CASE REPORT
NJOG 2011 Nov-Dec; 6 (2): 49-50
Dinoprostone Use and Rupture of Uterus in Primigravida: A
Report of Two Cases
Upadhyaya I
Paropakar Maternity and Women’s Hospital, Thapathali
Two cases of complete and incomplete uterine rupture following the use of dinoprostone gel for induction of labor (IOL)
at 41 weeks of pregnancy in primigravidas; one of the two being diagnosed after vaginal delivery is presented herewith to
alert cautious use of this important agent.
Keywords: Dinoprostone gel, induction of labour, ruptured uterus
INTRODUCTION
ZƵƉƚƵƌĞ ŽĨ ƉƌĞŐŶĂŶƚ ƵƚĞƌƵƐ ŝƐ ŽŶĞ ŽĨ ƚŚĞ ŵŽƐƚ ƐĞƌŝŽƵƐ
obstetrical emergencies requiring prompt diagnosis and
ŵĂŶĂŐĞŵĞŶƚ͕ĂƐŝƚŝƐĂĐĂƚĂƐƚƌŽƉŚŝĐĐŽŵƉůŝĐĂƟŽŶ͕ĂƐƐŽĐŝĂƚĞĚ
with high rates of maternal as well as fetal morbidity and
ŵŽƌƚĂůŝƚLJ͘ DŽƐƚ ĐĂƐĞƐ ŽĨ ƵƚĞƌŝŶĞ ƌƵƉƚƵƌĞ ŽĐĐƵƌ ŝŶ ǁŽŵĞŶ
ǁŝƚŚĂƉƌĞǀŝŽƵƐĐĞƐĂƌĞĂŶĚĞůŝǀĞƌLJ͘/ŶĨĂĐƚ͕ƉƌŝŵŝŐƌĂǀŝĚƵƚĞƌƵƐ
ŚĂƐ ďĞĞŶ ĐŽŶƐŝĚĞƌĞĚ ĂůŵŽƐƚ ŝŵŵƵŶĞ ƚŽ ƌƵƉƚƵƌĞ͘ WƌŽŵƉƚ
ƌĞĐŽŐŶŝƟŽŶŽĨƵƚĞƌŝŶĞƌƵƉƚƵƌĞĂŶĚĞdžƉĞĚŝƟŽƵƐƌĞĐŽƵƌƐĞƚŽ
ůĂƉĂƌŽƚŽŵLJĂƌĞĐƌŝƟĐĂůŝŶŝŶŇƵĞŶĐŝŶŐƉĞƌŝŶĂƚĂůĂŶĚŵĂƚĞƌŶĂů
ŵŽƌďŝĚŝƚLJ͘ dǁŽ ĐĂƐĞƐ ŽĨ ƌƵƉƚƵƌĞ ŽĨ ƉƌŝŵŝŐƌĂǀŝĚ ƵƚĞƌƵƐ
