Skip to main content
NCBI home page
Archives of Disease in Childhood. Fetal and Neonatal Edition logoLink to Archives of Disease in Childhood. Fetal and Neonatal Edition
. 2004 Mar;89(2):F131–F135. doi: 10.1136/adc.2002.025957

Maternal intravaginal prostaglandin E2 gel before elective caesarean section at term to induce catecholamine surge in cord blood: randomised, placebo controlled study

M Singh, S Patole, A Rane, D Naidoo, P Buettner
PMCID: PMC1756045  PMID: 14977896

Abstract

Objective: To test the hypothesis that the application of intravaginal prostaglandin E2 gel before elective caesarean section (ECS) will induce a catecholamine surge in umbilical arterial blood.

Design: Randomised, double blind, placebo controlled trial.

Setting: A regional perinatal referral centre.

Patients: Mothers booked for ECS at or above 38 weeks gestation.

Interventions: Thirty six consenting mothers were randomly allocated to receive either 2 mg intravaginal prostaglandin E2 gel (study group; n = 18) or an equal volume of K-Y jelly as a placebo (control group; n = 18) 60 minutes before the ECS. Computer generated random numbers contained in coded, sealed envelopes were used for allocation. The obstetric and neonatal teams were blinded to the randomisation status of enrolled mothers.

Main outcome measures: Catecholamine concentrations in the umbilical arterial blood samples collected at delivery.

Results: The median (interquartile range) neonatal gestation and birth weight were 271 (269–274) days and 3605 (3072–3970) g for the study group and 271 (270–273) days and 3340 (3000–3622) g for the control group. Median (interquartile range) noradrenaline (norepinephrine) concentrations in the umbilical arterial blood were significantly higher in the study group than the control group (15.9 (9.8–28.92) v 4.6 (1.65–14.4) ng/l, p = 0.03). Adrenaline (epinephrine) concentrations did not differ significantly between the two groups (1.6 (< 0.5–3.1) v 1.4 (< 0.5–2.75) ng/l, p = 0.6). No treatment related complications occurred.

Conclusion: A labour related catecholamine surge could be simulated by intravaginal prostaglandin E2 gel.

Full Text

The Full Text of this article is available as a PDF (193.6 KB).

Figure 1 .

