EFFECT OF LOCAL PROSTAGLANDIN E-2 ON UTERINE AND FETAL DOPPLER FLOW IN PREGNANCY-INDUCED HYPERTENSION

Objectives: To evaluate the effects of vaginal and intracervical admin istration of prostaglandin E-2 (PGE(2)) on the uterine, umbilical, and fetal blood flow in hypertensive pregnancies. Methods: Thirty-two wom en with pregnancy-induced hypertension undergoing cervical ripening fo r preinduction of labor were randomized to receive either 2.0 mg of PG E(2) gel vaginally (n = 12), 0.5 mg of PGE(2) gel intracervically (n = 10), or placebo gel vaginally (n = 10). The pulsatility index (PI) an d resistance index (RI) in uterine arteries, umbilical artery, and fet al middle cerebral artery were calculated before and 30 and 60 min aft er administration of PGE(2) or placebo. Results: Placebo gel caused no changes in any one flow variable. Because the vaginal and intracervic al mode of administration of PGE(2) caused similar changes in flow, th ese groups were combined. PGE(2) increased (P < 0.0001) impedance to f low in uterine arteries 30 min (9.7 +/- 2.8%, mean +/- SE) and 60 min (20.5 +/- 4.8%) after application. In contrast, impedance to flow tend ed to decrease in fetal cerebral arteries 30 min (8.1 +/- 4.0%, NS) an d 60 min (11.5 +/- 3.5%, P < 0.004) later. No changes were seen, follo wing PGE(2) use, in umbilical blood how. No clear-cut relationships co uld be found between changes in blood flow and uterine contractility, as assessed by external tochography. Conclusion: In hypertensive pregn ancies, cervical ripening with PGE(2) gel leads to increase in uterine vascular resistance, and to decrease in fetal middle cerebral artery resistance.