ĨŽůůŽǁŝŶŐ ƵƐĞ ŽĨ ĚŝŶŽƉƌŽƐƚŽŶĞ ĨŽƌ ŝŶĚƵĐƟŽŶ ŽĨ ůĂďŽƵƌ ĂƌĞ
ƉƌĞƐĞŶƚĞĚŚĞƌĞ͘
CASE
Case 1: A 23 year primigravida at 41 weeks pregnancy
ǁŝƚŚ ŝƐŚŽƉ ƐĐŽƌĞ ϰ ŚĂĚ ƵŶĚĞƌŐŽŶĞ ŝŶĚƵĐƟŽŶ ŽĨ ůĂďŽƌ ǁŝƚŚ
ĚŝŶŽƉƌŽƐƚŽŶĞ;Ϭ͘ϱŵŐͿŝŶƚƌŽĚƵĐĞĚŝŶƉŽƐƚĞƌŝŽƌĨŽƌŶŝdžϮĚŽƐĞƐ
ϲŚŽƵƌƐĂƉĂƌƚ͘ƵŐŵĞŶƚĂƟŽŶŽĨůĂďŽƵƌǁŝƚŚϮ͘ϱƵŶŝƚƐKdžLJƚŽĐŝŶ
ǁĂƐƐƚĂƌƚĞĚĂŌĞƌϭϮŚŽƵƌƐŽĨůĂƐƚĚŽƐĞŽĨĚŝŶŽƉƌŽƐƚŽŶĞ͘^ŚĞ
ĚĞǀĞůŽƉĞĚ ŵŽĚĞƌĂƚĞ ƵƚĞƌŝŶĞ ĐŽŶƚƌĂĐƟŽŶƐ͘ dǁŽ ŚŽƵƌ ůĂƚĞƌ͕
ƐŚĞ ǁĂƐ ĨŽƵŶĚ ƉĂůĞ͕ ƉƵůƐĞ ƌĂƚĞ ϭϬϬďƉͬŵ͕ W ϵϬͬϲϬŵŵ ŽĨ
,Ő͘ ďĚŽŵŝŶĂů ĞdžĂŵŝŶĂƟŽŶ ƌĞǀĞĂůĞĚ ƐĞǀĞƌĞ ƚĞŶĚĞƌŶĞƐƐ
specially at fundal region of uterus and absent fetal heart
ƐŽƵŶĚ͘ sĂŐŝŶĂů ĞdžĂŵŝŶĂƟŽŶ ƌĞǀĞĂůĞĚ ŵŽĚĞƌĂƚĞ ĂŵŽƵŶƚ ŽĨ
ĨƌĞƐŚďůĞĞĚŝŶŐĂŶĚƉƌĞƐĞŶƟŶŐƉĂƌƚǁĂƐŶŽƚĨĞůƚƚŚƌŽƵŐŚƚŚĞ
ĐĞƌǀŝĐĂůŽƐǁŚĞƌĞĂƐƉƌĞǀŝŽƵƐĞdžĂŵŝŶĂƟŽŶƌĞĐŽƌĚĞĚǀĞƌƚĞdžĂƚ
ŵŝŶƵƐϭƐƚĂƟŽŶ͘tŝƚŚ^ƵƐƉŝƐŝŽŶŽĨ ƵƚĞƌŝŶĞƌĞƉƚƵƌĞĂŶĚh^'
ŽŶĮƌŵĂƟŽŶ ŽŶ ŽƉĞŶŝŶŐ ĂďĚŽŵĞŶ ƵƚĞƌŝŶĞ ƌƵƉƚƵƌĞ ǁŝƚŚ
ĞdžƉƵůƐŝŽŶŽĨƚŚĞĨĞƚƵƐĂŶĚƉůĂĐĞŶƚĂŝŶƚŽƚŚĞƉĞƌŝƚŽŶĞĂůĐĂǀŝƚLJ
ǁĂƐĨŽƵŶĚ͘ŽŵƉůĞƚĞƌƵƉƚƵƌĞŽĨƚŚĞƵƚĞƌƵƐĨƌŽŵƌŝŐŚƚůĂƚĞƌĂů
ƐŝĚĞŽĨĨƵŶĚƵƐĞdžƚĞŶĚŝŶŐƵƉƚŽƚŚĞĐĞƌǀŝdžǁĂƐŶŽƟĐĞĚ͘ďŽƵƚ
ϱϬϬ ŵů ŽĨ ďůŽŽĚ ĐůŽƚƐ ĂŶĚ Ă ůŝƚĞƌ ŽĨ ŚĞŵŽƉĞƌŝƚŽŶĞƵŵ ǁĂƐ
ĨŽƵŶĚŝŶƚŚĞƉĞƌŝƚŽŶĞĂůĐĂǀŝƚLJ͘
hƚĞƌŝŶĞƌƵƉƚƵƌĞǁĂƐƌĞƉĂŝƌĞĚŝŶϮůĂLJĞƌƐ͘&ŽƵƌƵŶŝƚƐŽĨǁŚŽůĞ