Figure 1

Open in a new tab

Catecholamine concentrations in the umbilical arterial blood. Mothers in the study group received 2 mg intravaginal prostaglandin gel and those in the control group received an equal volume of K-Y jelly as placebo. (A) Noradrenaline; (B) adrenaline. Median values are represented by a horizontal bar.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Berger P. J., Kyriakides M. A., Smolich J. J., Ramsden C. A., Walker A. M. Influence of prenatal adrenaline infusion on arterial blood gases after caesarean delivery in the lamb. J Physiol. 2000 Sep 1;527(Pt 2):377–385. doi: 10.1111/j.1469-7793.2000.00377.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Cohen M., Carson B. S. Respiratory morbidity benefit of awaiting onset of labor after elective cesarean section. Obstet Gynecol. 1985 Jun;65(6):818–824. [PubMed] [Google Scholar]
  3. Costa A., De Filippis V., Voglino M., Giraudi G., Massobrio M., Benedetto C., Marozio L., Gallo M., Molina G., Fabris C. Adrenocorticotropic hormone and catecholamines in maternal, umbilical and neonatal plasma in relation to vaginal delivery. J Endocrinol Invest. 1988 Nov;11(10):703–709. doi: 10.1007/BF03350923. [DOI] [PubMed] [Google Scholar]
  4. Crane J. M., Young D. C., Butt K. D., Bennett K. A., Hutchens D. Excessive uterine activity accompanying induced labor. Obstet Gynecol. 2001 Jun;97(6):926–931. doi: 10.1016/s0029-7844(01)01332-1. [DOI] [PubMed] [Google Scholar]
  5. Doe S., Woods B., Perks A. M. Effects of norepinephrine on lung liquid production by in vitro lungs from fetal guinea pigs. Can J Physiol Pharmacol. 1998 Oct-Nov;76(10-11):967–974. doi: 10.1139/cjpp-76-10-11-967. [DOI] [PubMed] [Google Scholar]
  6. Duncan M. W., Compton P., Lazarus L., Smythe G. A. Measurement of norepinephrine and 3,4-dihydroxyphenylglycol in urine and plasma for the diagnosis of pheochromocytoma. N Engl J Med. 1988 Jul 21;319(3):136–142. doi: 10.1056/NEJM198807213190303. [DOI] [PubMed] [Google Scholar]
  7. Egarter C. H., Husslein P. W., Rayburn W. F. Uterine hyperstimulation after low-dose prostaglandin E2 therapy: tocolytic treatment in 181 cases. Am J Obstet Gynecol. 1990 Sep;163(3):794–796. doi: 10.1016/0002-9378(90)91070-s. [DOI] [PubMed] [Google Scholar]
  8. Eliot R. J., Lam R., Leake R. D., Hobel C. J., Fisher D. A. Plasma catecholamine concentrations in infants at birth and during the first 48 hours of life. J Pediatr. 1980 Feb;96(2):311–315. doi: 10.1016/s0022-3476(80)80836-5. [DOI] [PubMed] [Google Scholar]
  9. Erkkola R., Kero P., Kanto J., Korvenranta H., Nanto V., Peltonen T. Delayed cord clamping in cesarean section with general anesthesia. Am J Perinatol. 1984 Jan;1(2):165–169. doi: 10.1055/s-2007-999995. [DOI] [PubMed] [Google Scholar]
  10. Faxelius G., Hägnevik K., Lagercrantz H., Lundell B., Irestedt L. Catecholamine surge and lung function after delivery. Arch Dis Child. 1983 Apr;58(4):262–266. doi: 10.1136/adc.58.4.262. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Faxelius G., Lagercrantz H., Yao A. Sympathoadrenal activity and peripheral blood flow after birth: comparison in infants delivered vaginally and by cesarean section. J Pediatr. 1984 Jul;105(1):144–148. doi: 10.1016/s0022-3476(84)80381-9. [DOI] [PubMed] [Google Scholar]
  12. Halliday H. L. Elective delivery at "term": implications for the newborn. Acta Paediatr. 1999 Nov;88(11):1180–1181. doi: 10.1080/080352599750030257. [DOI] [PubMed] [Google Scholar]
  13. Hallman H., Farnebo L. O., Hamberger B., Johnsson G. A sensitive method for the determination of plasma catecholamines using liquid chromatography with electrochemical detection. Life Sci. 1978 Sep 11;23(10):1049–1052. doi: 10.1016/0024-3205(78)90665-3. [DOI] [PubMed] [Google Scholar]
  14. Hata T., Manabe A., Makihara K., Hata K., Miyazaki K. Plasma catecholamines and Doppler-derived cardiac time intervals in vaginally and cesarean delivered neonates. Gynecol Obstet Invest. 1997;44(3):173–176. doi: 10.1159/000291513. [DOI] [PubMed] [Google Scholar]
