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  • Title: The relation between plasma oestrogen, progesterone and prolactin concentrations and the efficacy of vaginal prostaglandin E2 gel in initiating labour.
    Author: MacKenzie IZ, Jenkin G, Bradley S.
    Journal: Br J Obstet Gynaecol; 1979 Mar; 86(3):171-4. PubMed ID: 427057.
    Abstract:
    In an attempt to relate the efficacy of treatment to endogenous hormone levels, plasma oestrogen, progesterone and prolactin levels were analysed in women at term following the vaginal administration of prostaglandin E2 gel to induce labour. Patients who went into labour after treatment had significantly higher oestradiol-17 beta levels before treatment compared with those requiring formal surgical induction the following day. No difference could be demonstrated in levels of progesterone or prolactin in the two groups of patients. The significance of these results is discussed. 87 patients with singleton viable pregnancies and fetal cephalic presentation were studied to determine the efficacy of prostaglandin treatment to endogenous hormone levels, plasma estrogen, progesterone and prolactin levels. 69 patients with gestational age of 277.9 + or - 8.9 days were treated with PGE2 (prostaglandin) in a 5% viscous solution of aqueous methyl-hydroxy-ethyl cellulose gel for induction of labor; most had unfavorable cervical features. 18 patients with a gestational age of 281.6 + or - 7.9 days and with favorable cervical features were used as controls. No PGE2 was given; venous blood samples were collected before amniotomy was performed. Birthweights of the newborn infants were recorded. Analysis showed that patients who went into labor following PGE2 treatment exhibited a significantly higher level (p .0025) of circulating estradiol-17B (26.71 + or - 11.7 ng/ml) compared with those who did not. No other significant differences were observed in the levels of circulating prolactin or progesterone and progesterone/estradiol ratios for both groups. The findings are suggestive of the intermediary role of circulating estradiol in the parturition process. The fact that the varying dosages of PGE2 used in this study did not affect the circulating endogenous levels of estradiol-17B in the peripheral blood is noteworthy of consideration, as is the observation that prolactin does not play a significant role in the process of labor. It was recommended that more reliability and predictability can be achieved when inducing labor with vaginal prostaglandins by either a pre-induction measurement of circulating estradiol 17B levels and titration of prostaglandin dosage, or use of estradiol combined with prostaglandins in the viscous gel.
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