ďůŽŽĚǁĂƐƚƌĂŶƐĨƵƐĞĚ͘ĂďLJǁĂƐĨƌĞƐŚƐƟůůďŽƌŶŵĂůĞϮ͘ϵŬŐ͘
WŽƐƚŽƉĞƌĂƟǀĞƌĞĐŽǀĞƌLJǁĂƐƵŶĞǀĞŶƞƵůĂŶĚƚŚĞƉĂƟĞŶƚǁĂƐ
ĚŝƐĐŚĂƌŐĞĚŽŶϳƚŚƉŽƐƚŽƉĞƌĂƟǀĞĚĂLJ;&ŝŐƵƌĞϭĂŶĚϮͿ͘
Case 2: A 29 year primigravida at 41 weeks pregnancy
ǁŝƚŚ ŝƐŚŽƉ ƐĐŽƌĞ ϰ ǁĂƐ ĂĚŵŝƩĞĚ ĨŽƌ ŝŶĚƵĐƟŽŶ ŽĨ ůĂďŽƵƌ͘
ŝŶŽƉƌŽƐƚŽŶĞ ;Ϭ͘ϱ ŵŐͿ ǁĂƐ ŝŶƚƌŽĚƵĐĞĚ ŝŶ ƉŽƐƚĞƌŝŽƌ ĨŽƌŶŝdž Ϯ
ĚŽƐĞƐϲŚŽƵƌƐĂƉĂƌƚ͘ŌĞƌϴŚŽƵƌƐŽĨϮŶĚĚŽƐĞŝŶŽƉƌŽƐƚŽŶĞ
ƐŚĞ ĚĞǀĞůŽƉĞĚ ŵŝůĚ ƵƚĞƌŝŶĞ ĐŽŶƚƌĂĐƟŽŶƐ͘ ďĚŽŵŝŶĂů
ĞdžĂŵŝŶĂƟŽŶ ƐŚŽǁĞĚ ĐĞƉŚĂůŝĐ ƉƌĞƐĞŶƚĂƟŽŶ ϯͬϱƚŚ ƉĂůƉĂďůĞ
ĂŶĚĨĞƚĂůŚĞĂƌƚƐŽƵŶĚϭϰϰͬŵ͘sĂŐŝŶĂůĞdžĂŵŝŶĂƟŽŶƌĞǀĞĂůĞĚ
ĐĞƌǀŝĐĂůŽƐϱĐŵĚŝůĂƚĞĚ͕ĐĞƌǀŝdžϳϬйĞīĂĐĞĚ͕ĂŶĚǀĞƌƚĞdžĂƚͲϭ
ƐƚĂƟŽŶ͕ŵĞŵďƌĂŶĞƌƵƉƚƵƌĞĚƐƉŽŶƚĂŶĞŽƵƐůLJ͘&ŽƵƌŚŽƵƌƐůĂƚĞƌ
ůĂďŽƌ ǁĂƐ ĂƵŐŵĞŶƚĞĚ ǁŝƚŚ Ϯ͘ϱ ƵŶŝƚƐ KdžLJƚŽĐŝŶ͘ dŚƌĞĞ ŚŽƵƌƐ
ůĂƚĞƌ ƐŚĞ ĚĞůŝǀĞƌĞĚ Ă ŵĂůĞ ďĂďLJ ŽĨ Ϯ͘ϵŬŐ͕ ǁŝƚŚ ĂƉŐĂƌ ƐĐŽƌĞ
ϭͬϭϬ͕ϯͬϭϬ͕ƉůĂĐĞŶƚĂǁĂƐĚĞůŝǀĞƌĞĚďLJĐŽŶƚƌŽůůĞĚĐŽƌĚƚƌĂĐƟŽŶ͘
ŌĞƌ ƌĞŵŽǀĂů ŽĨ ƚŚĞ ƉůĂĐĞŶƚĂ͕ ƚŚĞƌĞ ǁĂƐ ƵŶĐŽŶƚƌŽůůĂďůĞ
ďůĞĞĚŝŶŐ͘^ŚĞǁĂƐƚĂŬĞŶƚŽŽƉĞƌĂƟŽŶƚŚĞĂƚƌĞǁŝƚŚƐƵƐƉŝĐŝŽŶ
of rupture uterus while compression of abdominal aorta
ǁĂƐƵŶĚĞƌƚĂŬĞŶƚŽĐŽŶƚƌŽůƚŚĞďůĞĞĚŝŶŐ͘
CORRESPONDENCE
Dr. Indira Upadhyaya, MD
Paropakar Maternity and Women’s Hospital,
Kathmandu, Nepal
Phone : 9851074598
