Chronic stimulation of uterine prostaglandin synthesis during cervical ripening before the onset of labor

Concentrations of 13, 14-dihydro-15-keto-PGF2α (PGFM) were measured in plasma of six carefully selected primigravid women with an unripe cervix at term before and at various intervals after extra-amniotic insertion of a Foley catheter with or without methylhydroxyethylcellulose (Tylose^R) gel. The procedure caused an acute elevation of PGFM levels within 5 min (P < 0.025), which was maintained for at least 6 hours in the absence of uterine activation at 179 ± 32% of the initial values (P < 0.01). Extra-amniotic administration of Tylose gel caused an increase in PGFM levels which was both higher and more prolonged ( > 12 hours) than insertion of a Foley catheter alone.The observations indicate that cervical ripening without concomitant uterine activation is associated with an increase in PGFM levels. They also demonstrate that prolonged activation of (intra)uterine prostaglandin synthesis may occur several hours before the onset of labor-like uterine activity. A chance finding further suggests that spontaneous rupture of the membranes too may be preceeded by an increase in (intra)uterine prostaglandin synthesis. In their totality these observations lend strong support to the proposition that an increase in (intra)uterine prostaglandin production is a prerequisite to rather than a consequence of the initiation of labor.