Catecholamines during therapeutic abortion induced with intra-amniotic prostaglandin FZcw WILLIAM PAUL
E. BRENNER, L. OGBURN,
JAMES
R. DINGFELDER,
LINDA
G. STAUROVSKY,
FREDERICK
M.D.
JR.,
M.D.* M.D. C.N.M.
P. ZUSPAN,
Chapel HiU, North Carolina,
M.D.
and Columbus, Ohio
Serial plasma, amniotic fluid, and urine samples were analyzed for epinephrine (E) and norepinephrine (NE) in eight subjects during midtrimester abortion induced by intra-amniotic prostaglandin Fza (PGF,d. After PGF,, administration, plasma E increased and there was no change in plasma NE levels. Amniotic fluid levels of E and NE decreased initially. During the course of abortion the mean level of E in the amniotic fluid increased after fetal distress and decreased after fetal death, indicating that the midtrimester fetus may respond to stress by the urinary excretion of E. The maternal urinary excretion rates of both E and NE increased following PGFP,. The observation that mean plasma levels and urinary excretion rat@ changes correlated better with the course of abortion and uterine contractility rather than with the time of PGF- administration was consistent with the hypothesis that the catecholamine response may be due to the stress of labor rather than to the PGF2, per se. (AM. J. OBSTET. GYNECOL. 130: 178, 1978.)
THE INTRA-AMNIOTIC administration of prostaglandin F,, (PGF,o) is a common method of inducing artificial midtrimester abortion in the United States. Although the method appears to be relatively safe,’ PGF20 affects the autonomic nervous system. Endogenous prostaglandins have been implicated in sympathetic and parasympathetic neuroeffector and ganglionic transmission.2* 3 Prostaglandins appear to act at pre- and post-junctional sites and alter transmitter release.4 Feedback of sympathetic neuroeffector transmission may be modulated by prostaglandins.5 Administration of appropriate amounts of specific PG’s
to animals effected neuroeffector transmission in the heart, blood vessels, spleen, vas deferens, and adipose tissue.6-10 Intravenous infusion of PGF2o in abortifacient doses to gravidas resulted in an increase in circulating norepinephrine (NE) without rapidly altering the plasma concentration of epinephrine (E) or dopamine+hydroxylase.” To evaluate the changes in E and NE that occur during PGFzQ-induced abortion, serial plasma, amniotic fluid, and urine samples were analyzed for E and NE in eight midtrimester subjects after they had received 40 mg. of PGF2~ intra-amniotically.
Material and methods
From the Departments of Obstetrics and Gynecology, University of North Carolina and Ohio State University.
Eight physically healthy gravidas from 18 to 2 1 years of age and 18 to 21 menstrual weeks’ gestation were aborted in the Clinical Research Unit of the University of North Carolina. A single dose of 40 mg. of PGFzo as the Tham salt in a concentration of 5 mg. per milliiiter was administered intra-amniotically through a transabdominally placed catheter by a previously described and course of technique. ** The specific characteristics each patient are portrayed in Table I. All subjects were managed and monitored in a similar manner (Fig. 1). The patients had nothing by
Supported in part by grants from the International Fer[ility Research Program, Research Triangle Park, No& Carolina (AIDlcsd 2979), and the Ford Foundation (Grant No. 690-0108). Received for publication Accepted July
May
2 7, 1977.
13, 1977.
Reprint requests: Dr. William E. Brenner, Department Obstetrics and Gynecology, Old Clinic Bug. 226 H, Chapel Hill, North Carolina 27514.
of
*Present address: Universig of Minnesota, Department Obstetrics and Gynecology, Minneapolis, Minnesota.
of
178
Volume Number
Catechoiamines
130
‘L
mouth for nine hours before induction. Intrauterine catheters for monitoring and injecting PGF~Q and brachial venous catheters for obtaining blood specimens were inserted a minimum of four hours prior to PGFZa injections, which were all performed sometime between 9:00 and 1O:OO A.M. Following administration of PC, the patients ate a regular diet, excepting that no caffeine was ingested. Heart rate, respiratory rate, indirect brachial blood pressure, fetal heart rate, and oral temperature were recorded every hour from four hours prior to the administration of PGFzcv until a minimum of four hours after completion of the abortion. All subjects were continuously observed and monitored in duplicate for intra-amniotic pressure by the open-end catheter technique I3 from four hours prior to administration until abortion of the fetus. Total urinary output for quantitative analysis of E and NE was collected in the following time periods: Four hours prior until immediately before PGFZa administration, from PGFza administration (time 0) to 4 hours, four to eight hours, eight to 16 hours, and 16 to 24 hours. Urine samples were refrigerated and preserved with sodium metabisulfite (50 mg. for
E. BRENNER, L. OGBURN,
JAMES
R. DINGFELDER,
LINDA
G. STAUROVSKY,
FREDERICK
M.D.