Email: [email protected]
49
Upadhyaya. Dinoprostone Use and Rupture of Uterus in Primigravida: A Report of Two Cases
ŽǀĞƌĐŽŵĞ ƐƚƌŽŶŐ ƐƵƐƚĂŝŶĞĚ ĐŽŶƚƌĂĐƟŽŶ ŚĂƐ ďŝŐ ƌŽůĞ ƚŽ
ƉƌĞǀĞŶƚ ƚŚĞ ƐŝƚƵĂƟŽŶ͘ hƐĞ ŽĨ ŝŶŽƉƌŽƐƚŽŶĞ ĨŽƌ ĐĞƌǀŝĐĂů
ƌŝƉĞŶŝŶŐĨŽůůŽǁĞĚďLJĂƵŐŵĞŶƚĂƟŽŶŽĨůĂďŽƵƌǁŝƚŚKdžLJƚŽĐŝŶ
ǁĂƐ ƚŚĞ ƉŽƐƐŝďůĞ ĨĂĐƚŽƌ ĐŽŶƚƌŝďƵƟŶŐ ƚŽ ƌƵƉƚƵƌĞ ƵƚĞƌƵƐ͘
ŽŶĐŽŵŝƚĂŶƚ ƵƐĞ ŽĨ ŝŶŽƉƌŽƐƚŽŶĞ ĂŶĚ KdžLJƚŽĐŝŶ ŝƐ ŶŽƚ
ƌĞĐŽŵŵĞŶĚĞĚ͘dŚŝƐďƌŝŶŐƐƚŽĨŽƌĞĨƌŽŶƚƚŚĞŶĞĞĚŽĨĐĂƌĞĨƵů
ŵŽŶŝƚŽƌŝŶŐ ǁŚŝůĞ ƵƐŝŶŐ ƉƌŽƐƚĂŐůĂŶĚŝŶ ĂŶĚ KdžLJƚŽĐŝŶ͘
KŶĞ ƐŚŽƵůĚ ŶĞǀĞƌ ĨŽƌŐĞƚ ƚŚĂƚ ƚŚĞ ŝŶĚŝǀŝĚƵĂů ƌĞƐƉŽŶƐĞ
ƚŽ ƉĂƌƟĐƵůĂƌ ĚƌƵŐ ŝƐ ŶŽƚ ŬŶŽǁŶ͘ Ɛ ůŝƚĞƌĂƚƵƌĞ ƌĞƉŽƌƚƐ
KdžLJƚŽĐŝŶͲŝŶĚƵĐĞĚ ƌƵƉƚƵƌĞ ŽĨ ƚŚĞ ƉƌŝŵŝŐƌĂǀŝĚ ƵƚĞƌƵƐ ŝƐ ƚŽŽ
ƌĂƌĞ͘ϰ͕ϱdŚĞŵŽƐƚĐŽŵŵŽŶƌŝƐŬĨĂĐƚŽƌƐĂƌĞƉƌĞǀŝŽƵƐƵƚĞƌŝŶĞ
surgery, and most of uterine rupture occurs in women with a
previous cesarean delivery but now a days iatrogenic rupture
ƵƚĞƌƵƐĂƌĞĂůƐŽƌĞƉŽƌƚĞĚĨƌĞƋƵĞŶƚůLJ͘
Figure 1. Picture showing side of the rupture uterus
KŶ ůĂƉĂƌŽƚŽŵLJ͕ ŝŶĐŽŵƉůĞƚĞ ƌƵƉƚƵƌĞ ǁĂƐ ĚĞƚĞĐƚĞĚ Ăƚ ƌŝŐŚƚ
ƐŝĚĞ ŽĨ ƚŚĞ ƵƚĞƌƵƐ ďĞůŽǁ ƚŚĞ ŝŶƐĞƌƟŽŶ ŽĨ ŽǀĂƌŝĂŶ ůŝŐĂŵĞŶƚ
ƵƉƚŽ ƚŚĞ ůŽǁĞƌ ƐĞŐŵĞŶƚ ǁŝƚŚ ŝŶƚĂĐƚ ƉĞƌŝƚŽŶĞƵŵ͘ dŚĞƌĞ
