title: The effect of orally and vaginally administered misoprostol on inflammatory mediators and cervical ripening during early pregnancy.
abstract: OBJECTIVE
  The objective of the present study was to investigate the effect of vaginally and orally administered misoprostol on the local cervical inflammatory response.
  
  
  METHODS
  Healthy women with a normal intrauterine pregnancy between 8 and 12 weeks of gestation presenting for an elective termination of pregnancy by vacuum aspiration were recruited into a cohort study with a control and a treatment group. In the treatment group, the women were randomized to misoprostol, 400 mug, given either orally or vaginally 3 h before surgery. Immunohistochemistry staining of CD45, CD68, MMP 8, MMP 9, TIMP 1 and TIMP 2 were assessed in cervical biopsies obtained directly prior to mechanical cervical dilatation and vacuum aspiration.
  
  
  RESULTS
  In the treatment group, there was a greater amount of CD45-positive cells in the subepithelium region of the cervix compared to the control group. The staining of CD68 was similar in both groups. The immunostaining of MMP 8 and MMP 9 was greater in the treatment group, while the expression of TIMP 1 and TIMP 2 did not differ between control and treatment groups.
  
  
  CONCLUSIONS
  Compared to untreated controls, treatment with misoprostol was associated with a greater expression of inflammatory cells. It could be hypothesized that administration of misoprostol mimics the cervical ripening at term pregnancy by a possible influx and activation of inflammatory cells, which increases MMP 8 and MMP 9 and thereby leads to the degradation of collagen and cervical softening.
authors.affiliation: Department of Woman and Child Health, Division for Obstetrics and Gynecology, Karolinska Institute, S-171 76 Stockholm, Sweden.
authors.forename: Annette
authors.initials: A
authors.lastname: Aronsson
authors.forename: Ann-Kristin
authors.initials: AK
authors.lastname: Ulfgren
authors.forename: Berit
authors.initials: B
authors.lastname: Ståbi
authors.forename: Anneli
authors.initials: A
authors.lastname: Stavreus-Evers
authors.forename: Kristina
authors.initials: K
authors.lastname: Gemzell-Danielsson
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage*; D000028:Abortion, Induced; D000282:Administration, Intravaginal; D000284:Administration, Oral; D000328:Adult; D015703:Antigens, CD / Q000032:analysis; D015214:Antigens, Differentiation, Myelomonocytic / Q000032:analysis; D020070:Cervical Ripening / Q000187:drug effects*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007150:Immunohistochemistry; D007249:Inflammation; D017493:Leukocyte Common Antigens / Q000032:analysis; D020784:Matrix Metalloproteinase 8 / Q000032:analysis; D020780:Matrix Metalloproteinase 9 / Q000032:analysis; D016595:Misoprostol / Q000008:administration & dosage*; D011247:Pregnancy; D019715:Tissue Inhibitor of Metalloproteinase-1 / Q000032:analysis; D019716:Tissue Inhibitor of Metalloproteinase-2 / Q000032:analysis; D014619:Vacuum Curettage; D000097382:CD68 Molecule
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D015703:Antigens, CD; D015214:Antigens, Differentiation, Myelomonocytic; D017493:Leukocyte Common Antigens; D020784:Matrix Metalloproteinase 8; D020780:Matrix Metalloproteinase 9; D016595:Misoprostol; D019715:Tissue Inhibitor of Metalloproteinase-1; D019716:Tissue Inhibitor of Metalloproteinase-2; C067980:CD68 antigen, human; D000097382:CD68 Molecule