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 23,468 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The effect of prostaglandin E2 (PGE2) release rate from an intravaginal suppository on induced abortion was investigated in a randomized, double-blind study of 71 women who were 7-22 weeks pregnant. 2 dosage forms were compared. Base A was selected to provide a more hydrophilic character than base B. 6 vaginal suppositories, inserted at 4-8 hour intervals as deemed necessary for the clinical progress of abortion, were available for each patient. If abortion did not occur within 48 hours, the trial was discontinued. When time for 50% dissolution of PGE2 (t50%) was plotted as a function of pH for the 2 suppository formulations, the curve for base A was sigmoidal in shape, showing a more rapid release of PGE2 and pH increase. In contrast, base B demonstrated a t50% value of 30 hours which was independent of pH. This independence suggested the hypothesis that the clinical performance of base B would be more uniform than a base A formulation and would exhibit a longer duration of biologic action. Use of base A was found to produce a slight increase in the frequency of successful abortions (79% with base A versus 70.3% with base B). There were no significant differences in the mean times from treatment initiation to complete abortion, the number of incomplete abortions, or failure to abort between the 2 study groups. There was a nonsignificant trend toward reduced total drug use in the base A group. Examination of side effects indicated that women receiving PGE2 in base B had a greater but nonsignificant tendency to experience nausea (62.2% in group B, 58.8% in group A) and vomiting (83.8% group B, 76.5% group A); however, there was a significantly greater amount of diarrhea in the base B group (70.3%) than in the base A group (41.2%). It was concluded that there are no major differences in abortifacient efficiency or the general incidence of side effects when PGE2 therapy in 2 dosage forms is compared. However, a more hydrophilic base, which exhibits a more rapid release of PGE2, appears to slightly reduce side effects and efficacy.
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PMID:Clinical comparison of abortifacient activity of vaginally administered prostaglandin E2 in two dosage forms. 1 73

Prostaglandins have found clinical applications in: 1) termination of midtrimester pregnancy; 2) induction of labor; 3) menstrual regulation; and 4) control of postpartum hemorrhage. In abortion, prostaglandins (PGs) are used to bring about rapid dilatation of the cervix and diminished flow of the utero-placental blood. They are administered via intravenous, intra- and extra-amniotic, vaginal, and intramuscular routes, and are considered to be the most efficient and safest abortifacient known. Common side effects (nausea, diarrhea, phlebitis, fever, chills and rigors, hypotension, chest pains) can be controlled by simultaneous use of drugs such as Diazapan, Squil, Stemetil, Eskazil, and Lomotil. In cases of induction of labor (e.g., intrauterine fetal death or missed abortion), PGs have a success rate of 85-98%, with minor side effects. Although PGs are used to regulate menstruation, accompanying side effects make their use for this purpose almost unacceptable. In addition, their role in controlling postpartum hemorrhage has been found to be insignificant. A clinical trial of 341 healthy pregnant women who had abortion using PGs is briefly described.
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PMID:Clinical uses of prostaglandins in human reproduction. 30 21

Difficulties arise in the interpretation of liver tests in the pregnant subject, since some values increase (alkaline phosphatase) whilst others remain unchanged (transaminases) or fall during pregnancy. The diagnosis and management of some causes of jaundice in pregnancy, such as viral hepatitis, gall stones, benign intrahepatic cholestasis and acute fatty liver of pregnancy are discussed. Little is known about the commonest symptoms of pregnancy (nausea, vomiting and constipation) other than that they might be due to hormonally induced alteration of sphincter tone. However, pre-existing bowel disease has a greater effect on pregnancy. Fertility is reduced in poor nutritional states (e.g. coeliac and Crohn's diseases) and an increased occurrence of spontaneous abortion has been noted. For inflammatory bowel diseases, the time of onset is important in determining the outcome of pregnancy. Relapse in the disease is commonest in the first trimester and in the puerperium. Treatment of these conditions is essentially as in the non-pregnant subject. The controversial subject of sulphasalazine and steroid usage in pregnancy is discussed.
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PMID:Liver and gastrointestinal function in pregnancy. 38 67

