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, M Singh, S Patole, A Rane, D Naidoo, P Buettner

Abstract

Objective: To test the hypothesis that the application of intravaginal prostaglandin E(2) 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 E(2) 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 E(2) gel.

Figures

Figure 1
Figure 1
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.

References

    1. Am J Perinatol. 1984 Jan;1(2):165-9
    1. Arch Dis Child. 1983 Apr;58(4):262-6
    1. Obstet Gynecol. 1985 Jun;65(6):818-24
    1. N Engl J Med. 1988 Jul 21;319(3):136-42
    1. J Endocrinol Invest. 1988 Nov;11(10):703-9
    1. Am J Obstet Gynecol. 1989 Mar;160(3):529-34
    1. Am J Obstet Gynecol. 1990 Sep;163(3):794-6
    1. Am J Obstet Gynecol. 1991 Oct;165(4 Pt 1):1006-9
    1. Br J Obstet Gynaecol. 1995 Feb;102(2):101-6
    1. Early Hum Dev. 1996 Sep 20;46(1-2):97-104
    1. Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi. 1997 Jan-Feb;38(1):38-43
    1. Pediatrics. 1997 Sep;100(3 Pt 1):348-53
    1. Can J Physiol Pharmacol. 1997 Jul;75(7):772-80
    1. Gynecol Obstet Invest. 1997;44(3):173-6
    1. J Pediatr. 1984 Jul;105(1):144-8
    1. Acta Paediatr Scand. 1984 Sep;73(5):602-9
    1. Can J Physiol Pharmacol. 1998 Oct-Nov;76(10-11):967-74
    1. BMJ. 1999 Apr 17;318(7190):1056-8
    1. Acta Paediatr. 1999 Nov;88(11):1180-1
    1. J Physiol. 2000 Sep 1;527 Pt 2:377-85
    1. Obstet Gynecol. 2001 Mar;97(3):439-42
    1. Am J Physiol Lung Cell Mol Physiol. 2001 Apr;280(4):L606-16
    1. Obstet Gynecol. 2001 Jun;97(6):926-31
    1. Eur J Obstet Gynecol Reprod Biol. 2002 Feb 10;101(1):87-8
    1. Am J Perinatol. 2002 Feb;19(2):81-6
    1. Life Sci. 1978 Sep 11;23(10):1049-52
    1. J Pediatr. 1980 Feb;96(2):311-5
    1. Am J Obstet Gynecol. 1982 Apr 15;142(8):1004-10
    1. Arch Dis Child. 1984 Dec;59(12):1155-8

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