Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0002453 (amenorrhea)
 6,245 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Molar pregnancy, which results from an anomaly in the development of the trophoblastic tissue, is now easy to diagnose based on clinical evidence, beta hCG level, and sonography, although it must be histologically confirmed. Treatment remains difficult because of the danger of hemorrhage or trauma during uterine evacuation. Hydatidiform mole was diagnosed in the 1st pregnancy of a 27-year-old woman on the basis of a routine 1st trimester sonogram. Clinical examination revealed a voluminous uterus and a long, closed, very tonic cervix. Sulprostone was administered to aid cervical dilatation. An initial intramuscular injection of sulprostone caused uterine contractions without cervical modifications. 5 hours later an intravenous perfusion of sulprostone was started, during which significant contractions and cervical modifications were observed. An aspiration curettage was performed, in which numerous vesicles typical of the hydatidiform mole were evacuated. There was no need for further cervical dilatation and the curettage was rapid and nonhemorrhagic. The postoperative course was uneventful, and a test of beta hCG levels 6 weeks later was negative. The patient complained of pain during uterine contractions despite use of high doses of pethidine. The frequency of hydatidiform mole varies in different countries. It has been estimated at 1/85 in Indonesia and 1/2000 in the US. The clinical picture of hydatidiform mole includes vomiting often nonresponsive to treatment and metrorrhagia of varying volume, a large uterus for the gestational age, and often bilateral ovarian cysts. A vasculorenal syndrome may also begin at 13-16 weeks of amenorrhea. Beta hCG levels are high for the gestational age. Sonography reveals no embryonic structures. Biopsy shows a complete absence of embryo and amniotic sac. The karyotype is diploid and almost always XX. The mechanism is fertilization of an ovocyte whose nucleus is absent or inactive. The 2 chromosome sets are contributed by the father, a circumstance incompatible with embryonic development. Trophoblastic proliferation occurs without embryonic development. Hydatidiform moles may be transformed to invasive moles or chorioepithelioma. Treatment includes uterine evacuation by aspiration under sonographic control if possible. Many authors recommend oxytocin and antibiotic cover. The use of prostaglandin analogs to facilitate uterine evacuation is controversial, with some authors citing the increased risk of trophoblastic embolism. The mole should be histopathologically and cytogenetically studied, and postmolar follow-up is essential.
 ...
PMID:[Use of sulprostone in the evacuation of molar pregnancies]. 206 88

The paper attempts to assess the efficacy of Sulprostone as a preoperative dilator of the uterine cervix in the +VIG operations performed both before and after the 90th day of amenorrhea and in cases of intrauterine fetal death. From January to September 1987, 271 cases of VIG before the 90th day of amenorrhea, 2 cases of VIG after the 90th day of amenorrhea, and 3 cases of intrauterine fetal death were operated at Vercelli Midwifery School. Sulprostone, a synthetic prostaglandin, was shown to be a valuable aid on the basis of the results obtained and the slight side effects observed.
 ...
PMID:[The use of sulprostone for voluntary interruption of gestation and in intrauterine fetal death]. 233 63

262 patients with normal pregnancy in the 1st and 2nd trimester and 55 patients with pathological pregnancy (missed abortion, intrauterine death of the fetus, molar pregnancy) were treated with the prostaglandin E2 analogue Sulprostone to evaluate the safety, effectiveness, and acceptability of this drug to induce abortion in the 1st and 2nd trimesters of normal and pathological pregnancy as well as to dilate the cervix prior to surgical artificial abortion. The patients, ranging in age from 16-38 years, were admitted to the Institute of Obstetrics and Gynecology of the Medical Academy of Poznan, Poland. All patients volunteered to participate in this study. Among those patients admitted because of artificial abortion, duration of amenorrhea ranged from 6-12 weeks. The patients were divided into 3 groups. To the 23 patients in the 1st group, Sulprostone was given 2-3 times 500 mcg intramuscularly at 3-6 hour intervals to induce abortion. Curettage was performed after abortion or within 24 hours when abortion failed to occur. In the 2nd group of 10, Sulprostone was used for pharmacological cervix dilatation prior to curettage. 25 mcg of the drug was administered intramuscular-cervically to 32 patients 12 hours before surgical evacuation of cavum uteri. In 191 pregnancies Sulprostone was administered intramuscularly with 1 dose of 500 mcg also 12 hours prior to curettage. In the group of missed abortion (n = 23), 1-3 doses of 500 mcg were injected intramuscularly. In the case of 10 patients admitted for therapeutic abortion in the 2nd trimester group of intrauterine fetal death, a total dose of 1000-1500 mcg of Sulprostone was infused for over 12 hours. The incidence of gastrointestinal side effects in all groups was limited and clinically acceptable. In the case of induced uterine pains, the analgesic Dolantin was offered on an as-needed basis. Systemic side-effects requiring discontinuation of therapy with Sulprostone were not observed. The 262 patients with normal pregnancy and the 55 patients with pathological pregnancy were treated successfully with Sulprostone. The intramuscular administration seems to be preferable in the 1st trimester for cervical dilatation and other indications and intravenous infusion in the 2nd and 3rd trimesters.
 ...
PMID:Termination of normal and pathological pregnancy with Sulprostone. 382 7