ǁĂƐ Ă ůĂƌŐĞ ďƌŽĂĚ ůŝŐĂŵĞŶƚ ŚĂĞŵĂƚŽŵĂ ŽŶ ƚŚĞ ƌŝŐŚƚ ƐŝĚĞ͘
Peritoneum was opened to evacuate the hematoma and
ƚĞĂƌƌĞƉĂŝƌĞĚ͘dĞŶƵŶŝƚƐŽĨǁŚŽůĞďůŽŽĚĂŶĚϯƵŶŝƚƐŽĨĨƌĞƐŚ
ĨƌŽnjĞŶƉůĂƐŵĂǁĞƌĞƚƌĂŶƐĨƵƐĞĚ͘WŽƐƚŽƉĞƌĂƟǀĞƌĞĐŽǀĞƌLJǁĂƐ
ƵŶĞǀĞŶƞƵůĂŶĚƐŚĞǁĂƐĚŝƐĐŚĂƌŐĞĚŽŶϭϮƚŚƉŽƐƚŽƉĞƌĂƟǀĞ
ĚĂLJ͘dŚĞďĂďLJĚŝĞĚŽŶϰƚŚĚĂLJĚƵĞƚŽŚLJƉŽdžŝĐĞŶĐĞƉŚĂůŽƉĂƚŚLJ
ŐƌĂĚĞ///͘
WƌŽŵƉƚ ƌĞƐƵƐĐŝƚĂƟŽŶ ĂŶĚ ƐƵƌŐŝĐĂů ŝŶƚĞƌǀĞŶƟŽŶ ĂƌĞ ƚŚĞ
mainstays of the treatment of uterine rupture once the
ĚŝĂŐŶŽƐŝƐ ŝƐ ŵĂĚĞ͘ dŚĞ ƐƵƌŐŝĐĂů ŵĂŶĂŐĞŵĞŶƚ ŽĨ ƵƚĞƌŝŶĞ
ƌƵƉƚƵƌĞ ƐŚŽƵůĚ ďĞ ŝŶĚŝǀŝĚƵĂůŝnjĞĚ͘ dŚĞ ƚLJƉĞ͕ ĞdžƚĞŶƚ ĂŶĚ
ůŽĐĂƟŽŶ ŽĨ ƌƵƉƚƵƌĞ͕ ƚŚĞ ƉĂƟĞŶƚ͛Ɛ ĐůŝŶŝĐĂů ĐŽŶĚŝƟŽŶ͕ ĂŐĞ͕
parity and number of living children should be taken
ŝŶƚŽ ĐŽŶƐŝĚĞƌĂƟŽŶ͘ ůƐŽ ƚŚĞ ƉƌĞƐĞŶĐĞ ŽĨ ŝŶĨĞĐƟŽŶ͕
ĂǀĂŝůĂďŝůŝƚLJ ĂŶĚ ĞdžƉĞƌŝĞŶĐĞ ŽĨ ƚŚĞ ƐƵƌŐĞŽŶ ĂƌĞ ĐƌƵĐŝĂů͘
ĂƐŝĞƐƚ ĂŶĚ ƐŚŽƌƚĞƐƚ ƉƌŽĐĞĚƵƌĞ ƐŚŽƵůĚ ďĞ ĂƩĞŵƉƚĞĚ
ŝŶ ĞĂĐŚ ĐĂƐĞ͘ /Ŷ ďŽƚŚ ŽĨ ŽƵƌ ĐĂƐĞƐ͕ Ăůů ƚŚĞƐĞ ĨĂĐƚŽƌƐ
ǁĞƌĞ ƚĂŬĞŶ ŝŶƚŽ ĐŽŶƐŝĚĞƌĂƟŽŶ ĂŶĚ ŽŶůLJ ƌĞƉĂŝƌ ǁĂƐ
ĚŽŶĞ͘ ĐƵƚĞ ďůŽŽĚ ůŽƐƐ͕ ĂƐƉŚLJdžŝĂ ĂŶĚ ƐƵĚĚĞŶ ĞdžƉƵůƐŝŽŶ
of fetus into the abdominal cavity during the rupture
ŽĨƚŚĞƵƚĞƌƵƐƌĞƐƵůƚĞĚŝŶŝŵŵĞĚŝĂƚĞĨĞƚĂůĚĞĂƚŚŝŶĮƌƐƚĐĂƐĞ
whereas neonatal death occurred on third postpartum day
