Therapeutic effects of benzoylaconitine and paeoniflorin in rats with collagen-induced arthritis

Abstract To explore the effects and mechanisms of benzoylaconitine and paeoniflorin on collagen-induced arthritis (CIA) rats. Weight, paw swelling, arthritis index and joint pathologic changes were examined in each group after CIA induction. PGE2, IL-1ß, IL-6, IL-10, TNF-α, VEGF, MMP-3, IgG and anti-CII Ab were assessed by ELISA; STAT1 and STAT3 expressions were analyzed immunohistochemically, and the ultrastructure of synovial cells was observed by transmission electron microscopy. Therapeutic effects were determined in CIA rats via injecting benzoylaconitine and paeoniflorin, which could alleviate the degree of swelling and arthritis index (AI) and pathological lesions of the sacroiliac gland; decrease the levels of PGE2, IL-1ß, TNF-α, VEGF and IgG in serum; reduce STAT1 and STAT3 expression in the membrane tissue; and inhibit the secretion and proliferation of synovial cells. These results showed that benzoylaconitine and paeoniflorin could significantly palliate the arthritic symptoms of CIA rats, and better therapeutic effects could be achieved if the two components were used in combination

Dinoprostone en labor de parto: estudio clínico aleatorizado / Dinoprostone in labor: a randomized clinical trial

Objetivo: el propósito de este estudio es comparar el uso de dos preparados de prostaglandinas (dinoprostona) para la maduración cervical y alcanzar un índice de Bishop favorable, la de liberación prolongada (PROPESS) vs gel vaginal (Prostin E2)...

Intracervical PGE2 gel for cervical ripening and induction of Labour

The objectives of the study were to evaluate the efficacy of interacervical gel as a cervical ripening agent in the unfavourable cervix. The changes in the Bishops score, onset of labour and its progress were secondary outcome measures. Fifty patients were enrolled in this prospective study conducted in Gynae "A" unit of Khyber Teaching Hospital, Peshawar from January to December 2004. Patients with singleton living fetus, cephalic presentation, gestational age of >36 weeks completed were included. Half milligram [0.5mg] of prostaglandin E2 gel intracervical was used for intracervical application. The application was repeated after 6-12 hours if the Bishop score remained unfavourable i-e < 5. The indications were postdates pregnancy [50%], PIH [18%], Diabetes Mellitus [18%] and Rh isoimmnization [6%]. The success rate in terms of vaginal delivery was 82%. The lower segment caesarean section rate was 18%. The commonest indication for caesarean section was failure to progress. The complications side effects were minimal and the neonatal outcome was good. This study showed that intracervical application of prostaglandin E2 gel is effective, safe acceptable method for ripening of cervix in women with unfavourable cervix

Risk of uterine rupture with the use of prostaglandin E2 for induction of labor in women with a previous cesarean section scar

To determine the risk of symptomtic uterine rupture in women induced with prostaglandin E[2] vaginal tablet [PGE[2]] after 1 previous cesarean section. A cohort study of all women with a live singleton fetus undergoing a trial of labor [TOL] after a previous low - transverse cesarean delivery was performed in King Faisal Armed Forces Hospital, Saudi Arabia. The current analysis was limited to women at term with 1 prior cesarean delivery. We assessed the risk of uterine rupture for deliveries with spontaneous onset of labor and those in which labor was induced by PGE[2] vaginal tablets. Rates of uterine rupture were compared for these 2 groups. Potential confounding variables were controlled by using logistic regression analysis. Of 3200 trials of labor, 960 [30%] were PGE[2] induced and 2240 [70%] were spontaneous labor. The uterine rupture rate with PGE[2] - induced trial of labor [24 / 960; 2.5%] was significantly higher than with a spontaneous trials of labor [11 / 2240; 0.50%; P = 0.01]. In a logistic regression analysis that was controlled for maternal age, use of epidural analgesia, oxytocin augmentation, birth weight, gestational age, year of trial of labor, and prior vaginal delivery, the odds ratio for uterine rupture in those patients with PGE[2] - induced trial of labor was 5.1 [95% confidence interval, 1.9 -14.2]. For women with one prior cesarean delivery, induction of labor with PGE[2] is associated with an almost 5 - fold greater risk of uterine rupture than those who deliver after spontaneous labor

