The effect of orally and vaginally administered misoprostol on inflammatory mediators and cervical ripening during early pregnancy.
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.
Aronsson
Annette
A
Department of Woman and Child Health, Division for Obstetrics and Gynecology, Karolinska Institute, S-171 76 Stockholm, Sweden.
Ulfgren
Ann-Kristin
AK
Ståbi
Berit
B
Stavreus-Evers
Anneli
A
Gemzell-Danielsson
Kristina
K
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
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