ŝŶ ƐĞĐŽŶĚ ĐĂƐĞ ĚƵĞ ƚŽ ƐĞǀĞƌĞ ďŝƌƚŚ ĂƐƉŚLJdžŝĂ͕ ƐŝŵŝůĂƌ ĨĞƚĂů
ŽƵƚĐŽŵĞƐǁĞƌĞƌĞƉŽƌƚĞĚŝŶŽƚŚĞƌƐƚƵĚŝĞƐƚŽŽ͘ϲͲϴ
CONCLUSIONS
hƚĞƌŝŶĞƌƵƉƚƵƌĞ͕ĂĚĞǀĂƐƚĂƟŶŐĂŶĚĐĂƚĂƐƚƌŽƉŚŝĐĐŽŵƉůŝĐĂƟŽŶ
ĐĂŶďĞŵŝŶŝŵŝnjĞĚŝĨƉƌŽƐƚĂŐůĂŶĚŝŶĂŶĚKdžLJƚŽĐŝŶĂƌĞƵƐĞĚǁŝƚŚ
ĐĂƵƟŽŶ͘hƚĞƌŝŶĞƌƵƉƚƵƌĞŝŶƉƌŝŵŝŐƌĂǀŝĚĂŝƐĂƌĂƌĞĞǀĞŶƚ͕ďƵƚ
results in increased morbidity and mortality of the mother
ĂŶĚĐŚŝůĚ͘
Figure 2. Repairing of the rupture of uterus
REFERENCES
ϭ͘
/ŶĚƵĐƟŽŶ ŽĨ ůĂďŽƌ͗ ZK' ŐƵŝĚĞůŝŶĞ͘ ǀŝĚĞŶĐĞͲďĂƐĞĚ ůŝŶŝĐĂů
'ƵŝĚĞůŝŶĞEŽ͘ϵ͘>ŽŶĚŽŶ͗ZK'͖ϮϬϬϭ͘
Ϯ͘
dŚĂǀĂƌĂƐĂŚ ^͕ ĐŚĂŶŶĂ <^͘ hƚĞƌŝŶĞ ZƵƉƚƵƌĞ ǁŝƚŚ ƚŚĞ ƵƐĞ ŽĨ
ĐĞƌǀĂŐĞŵ;WƌŽƐƚĂŐůĂŶĚŝŶϭͿĨŽƌŝŶĚƵĐƟŽŶŽĨůĂďŽƵƌŽŶĂĐĐŽƵŶƚŽĨ
ŝŶƚƌĂͲƵƚĞƌŝŶĞĚĞĂƚŚ͘^ŝŶŐĂƉŽƌĞDĞĚ:͘ϭϵϴϴ͖Ϯϵ;ϰͿ͗ϯϱϭͲϮ͘
ϯ͘
ŚƵŶŝE͘ŶĂůLJƐŝƐŽĨƵƚĞƌŝŶĞƌƵƉƚƵƌĞŝŶĂƚĞƌƟĂƌLJĐĞŶƚĞƌŝŶĞĂƐƚĞƌŶ
EĞƉĂů͗ >ĞƐƐŽŶƐ ĨŽƌ ŽďƐƚĞƚƌŝĐ ĐĂƌĞ͘ dŚĞ :ŽƵƌŶĂů ŽĨ KďƐƚĞƚƌŝĐƐ ĂŶĚ
'LJŶĂĞĐŽůŽŐLJZĞƐĞĂƌĐŚ͘ϮϬϬϲ͖ϯϮ͗ϱϳϰͲϵ͘
ϰ͘
ďŽLJĞũŝW͕/ũĂŝLJĂDͲ͕zĂŚĂLJĂhZ͘ZƵƉƚƵƌĞĚƵƚĞƌƵƐ͗ƐƚƵĚLJŽĨϭϬϬ
ĐŽŶƐĞĐƵƟǀĞ ĐĂƐĞƐ ŝŶ /ůŽƌŝŶ͕ EŝŐĞƌŝĂ͘ dŚĞ :ŽƵƌŶĂů ŽĨ KďƐƚĞƚƌŝĐƐ ĂŶĚ
'LJŶĂĞĐŽůŽŐLJZĞƐĞĂƌĐŚ͘ϮϬϬϭ͖Ϯϳ͗ϯϰϭͲϴ͘
ϱ͘
tĂůƐŚ͕Ădžŝ>s͘ZƵƉƚƵƌĞŽĨƚŚĞƉƌŝŵŝŐƌĂǀŝĚƵƚĞƌƵƐ͗ƌĞǀŝĞǁŽĨ
ƚŚĞůŝƚĞƌĂƚƵƌĞ͘KďƐƚĞƚ'LJŶĞĐŽů^Ƶƌǀ͘ϮϬϬϳ͖ϲϮ;ϱͿ͗ϯϮϳͲϯϰ͘
ϲ͘