Induction of labour single vaginal PGE 2 Vs early amniotomy and I/V oxytocin

To compare two methods of induction of labour. Amniotomy with intravenous oxytocin infusion versus single use of prostaglandin E2 vaginal tablet. Design Perspective randomized clinical trial. The department of Gynae and Obs Nishtar Hospital Multan and Ganga Ram hospital lahore 100 patients were recruited .50 were randomized for amniotomy followed by oxytocin infusion. Second group underwent labour induction with PGE2 which was repeated after 6 hours, if n o change in bishop score is observed. 17 .2 .2004 to 17 .2.2005 In the study the results regarding mean Bishop score change, duration of labour and apgar score at 5 minutes were comparable in both groups. In the group 2 mean induction to delivery time was 9 hours.[6-12 hrs].The mean cervical change score was 8.5 Duration of labour in group 2 was in the mean of 7hrs. In group 1 mean cervical change was 7.5 [range5-7], induction to delivery time was 10.5 hrs. The duration of labour was 7.5 hrs. Analgesic requirements varied in both groups. No patient with PGE2 required pain relief before membrane rupture. In the oxytocin group narcotic analgesia was given from the start of uterine contractions. PGE2 vaginal tablet for induction of labour in case of unfavourable cervix is superior to use of amniotomy and oxytocin. It was found to be safe and effective with minimum of patient interference

Vaginal prostaglandin E2 pessary versus gel in induction of labour at term

To compare the prostaglandin E2 Vaginal pessary and gel with respect to cervical ripening, labour out come, side effects and cost effectiveness in induction of labour at term. Experimental study. Lady Willingdon Hospital, Lahore February to July, 2005. The trial was conducted on two group of patient for labour induction such that one group [n=30] received PGE2 vaginal pessary 6 hourly to maximum of 3 doses. Other group [n=30] received PGE2 gel at 6 hourly interval upto 2 doses. Labour induction, number of doses applied, need of augmentation, side effects, induction to delivery interval, mode of delivery, neonatal outcome and cost effectiveness were the main outcome measures. Our results depicted that PGE2 gel produced favourable bishop score more rapidly and initiating uterine contraction simultaneously than PGE2 pessary. Few patients required oxytocin augmentation in gel group [P<0.05]. There was no statistically significant d ifference in number of patients delivering vaginally with in 24 hours, the neonatal outcome and cost effectiveness in two groups [P>0.05]. However, more side effects such as uterine contractions, abnormalities, and fetal distress observed in gel group [P<0.05]. The PGE2 pessary was safe and easily applied, but PGE2 intracervical gel was more effective as it achieved greater changes in mean bishop score. However, more side effects encountered with gel catego

Prostaglandin E2 gel for cervical priming and induction of labour in unfavourable cervical state.

To know the safety and efficacy of intracervical prostaglandin E2 gel over conventional intravenous infusion of oxytocin for priming and induction of labour, a prospective study was undertaken in 96 cases selected at random for both study and control series consisting 48 cases in each group with definite indication for termination of pregnancy having unfavourable cervical state. Periodic clinical assessment in different groups following the procedure revealed that by the end of 12 hours, 39 cases in the study and 28 cases in the control group had uterine contraction. Foetal heart rate abnormality was more marked in the oxytocin group (1.56% in the study group and 20.31% in the control group) while increase in Bishop's cervical scoring was noticed more often in the prostaglandin group. By the end of 12 hours of initiation of therapy, 17 cases in the study group and only 3 cases in the control group had spontaneous vaginal delivery. There was significant shortening of instillation and delivery interval in PGE2 group. The number of caesarean section in the study group was only 16.66% in comparison to 25% in the control group. Analysing the efficacy of the procedures adopted, the success rate in the prostaglandin group was 91.66% in contrast to 64.58% in the oxytocin group.

Experiencia con prostaglandinas E2 en gel intracervicales y tabletas intravaginales en óbitos fetales / Experience with E2 prostaglandins in intracervical gel and intravaginal pills in death fetus

Se presenta nuestra experiencia clínica con el uso de prostaglandinas E2 en gel intracervicales y en tabletas intravaginales en la inducción del parto o abortos en fetos muertos. Considerados globalmente las 50 pacientes, el éxito fue de 70 por ciento, excluídos los 9 casos de fetos acráneos; esta proporción de éxito asciende a 77,7 por ciento en los casos de aborto retenido y a 78,26 por ciento en los casos de feto muerto in utero

Uterine rupture and labor induction with prostaglandins.

Uterine rupture in patients with labor induction with prostaglandin E2 application though uncommon is a very serious complication and preventable in obstetrics. We reported three cases of spontaneous uterine rupture following induction of labor with intracervical PGE2 gel administration in a dosage of 3-6 mg and two in whom labor was augmented with oxytocin infusion. To avoid such a complication, intracervical PGE2 gel administration should be started with a smaller dose and should augmentation with oxytocin be required careful evaluation and monitoring by a specialist is desirable.

Control of uterine hyperactivity caused by prostaglandin with intravenous terbutaline: a case report.

Prostaglandin E2 is beginning to be used more widely for the induction of labor in this country. The main concern with vaginal administration is the difficulty in stopping uterine hyperactivity. This report is a case where intravenous terbutaline was given as soon as hyperactivity and fetal heart rate deceleration were detected. Using this treatment, hyperactivity was controlled and the fetal heart rate returned to normal. Unfortunately, cesarean section was necessary for fetal distress which developed two and a half hours later when syntocinon was started intravenously to augment the labor.