This chapter addresses the role of health professionals in providing abortions and examines the dynamic technology of this field. Once the decision to perform an abortion is made, the proper procedure must be selected. Gestational age is the fundamental determinant but the experience and capability of the practitioner are also crucial. Suction curettage is the safest and most effective procedure available for abortions performed within 10 weeks of conception. Evaluation of the abortion patient should include, at a minimum, tests for hemoglobin, presence of gonococci, and Rh type. One of the most important parts of preparation for an abortion is sensitive and searching counseling. A potentially serious complication of suction curettage is perforation of the uterus. Dilatation and evacuation (D and E), is similar to the suction curettage procedure. This method may be used for gestations of 20 or more weeks after conception and requires greater operator expertise and experience. The complications of D and E are similar to those of suction curettage but are more frequent. Amnioinfusion is currently the most widely used method of pregnancy termination after 14 weeks in the US. The abortifacient agent that has had the greatest use is hypertonic saline. Morbidity associated with saline amnioinfusion includes hemorrhage requiring transfusion, retained tissue requiring manual or surgical removal infection, coagulopathy, and hypernatremia. Prostaglandins are alternative abortifacient agents. A disadvantage of using prostaglandins to induce abortion is that they frequently require repeat doses to be effective. Other disadvantages include nausea, vomiting, diarhea, and bronchospasm. Urea is anther effective abortifacient agent.
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PMID:Abortion. 38 51

A case history of an 18-year-old woman admitted 2 days after undergoing a therapeutic abortion with acute abdominal pain is reported. The patient denied nausea or vomiting, but she appeared very ill with a temperature of 38.3 degrees centigrade. Pelvic examination was normal. The possibility of gonococcal perihepatitis was considered. When endocervical secretions were Gram-stained, gram-negative intracellular diplococci and neisseria gonorrhoeae were cultured. The patient had only 1 sexual partner, but that partner had had intercourse with at least 2 other women during the same period he was intimate with the patient. The patient responded to intravenous penicillin and was discharged after 5 days of treatment. It was suspected that dissemination of the gonococci was during the therapeutic abortion via the fallopian tubes. Neither the patient nor her partner, it was emphasized, showed genital symptoms, therefore the need to screen potential abortion patients is acute with gonorrhea at the epidemic stage.
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PMID:Occurrence of gonococcal perihepatitis after therapeutic abortion. 44 81

The results of 98 therapeutic abortions in the first and second trimester of pregnancy using F prostaglandins are reported. The prostaglandins were eigher administered by fractionated extra-aminotic PGF2 alpha, intramuscular 15-methyl PGF2 alpha or extra-amniotic or intracervical single shot 15-methyl PGF2 alpha. The induction abortion time of 13 hours and 15minutes for the single shot and 14 hours and 28 minutes for the intramuscular administratic with the prostaglandin derivatives is shorter than with natural prostaglandins which showed a mean induction to abortion time of 19 hours and 30 minutes. The blood loss was low in all groups at approximately 75 mls. Side effects are least with the single shot method (11%). Two patients had nausea, two patients had vomiting, three patients had flush or lower abdominal cramps. The intramuscular administration showed the highest frequency of side effects (80%). In the first trimester the single shot method always leads to sufficient cervical dilatation although the abortion rate was low at 59%. During the second trimester a high abortion rate is found. Therefore this method can be recommended for therapeutic abortions.
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PMID:[New considerations in therapeutic abortions using a second generation prostaglandins (author's transl)]. 47 57

