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Prostaglandins are hormone-like substances that act on smooth muscles of the uterus. Prostaglandins can be used at the end of pregnancy to soften the cervix of women requiring the induction of labor. However, unwanted muscle contractions and overstimulation can occur. To help minimize side effects, various techniques in the application of a prostaglandin gel were investigated. There were 12 pregnant women with unfavorable cervices before the induction of labor. The women were divided into three groups of four women each. The prostaglandin gel was applied strictly within the cervical canal, beyond the cervical canal (extra-amniotic) or to the back wall of the vagina. There was more uterine activity after the gel was applied vaginally and extra-amniotically. Softening of the cervix was achieved in six hours following all three application techniques. All infants were delivered within 24 hours of the induction. The condition of the fetus was not affected by the application of the gel. The application of prostaglandin gel only to the cervical canal minimized side effects of cervical ripening before the induction of labor. (Consumer Summary produced by Reliance Medical Information, Inc.)

To investigate whether the final cervical ripening just before or during labor corresponds to changes in cervical connective tissue metabolism and composition.

Objective: To determine whether there is a difference in collagen metabolism between comparable urinary stress-incontinent and -continent women.

The methods used to date to ripen the unfavorable cervix during pregnancy have considerable disadvantages, chiefly from the practical point of view. Intracervical application of a small dose (0.5 mg) of prostaglandin E2 (PGE2) in viscous gel is a safe, easily performed and effective method to ripen the cervix in both early and late pregnancy. A new starch-based gel seems to have solved the pharmaceutical problems associated with gel preparations used hitherto. The histological and biochemical changes induced by local application of PGE2 are similar to those oc-curing spontaneously during late pregnancy.

A survey of connective tissue in general and human cervical connective in particular is presented. It is concluded that about 90% of the human cervix consists of fibrous connective tissue which, according to the composition of the collagen and the proteoglycans, is very similar to that in skin and sclera. The high activity of collagenase probably gives the cervical connective tissue from pregnant women its potential to ripen following prostaglandin treatment. Electron microscopical examination has revealed an increased amount of amorphous substance after such treatment. This may be caused partly by degraded collagen fibers and partly by newly synthesized proteoglycans.

To elucidate how prostaglandin E2(PGE2) induces cervical ripening.

Connective tissue in biopsy specimens taken from the lower part of the uterine cervix in 40 pregnant women at various gestational ages was compared to that in similar biopsy specimens from 15 nonpregnant women. The concentrations of collagen, sulfated glycosaminoglycans, and hyaluronic acid decreased during pregnancy. At the gestational age of 10 weeks, the collagen concentration was 70%, and at term 30%, of that in the nonpregnant cervix. After delivery, no further decrease was observed. The extractability of collagen increased during pregnancy, as well as during labor. Also, the water concentration increased. An increase in the collagenolytic activity was observed with advancing gestational age. The 2,4-dinitrophenyl-Pro-Gln-Gly-Ile-Ala-Gly-Gln-d-Arg hydrolytic activity (collagenase) and the concentration of leukocyte elastase increased gradually by a factor of 10. The physiologic importance of the collagen was also demonstrated, since the cervical dilatation time during spontaneous labor was long in women with high concentrations of collagen and short in women with low concentrations of collagen.

Sixty term pregnant women with unripe cervix were randomly given either 0.5 mg of prostaglandin E2(PGE2) in 2 ml of gel intracervically or 4 mg of PGE2in 3 ml of gel intravaginally to prime the cervix and/or to induce labor. In patients with a highly unfavorable cervix (cervical score ≤3), the intracervical application was significantly more effective than the intravaginal. In patients with a more favorable cervical state (cervical score 4 or 5), the two routes of application were equipotent. Gastrointestinal side effects were registered after intravaginal but not after intracervical application. Myometrial activity was significantly more increased after intravaginal than after intracervical gel application. All children were born in good condition with an Apgar score >7 within 5 minutes.