^ĞīĂŚ :͘ ZƵƉƚƵƌĞĚ ƵƚĞƌƵƐ ĂŶĚ ƚŚĞ ƉĂƌƚŽŐƌĂƉŚ͘ /ŶƚΖů :ŽƵƌŶĂů ŽĨ
'LJŶĞĐŽůĂŶĚKďƐƚĞƚ͘ϮϬϬϯ͖ϴϬ͗ϭϲϵͲϳϮ͘
ϳ͘
Ăǁ ͘ KdžLJƚŽĐŝŶͲŝŶĚƵĐĞĚ ƌƵƉƚƵƌĞ ŽĨ ƚŚĞ ƉƌŝŵŝŐƌĂǀŝĚ ƵƚĞƌƵƐ͘ dŚĞ
:ŽƵƌŶĂůŽĨKďƐƚĞƚƌŝĐƐĂŶĚ'LJŶĂĞĐŽůŽŐLJŽĨƚŚĞƌŝƟƐŚŽŵŵŽŶǁĞĂůƚŚ
͘ϭϵϳϯ͖ϴϬ͗ϯϳϰͲϱ͘
ϴ͘
ƌŽƌĂD͘ZĞƚƌŽƐƉĞĐƟǀĞƐƚƵĚLJŽĨĐĂƐĞƐŽĨƌƵƉƚƵƌĞƵƚĞƌƵƐ͘KďƐĂŶĚ
'LJŶĂĞdŽĚĂLJ͘ϮϬϬϵ͖ϭϰ͗ϭϮϯͲϱ͘
COMMENT
Prostaglandins are now increasingly being used in the
ŵĂŶĂŐĞŵĞŶƚŽĨůĂďŽƵƌ͘KŶĞŽĨƚŚĞŵŝƐŝŶŽƉƌŽƐƚŽŶĞϬ͘ϱŵŐ
ŐĞů ǁŚŝĐŚ ŚĂƐ ůŽĐĂů ĐĞƌǀŝĐĂů ĞīĞĐƚ ŝŶ ŝŶŝƟĂƟŶŐ ƐŽŌĞŶŝŶŐ͕
ĞīĂĐĞŵĞŶƚ͕ ĂŶĚ ĚŝůĂƚĂƟŽŶ ŽĨ ĐĞƌǀŝdž͘ /ƚ ŝƐ ŵĂŝŶůLJ ƵƐĞĚ ǁŝƚŚ
ĂŝŵŽĨĐĞƌǀŝĐĂůƌŝƉĞŶŝŶŐĨŽůůŽǁĞĚďLJĂƵŐŵĞŶƚĂƟŽŶŽĨůĂďŽƵƌ
ĂŶĚǀĂŐŝŶĂůĚĞůŝǀĞƌLJŝŶĂǁŽŵĂŶǁŝƚŚƉŽŽƌŝƐŚŽƉscore at or
ŶĞĂƌƚĞƌŵ͘ϭ͕ϮŝŶŽƉƌŽƐƚŽŶĞĐĞƌǀŝĐĂůŐĞůŝƐƌĂƉŝĚůLJĂďƐŽƌďĞĚ
ǁŝƚŚƉĞĂŬƉůĂƐŵĂĐŽŶĐĞŶƚƌĂƟŽŶƐŝŶϯϬͲϰϱŵŝŶƵƚĞƐ͘
ƐƚƵĚLJĚŽŶĞŝŶĂƐƚĞƌŶEĞƉĂůĂŵŽŶŐϭϮϲĐĂƐĞƐŽĨƵƚĞƌŝŶĞ
ƌƵƉƚƵƌĞ͕ ůĂƚĞƌĂů ǁĂůů ŝŶǀŽůǀĞŵĞŶƚ ǁĂƐ ƐŝŐŶŝĮĐĂŶƚůLJ ŚŝŐŚĞƌ
in the unscarred uterus similar to this study where both
ĐĂƐĞƐ ŚĂĚ ůĂƚĞƌĂů ǁĂůů ƌƵƉƚƵƌĞ͘ϯ WƌŽǀŝƐŝŽŶ ŽĨ ĂĚĞƋƵĂƚĞ
ƐƚĂī ƐƵƉƉŽƌƚ ŝŶ ŚĞĂǀLJ ǁŽƌŬůŽĂĚ ƐŝƚƵĂƟŽŶƐ͕ ĐŽŶƟŶƵŽƵƐ
ƐƵƌǀĞŝůůĂŶĐĞ͕ ĐĂƌĚŝŽƚŽĐŽŐƌĂƉŚ ĂŶĚ ƵƐĞ ŽĨ ƚŽĐŽůLJƟĐƐ ƚŽ
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