Sulprostone was administered to 628 women, 14-47 years of age, to induce abortion in cases of intact and disturbed pregnancies in the 5th - 37th weeks. The preparation was administered in 30 cases as a suppository, in 86 cases intra- or extraamnially, in 302 cases intravenously (i.v.) and in 210 cases intramuscularly (I.m.). The suppositorial administration cannot be used in induce abortion. A complete abortion was induced in 10 of 56 women in the first trimester and in 15 of 20 women in the second trimester with an extraamnial instillation of sulprostone, and in 90% by intraamnial infusion. The best results from i.v. administration of sulprostone were obtained by administering a total dosage of 1000 mcg of the drug over a 10 hour period. Incomplete or complete abortion was induced in 84.7% of the women in the first trimester who received sulprostone i.v. with an average induction-abortion interval (i.a.i.) of 12.2 hours. Complete abortion was obtained in 90% of the women in the 2nd trimester who received sulprostone i.v., with an average i.a.i. of 13.2 hours for intact and 9.3 hours for disturbed pregnancies. 30 patients less than 6 weeks pregnant received two 500 mcg i.m. injections of sulprostone to induce bleeding. 167 women in the early second trimester were given sulprostone i.m., 1-3 doses of 500 mcg at 4-8 hr. intervals. An abortion resulted in 50% of the patients after 1 injection. The rate of incomplete abortions increased with increased dosage. An average i.a.i. of 11.4 hours was recorded. In both i.v. and i.m. applications, increased dosage did not cause increased effectiveness, but increased side effects. 23.5% of the patients experienced nausea, 15.1% vomiting, and less than 1% diarrhea. I.m. administration is preferred up to the 12th week of pregnancy, while i.v. administration is preferred for disturbed pregnancies after the 12th week.
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PMID:[A new therapeutic approach for terminating intact and disturbed pregnancies: three years of experience with the prostaglandin E2-derivative sulprostone (SHB 286) (author's transl)]. 47 68

Medicaments are used to prepare for instrument abortions in the 1st trimester and as inducers of abortion in the 2nd trimester. The effects, side effects, and dangers depend on the substances used and the route of application, which can be vaginal, cervical, injection, instillation, extraamniotic, intraamniotic, intravenous, or intramuscular. In the past, intraamniotic instillation of a 20% salt solution was the most common 2nd trimester method in Japan, the US, and Eastern Europe, giving a success rate of 90%. Serious side effects prompted substitution of extraamniotic instillation, which rarely produces serious side effects. Instillation of a 60% urea solution into the amniotic fluid in combination with oxytocin or prostaglandin produces an abortion in 13-21 hours, with a failure rate of 3% and a frequency of cervical laceration of under 1%. Extraamniotic use of a .1% solution of rivanol yields a success rate of about 85%, with a relatively long average time to explusion of 24-41 hours. In case of failure the procedure can be repeated. The advantage of the Rivanol method is the rarity of infectious complications. Alcohol is not used as a human abortifacient because it produces necrosis in the decidua and placenta. Prostaglandins are used in most 2nd trimester abortions. Research is underway to identify derivatives that will have an extended uterine impact without serious side effects. Different routes of administration have different effectiveness rates and dangers. All prostaglandins cause side effects including pain during uterine contractions, gastro-intestinal reactions, nausea, vomiting, fever, and headaches. Specific preparations are associated with other effects, some of them life-threatening. Emergency treatment should be available when these substances are used. Adjuvant measures may be employed before adminstration of an abortifacient agent to soften the cervix, or after administration to hasten the procedure. The choice of procedure depends upon the personality, health, and other characteristics of the woman and the experience of the doctor and the clinic.
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PMID:[Chemical methods of abortion]. 48 68

250 mcg 15(S)-15-methyl-prostaglandin F2alpha (PGF2alpha) was administered intramuscularly every 3 hours to 10 women between 12-18 weeks gestation. All aborted within 20 hours with a mean induction-abortion interval of 14.1 hours. 8 patients experienced side effects such as nausea, vomiting, and diarrhea. (author's modified)
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PMID:[Induced abortion with intramuscular administration of 15(S)-15methyl-prostaglandin F 2 alpha]. 56 Jul 70

Sulproston (SH B 286 AD), a PGE2-derivate, was used for termination of pregnancy in 40 patients during the IInd and IIIrd trimester. Mean abortion time was 12.7 hours (range:4 to 26 hours). Sulproston was given intravenously (150 to 1000 micrograms) or via an extraamnial catheter (200 to 400 micrograms). One single dose of 500 micrograms was sufficient in 26 patients. Five women required a dose of 150 to 400 micrograms, four patients a dose of 500 to 1000 micrograms. The rate of side effects was low and included freezing, nausea, vomiting or abdominal spasms and dyspnea in one case. An obligatory curettage followed the abortion without exception. There was no statistical significance for changes of blood pressure and heart rate during the perfusion of Sulproston and in the course of the abortion.
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PMID:[Termination of pregnancy during the IInd and IIIrd trimester with Sulproston (SH B 286 AD) (author's transl)]. 56 40


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