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Database - Alliance francophone pour l'accouchement respecté (AFAR)

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Currently 3059 records
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Created on : 19 Apr 2006
Modified on : 02 Dec 2007

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Bibliographical entry (without author) :

Cervical ripening agents and uterine stimulants. Review. {USA}. Clin Obstet Gynecol. 2002 Mar;45(1):114-24.

Author(s) :

Stitely ML, Satin AJ.

Year of publication :


URL(s) :…

Résumé (français)  :

Abstract (English)  :

Pharmacologic agents have been used to induce or stimulate labor for centuries. Ergot alkaloids, potent uterine stimulants derived from a fungus that grows on certain grains, have been used in various forms since 600 BC. In the mid-19th century, quinine was prescribed in an effort to initiate labor. Shortly thereafter, pituitary extracts were noted to stimulate contractions. In 1953 Vincent du Vigneaud synthesized oxytocin and was awarded the Nobel Prize for Chemistry. Clinical use of intravenous oxytocin to induce and augment labor soon became commonplace. The stimulation of uterine contractions may be characterized as labor induction or labor augmentation. Induction of labor implies stimulation of uterine contractions in their previous absence. Today, oxytocin is the only drug used to treat hypocontractile uterine activity once the active phase of labor has been achieved.

In the mid-20th century, investigators noted that extracts from the seminal vesical and prostate gland caused contraction or relaxation of smooth muscle. Five major categories of 20-carboxylic acids, differing slightly in clinical structure were identified and named prostaglandins (PGs). By 1968, PGs were synthesized in the laboratory. Currently a variety of these compounds are administered for cervical ripening and labor induction.

Thus, PG agents may stimulate uterine contractions for the delivery of a viable fetus. They may also induce contractions to evacuate the uterus in cases of intrauterine fetal death or for termination of pregnancy. Although there are surgical and medical methods to stimulate the uterus, this article will focus on pharmacologic agents that ripen the cervix and cause the uterus to contract.

The discussion of drugs for uterine stimulation is divided into discussion of labor induction versus labor augmentation. Use of cervical ripening agents for the induction of the unfavorable cervix has led to less failed inductions (Fig. 1). Misoprostol and dinoprostone are the most widely used pharmacologic agents for cervical repining. Oxytocin remains the only agent supported by a plethora of data for stimulation of uterine activity after the patient enters active labor. As cited above, a wide variety of acceptable dosing regimens exists. A common finding in comparing various uterine stimulants is more aggressive dosing regimens may reduce time in labor, but may increase the incidence of uterine hyperstimulation. The stimulation of labor with a viable fetus regardless of the agent or regimen requires monitoring of mother and fetus and the ability to promptly perform a cesarean if uterine stimulation is not tolerated by the fetus.

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Keywords :

➡ history, sociology ; evidence-based medicine/midwifery ; induction of labor ; ripening of cervix ; active management of labor ; oxytocin ; misoprostol (Cytotec) ; post-term pregnancy

Author of this record :

Cécile Loup — 19 Apr 2006
➡ latest update : Bernard Bel — 02 Dec 2007

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