Sulprostone has been demonstrated to be effective as a parenteral abortifacient, but not as a vaginal suppository. A vaginal preparation was given to 19 women to determine its mechanism of action, and to confirm the principle of uterine conversion as a biological model for the induction of an early abortion. The drug was administered to women with confirmed pregnancies and amenorrhea and not exceeding 49 days. A 95% success rate was obtained with an incidence of drug related side effects of 20% as opposed to the general 80-90% figure of PGE2 and F2a. The hormone profile obtained revealed a parallel fall in hCG and estradiol, and progesterone. This study confirms the value of uterine conversion, a concept that describes the change in uterine reactivity following PG administration and determines the phase when uterine activity is no longer dependent on exogenous oxytocic medication.
 ...
PMID:Early pregnancy-abortion model using sulprostone. 712 6

354 women seeking abortions were treated at a hospital in Paris between February-September 1988 with 600 mg of RU 486 taken orally in 1 dose and an injection of 500 mg sulprostone 48 hours later. The women all had amenorrhea of less than 49 days. 1/3 were 18-25 years old, 1/2 were 25-35, and 16% were over 35. 206 were nulliparas. 110 were married and the rest were separated, widowed, divorced, or single. Sulprostone was injected early in the morning in the hospital and the women were discharged after expulsion of the products of conception, which occurred usually 2 1/2 to 3 1/2 hours later. If expulsion did not occur, the woman returned in 3 days for a sonogram to confirm uterine vacuity. 13 of the 354 women had RU 486 only. 2 refused the sulprostone and underwent aspiration and 11 experienced spontaneous expulsions in the 48 hours following RU 486 administration. 338 of the women had spontaneous expulsions. 2 pregnancies were terminated but not expelled and aspiration was required. 285 of the women expelled in the hospital within 4 hours of sulprostone administration and the other 55 did so at home 6 or more hours later. RU 486 was very well tolerated. Secondary effects were more common with sulprostone but generally subsided within 3 hours. 70 patients required treatment for uterine pain after sulprostone administration. 150 complained of nausea but only 6 required treatment. 5 women required aspiration of curettage for hemorrhage but none required transfusion. In 3 cases the hemorrhages were due to histologically proven retention. 1 patient developed endometritis 3 days after expulsion and another, who had a history of extrauterine pregnancy, developed salpingitis 15 days after expulsion. Both patients were treated with antibiotics. The method appears to be safe and effective. Its major disadvantages are that it prolongs the amount of time required for abortion and it frequently causes pelvic pain. The responsibility of the patient is also increased.
 ...
PMID:[Clinical trial of pregnancy terminations in 353 patients where amenorrhea was present for less than 49 days by 600 mg of RU 486 (administered orally) and 500 mg of sulprostone (Nalador) administered intramuscularly]. 1228 75

It is estimated that at the current rate of growth the world's population will reach 8.5 billion by the year 2025 and 10-11 billion by the end of the 21st century. 90% of this population increase would occur in developing countries, where only 38% of couples used contraceptives during 1980-81 compared to 68% in developed countries. About 300 million couples in the Third World do not use contraceptives, although they do not want more children. Some of these contraceptives include natural steroids, such as progesterone and 17 beta-estradiol that is used for treatment of menopause (1-2 mg daily po). Medroxyprogesterone acetate and norethisterone enanthate depot injections have long-acting properties with low failure rates (3.6% + 0.7 pregnancies/100 women years) if given every 3 months, amenorrhea may occur. RU-486, substance with antiprogesterone activity, inhibits hormonal metabolism during ovulation in a dose of 100 mg/day, just like norgestimate. HRP 102 consists of 50 mg norethisterone enanthate and 5 mg estradiol valerate and cycloprovera contains 25 mg medroxyprogesterone acetate with 5 mg of estradiol cypionate. Both of these agents are effective contraceptives for 2 months. Norplant is implanted subcutaneously in capsule forms. It releases levonorgestrel/LNG for 6-7 years, and in a study of 992 women 2.6 pregnancies occurred for 100 women in the course of 5 years. Vaginal suppositories can release 20 mg/day LNG, or 5-10 mg progesterone/day, and they are considered ideal for nursing mothers. The IUD has been used by 60 million women, however, pelvic inflammatory disease may be associated with its use. Sulprostone and RU-486 (mifepristone) are post ovulatory agents with effectiveness of up to 90 day. Female sterilization has problems of reversibility, male sterilization is less accepted, and other male endocrine approaches producing azoospermia are in the testing phase. The ideal contraceptive with properties of wide acceptability, reversibility, and effectiveness is yet to come.
 ...
PMID:[Current status of and prospects for contraception]. 1234 94