JR.,
M.D.* M.D. C.N.M.
P. ZUSPAN,
Chapel HiU, North Carolina,
M.D.
and Columbus, Ohio
Serial plasma, amniotic fluid, and urine samples were analyzed for epinephrine (E) and norepinephrine (NE) in eight subjects during midtrimester abortion induced by intra-amniotic prostaglandin Fza (PGF,d. After PGF,, administration, plasma E increased and there was no change in plasma NE levels. Amniotic fluid levels of E and NE decreased initially. During the course of abortion the mean level of E in the amniotic fluid increased after fetal distress and decreased after fetal death, indicating that the midtrimester fetus may respond to stress by the urinary excretion of E. The maternal urinary excretion rates of both E and NE increased following PGFP,. The observation that mean plasma levels and urinary excretion rat@ changes correlated better with the course of abortion and uterine contractility rather than with the time of PGF- administration was consistent with the hypothesis that the catecholamine response may be due to the stress of labor rather than to the PGF2, per se. (AM. J. OBSTET. GYNECOL. 130: 178, 1978.)
THE INTRA-AMNIOTIC administration of prostaglandin F,, (PGF,o) is a common method of inducing artificial midtrimester abortion in the United States. Although the method appears to be relatively safe,’ PGF20 affects the autonomic nervous system. Endogenous prostaglandins have been implicated in sympathetic and parasympathetic neuroeffector and ganglionic transmission.2* 3 Prostaglandins appear to act at pre- and post-junctional sites and alter transmitter release.4 Feedback of sympathetic neuroeffector transmission may be modulated by prostaglandins.5 Administration of appropriate amounts of specific PG’s
to animals effected neuroeffector transmission in the heart, blood vessels, spleen, vas deferens, and adipose tissue.6-10 Intravenous infusion of PGF2o in abortifacient doses to gravidas resulted in an increase in circulating norepinephrine (NE) without rapidly altering the plasma concentration of epinephrine (E) or dopamine+hydroxylase.” To evaluate the changes in E and NE that occur during PGFzQ-induced abortion, serial plasma, amniotic fluid, and urine samples were analyzed for E and NE in eight midtrimester subjects after they had received 40 mg. of PGF2~ intra-amniotically.
Material and methods
From the Departments of Obstetrics and Gynecology, University of North Carolina and Ohio State University.
Eight physically healthy gravidas from 18 to 2 1 years of age and 18 to 21 menstrual weeks’ gestation were aborted in the Clinical Research Unit of the University of North Carolina. A single dose of 40 mg. of PGFzo as the Tham salt in a concentration of 5 mg. per milliiiter was administered intra-amniotically through a transabdominally placed catheter by a previously described and course of technique. ** The specific characteristics each patient are portrayed in Table I. All subjects were managed and monitored in a similar manner (Fig. 1). The patients had nothing by
Supported in part by grants from the International Fer[ility Research Program, Research Triangle Park, No& Carolina (AIDlcsd 2979), and the Ford Foundation (Grant No. 690-0108). Received for publication Accepted July
May
2 7, 1977.
13, 1977.
Reprint requests: Dr. William E. Brenner, Department Obstetrics and Gynecology, Old Clinic Bug. 226 H, Chapel Hill, North Carolina 27514.
of
*Present address: Universig of Minnesota, Department Obstetrics and Gynecology, Minneapolis, Minnesota.
of
178
Volume Number
Catechoiamines
130
‘L
mouth for nine hours before induction. Intrauterine catheters for monitoring and injecting PGF~Q and brachial venous catheters for obtaining blood specimens were inserted a minimum of four hours prior to PGFZa injections, which were all performed sometime between 9:00 and 1O:OO A.M. Following administration of PC, the patients ate a regular diet, excepting that no caffeine was ingested. Heart rate, respiratory rate, indirect brachial blood pressure, fetal heart rate, and oral temperature were recorded every hour from four hours prior to the administration of PGFzcv until a minimum of four hours after completion of the abortion. All subjects were continuously observed and monitored in duplicate for intra-amniotic pressure by the open-end catheter technique I3 from four hours prior to administration until abortion of the fetus. Total urinary output for quantitative analysis of E and NE was collected in the following time periods: Four hours prior until immediately before PGFZa administration, from PGFza administration (time 0) to 4 hours, four to eight hours, eight to 16 hours, and 16 to 24 hours. Urine samples were refrigerated and preserved with sodium metabisulfite (50 mg. for