  15. Hook B., Kiwi R., Amini S. B., Fanaroff A., Hack M. Neonatal morbidity after elective repeat cesarean section and trial of labor. Pediatrics. 1997 Sep;100(3 Pt 1):348–353. doi: 10.1542/peds.100.3.348. [DOI] [PubMed] [Google Scholar]
  16. Hägnevik K., Faxelius G., Irestedt L., Lagercrantz H., Lundell B., Persson B. Catecholamine surge and metabolic adaptation in the newborn after vaginal delivery and caesarean section. Acta Paediatr Scand. 1984 Sep;73(5):602–609. doi: 10.1111/j.1651-2227.1984.tb09982.x. [DOI] [PubMed] [Google Scholar]
  17. Irestedt L., Lagercrantz H., Hjemdahl P., Hägnevik K., Belfrage P. Fetal and maternal plasma catecholamine levels at elective cesarean section under general or epidural anesthesia versus vaginal delivery. Am J Obstet Gynecol. 1982 Apr 15;142(8):1004–1010. doi: 10.1016/0002-9378(82)90783-9. [DOI] [PubMed] [Google Scholar]
  18. Levine E. M., Ghai V., Barton J. J., Strom C. M. Mode of delivery and risk of respiratory diseases in newborns. Obstet Gynecol. 2001 Mar;97(3):439–442. doi: 10.1016/s0029-7844(00)01150-9. [DOI] [PubMed] [Google Scholar]
  19. Miller A. M., Rayburn W. F., Smith C. V. Patterns of uterine activity after intravaginal prostaglandin E2 during preinduction cervical ripening. Am J Obstet Gynecol. 1991 Oct;165(4 Pt 1):1006–1009. doi: 10.1016/0002-9378(91)90459-5. [DOI] [PubMed] [Google Scholar]
  20. Morrison J. J., Rennie J. M., Milton P. J. Neonatal respiratory morbidity and mode of delivery at term: influence of timing of elective caesarean section. Br J Obstet Gynaecol. 1995 Feb;102(2):101–106. doi: 10.1111/j.1471-0528.1995.tb09060.x. [DOI] [PubMed] [Google Scholar]
  21. Nordström L., Marcus C., Persson B., Shimojo N., Westgren M. Lactate in cord blood and its relationship to pH and catecholamines in spontaneous vaginal deliveries. Early Hum Dev. 1996 Sep 20;46(1-2):97–104. doi: 10.1016/0378-3782(96)01746-x. [DOI] [PubMed] [Google Scholar]
  22. Norlin A., Folkesson H. G. Alveolar fluid clearance in late-gestational guinea pigs after labor induction: mechanisms and regulation. Am J Physiol Lung Cell Mol Physiol. 2001 Apr;280(4):L606–L616. doi: 10.1152/ajplung.2001.280.4.L606. [DOI] [PubMed] [Google Scholar]
  23. Rayburn W. F. Prostaglandin E2 gel for cervical ripening and induction of labor: a critical analysis. Am J Obstet Gynecol. 1989 Mar;160(3):529–534. doi: 10.1016/s0002-9378(89)80020-1. [DOI] [PubMed] [Google Scholar]
  24. Selo-Ojeme Daniel O., Ayida Gubby A. Uterine rupture after a single vaginal 2 mg prostaglandin gel application in a primiparous woman. Eur J Obstet Gynecol Reprod Biol. 2002 Feb 10;101(1):87–88. doi: 10.1016/s0301-2115(01)00494-8. [DOI] [PubMed] [Google Scholar]
  25. Singhi S. C., Chookang E. Maternal fluid overload during labour; transplacental hyponatraemia and risk of transient neonatal tachypnoea in term infants. Arch Dis Child. 1984 Dec;59(12):1155–1158. doi: 10.1136/adc.59.12.1155. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Vause S., Macintosh M. Evidence based case report: use of prostaglandins to induce labour in women with a caesarean section scar. BMJ. 1999 Apr 17;318(7190):1056–1058. doi: 10.1136/bmj.318.7190.1056. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Wax Joseph R., Herson Victor, Carignan Eva, Mather Jeffrey, Ingardia Charles J. Contribution of elective delivery to severe respiratory distress at term. Am J Perinatol. 2002 Feb;19(2):81–86. doi: 10.1055/s-2002-23558. [DOI] [PubMed] [Google Scholar]
  28. Woods B. A., Doe S., Perks A. M. Effects of epinephrine on lung liquid production by in vitro lungs from fetal guinea pigs. Can J Physiol Pharmacol. 1997 Jul;75(7):772–780. [PubMed] [Google Scholar]
  29. Yang J. Y., Fang L. J., Tsou Yau K. I. Labor pain before elective cesarean section reduces neonatal respiratory distress. Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi. 1997 Jan-Feb;38(1):38–43. [PubMed] [Google Scholar]

Articles from Archives of Disease in Childhood Fetal and Neonatal Edition are provided here courtesy of BMJ Publishing Group

RESOURCES