriega-Guerra, L. Dose-response relationships in uterine effects of oxytocin infusion. Oxytocin. Eds., Caldero-Garcia, R. and Heller, J. Pergamon Press, New York, (1961).
    10. Cibils, L. Enhancement of induction of labor. In: Risks in the Practice of Modern Obstetrics. Aldjem, S. Ed. Mosby Publishing, St. Louis, (1972).
    11. Bryman, I., Lindblom, B., and Norstrom, A. Extreme sensitivity of cervical musculature to prostaglandin E2 in early pregnancy. Lancet, 2:1471, (1982).
    12. Thiery, M. Induction of labor with prostaglandins. In: Human Parturition. Eds. Keirse, M.J.N.C., Anderson, A.B.M., and Gravenhorst, J.B. Martinus Nijhoff Publ., Boston, 155-164, (1979).
    13. Thiery, M. and Amy, J.J. Induction of labor with prostaglandins. In:Advances in Prostaglandin Research. Prostaglandin and Reproduction, Karim, S.M.M., Ed., MTP, Lancaster, Pp. 149-228, (1975).
    14. MacLennan, A.H., Katz, M., and Creasey, R. The morphologic characteristics of cervical ripening induced by the hormones relaxin and prostaglandin F2 in a rabbit model. Am. J. Obstet. Gynecol, 152:910696, (1985).
    15. Bishop, E. Elective induction of labor. Obstet & Gynecol, 5: 519-527, (1955).
    16. Bishop, E. Pelvic scoring for elective induction. Obstet & Gynecol. 24: 266-268, (1969).
    17. Thiery, M. Preinduction cervical ripening. In: Obstetrics and Gynecology Annual, Vol. 12, Ed. Wynn, R. M. Appleton-Century-Crofts, New York, Pp. 103-146, (1983).
    18. MacKenzie, I.; Information on File: Controlled Therapeutics (Scotland).

    Mfg by:
    Controlled Therapeutics
    East Kilbride, Scotland, G74 5PB
    Made in the U.K.
    Distributed by: FOREST PHARMACEUTICALS, INC., Subsidiary of Forest Laboratories, Inc., St. Louis, MO 63045 USA





    PROSTAGLANDIN-RELATED LINKS

    VBAC & Prostaglandin Induction
    Outpatient Use of Prostaglandin Gel for Ripening The Cervix & Labor Induction
    Medication Safety Alert: Prostin: A drug name with many meanings
    Oral Prostaglandin E2 for Induction of Labor (Cochrane Review)
    The Unripe Cervix Management With Vaginal or Extra-amniotic PGE2
    Waiting It Out At Home - PGE2 Cervical Induction
    Gel Could Speed Delivery At StorkNet





    PGE2 ABORTION TECHNIQUE

    PGE2 can be given intravenously, intra-amniotically, or extra-amniotically through the cervix. This route has the least amount of systemic side-effects and is usually performed.



    DISADVANTAGES OF EXTRA-AMNIOTIC PGE2

  • Nausea and vomiting.
  • Pallor, rigors, sometimes pyrexia (fever).
  • Uterine pain may be intense and more analgesia is required.
  • There are the same risks of cervical damage as with intra-amniotic urea.
  • The presence of an intra-uterine catheter is a constant risk of infection, and this method should be avoided if there is any suspicion of gonorrhea.
  • Medical induction of abortion is psychologically more distressing to the patient than a surgical operation, and probably a more unpleasant experience. Clinically it is an obstetric procedure, calling for a knowledge of midwifery in the attendants.





  • PREGNANCY-PGE2 RELATED LINKS

    MoonDragon's Womens Health Information: Prostaglandin Induced Abortion
    MoonDragon's Pregnancy Information: Labor & Delivery






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    Verbena Oil
    Vetiver Oil
    Violet Oil
    White-Camphor Oil
    Yarrow Oil
    Ylang-Ylang Oil
    Aromatherapy
    Healing Baths For Colds
    Aromatherapy
    Herbal Cleansers
    Using Essential Oils


    AROMATHERAPY: HERBAL & CARRIER OILS DESCRIPTIONS & USES


    Almond, Sweet Oil
    Apricot Kernel Oil
    Argan Oil
    Arnica Oil
    Avocado Oil
    Baobab Oil
    Black Cumin Oil
    Black Currant Oil
    Black Seed Oil
    Borage Seed Oil
    Calendula Oil
    Camelina Oil
    Castor Oil
    Coconut Oil
    Comfrey Oil
    Evening Primrose Oil
    Flaxseed Oil
    Grapeseed Oil
    Hazelnut Oil
    Hemp Seed Oil
    Jojoba Oil
    Kukui Nut Oil
    Macadamia Nut Oil
    Meadowfoam Seed Oil
    Mullein Oil
    Neem Oil
    Olive Oil
    Palm Oil
    Plantain Oil
    Plum Kernel Oil
    Poke Root Oil
    Pomegranate Seed Oil
    Pumpkin Seed Oil
    Rosehip Seed Oil
    Safflower Oil
    Sea Buckthorn Oil
    Sesame Seed Oil
    Shea Nut Oil
    Soybean Oil
    St. Johns Wort Oil
    Sunflower Oil
    Tamanu Oil
    Vitamin E Oil
    Wheat Germ Oil





