Plasma concentrations of prostaglandin F_2α and prostaglandin E₂ metabolites after transabdominal and transvaginal cervical cerclage

Circulating prostaglandin metabolites 13,14-dihydro-15-keto-prostaglandin F_2α and the bicyclo derivative of prostaglandin E₂ were measured in maternal plasma by radioimmunoassay after transabdominal cervicoisthmic cerclage and after transvaginal cerclage (Shirodkar and McDonald procedures) performed in the first and second trimesters. Statistically significant elevations in prostaglandin E₂ metabolite or 13,14-dihydro-15-keto-prostaglandin F_2α occurred after transabdominal cervicolsthmic and transvaginal cerclage; they returned to control levels within 6 to 24 hours after surgery and were associated with good fetal outcome. Increases in 13,14-dihydro-15-keto-prostaglandin F_2α were proportionately greater than in prostaglandin E₂ metabolite. Mean basal levels and the rise in prostaglandin metabolites were not related to cerclage type, trimester of pregnancy, or cervical status (dilatation ≤ 3 cm; effacement ≤ 60%). Highest basal and postcerclage 13,14-dihydro-15-keto-prostaglandin F_2α and prostaglandin E₂ metabolite levels were associated with advanced cervical changes, uterine irritability, membrane prolapse or rupture, and premature delivery. Routine administration of prostaglandin synthetase inhibitors is not indicated for transvaginal cerclage or transabdominal cervicoisthmic cerclage; plasma prostaglandin metabolite levels may identify patients not suitable for cerclage.