    HELPFUL RELATED MOONDRAGON NUTRITION BASICS LINKS

  • MoonDragon's Nutrition Basics Index
  • MoonDragon's Nutrition Basics: Amino Acids Index
  • MoonDragon's Nutrition Basics: Antioxidants Index
  • MoonDragon's Nutrition Basics: Enzymes Information
  • MoonDragon's Nutrition Basics: Herbs Index
  • MoonDragon's Nutrition Basics: Homeopathics Index
  • MoonDragon's Nutrition Basics: Hydrosols Index
  • MoonDragon's Nutrition Basics: Minerals Index
  • MoonDragon's Nutrition Basics: Mineral Introduction
  • MoonDragon's Nutrition Basics: Dietary & Cosmetic Supplements Index
  • MoonDragon's Nutrition Basics: Dietary Supplements Introduction
  • MoonDragon's Nutrition Basics: Specialty Supplements
  • MoonDragon's Nutrition Basics: Vitamins Index
  • MoonDragon's Nutrition Basics: Vitamins Introduction


  • NUTRITION BASICS ARTICLES

  • MoonDragon's Nutrition Basics: 4 Basic Nutrients
  • MoonDragon's Nutrition Basics: Avoid Foods That Contain Additives & Artificial Ingredients
  • MoonDragon's Nutrition Basics: Is Aspartame A Safe Sugar Substitute?
  • MoonDragon's Nutrition Basics: Guidelines For Selecting & Preparing Foods
  • MoonDragon's Nutrition Basics: Foods That Destroy
  • MoonDragon's Nutrition Basics: Foods That Heal
  • MoonDragon's Nutrition Basics: The Micronutrients: Vitamins & Minerals
  • MoonDragon's Nutrition Basics: Avoid Overcooking Your Foods
  • MoonDragon's Nutrition Basics: Phytochemicals
  • MoonDragon's Nutrition Basics: Increase Your Consumption of Raw Produce
  • MoonDragon's Nutrition Basics: Limit Your Use of Salt
  • MoonDragon's Nutrition Basics: Use Proper Cooking Utensils
  • MoonDragon's Nutrition Basics: Choosing The Best Water & Types of Water





  • RELATED MOONDRAGON HEALTH LINKS & INFORMATION

  • MoonDragon's Nutrition Information Index
  • MoonDragon's Nutritional Therapy Index
  • MoonDragon's Nutritional Analysis Index
  • MoonDragon's Nutritional Diet Index
  • MoonDragon's Nutritional Recipe Index
  • MoonDragon's Nutrition Therapy: Preparing Produce for Juicing
  • MoonDragon's Nutrition Information: Food Additives Index
  • MoonDragon's Nutrition Information: Food Safety Links
  • MoonDragon's Aromatherapy Index
  • MoonDragon's Aromatherapy Articles
  • MoonDragon's Aromatherapy For Back Pain
  • MoonDragon's Aromatherapy For Labor & Birth
  • MoonDragon's Aromatherapy Blending Chart
  • MoonDragon's Aromatherapy Essential Oil Details
  • MoonDragon's Aromatherapy Links
  • MoonDragon's Aromatherapy For Miscarriage
  • MoonDragon's Aromatherapy For Post Partum
  • MoonDragon's Aromatherapy For Childbearing
  • MoonDragon's Aromatherapy For Problems in Pregnancy & Birthing
  • MoonDragon's Aromatherapy Chart of Essential Oils #1
  • MoonDragon's Aromatherapy Chart of Essential Oils #2
  • MoonDragon's Aromatherapy Tips
  • MoonDragon's Aromatherapy Uses
  • MoonDragon's Alternative Health Index
  • MoonDragon's Alternative Health Information Overview
  • MoonDragon's Alternative Health Therapy Index
  • MoonDragon's Alternative Health: Touch & Movement Therapies Index
  • MoonDragon's Alternative Health Therapy: Touch & Movement: Aromatherapy
  • MoonDragon's Alternative Therapy: Touch & Movement - Massage Therapy
  • MoonDragon's Alternative Health: Therapeutic Massage
  • MoonDragon's Holistic Health Links Page 1
  • MoonDragon's Holistic Health Links Page 2
  • MoonDragon's Health & Wellness: Nutrition Basics Index
  • MoonDragon's Health & Wellness: Therapy Index
  • MoonDragon's Health & Wellness: Massage Therapy
  • MoonDragon's Health & Wellness: Hydrotherapy
  • MoonDragon's Health & Wellness: Pain Control Therapy
  • MoonDragon's Health & Wellness: Relaxation Therapy
  • MoonDragon's Health & Wellness: Steam Inhalation Therapy
  • MoonDragon's Health & Wellness: Therapy - Herbal Oils Index







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    MOONDRAGON'S REALM - WEBSITE DIRECTORY


    A website map to help you find what you are looking for on MoonDragon.org's Website. Available pages have been listed under appropriate directory headings.




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