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Query: UMLS:C0042963 (vomiting)
 31,883 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

2 cases of undiagnosed abdominal pregnancy observed in a 1-year period are reported. Both were complications of 2nd-trimester induced abortion. In case 1, a 25-year old black woman (gravida 5, para 2), multiple attempts at amniocentesis resulted only in bloody fluid. Intramuscular methyl-prostaglandin F2alpha (PGF2alpha) was administered and hypertonic saline was infused, but neither uterine cramping nor rupture of the membranes followed. PGE2 vaginal suppositories produced no change. Laparotomy revealed a large abdominal mass superimposed on the fundus, extending posterior to the uterus in the cul-de-sac. The amniotic sac contained a 15 ounce stillborn fetus. In case 2, a 33-year old black woman (gravida 2, para 1), bloody fluid was again obtained on amniocentesis. Intravaginal PGE2 suppositories and oxytocin were given, but dilation did not proceed despite uterine cramping. Examination revealed a cystic mass to the right of the uterus and fixed to the cul-de-sac. Laparotomy resulted in removal of a 45 gm macerated fetus. There appeared to be a rent in the right tube from which the gestation had been extruded with secondary implantation upon the abdominal viscera. A 3rd abdominal pregnancy observed in that time period resulted in a live birth at 41.5 weeks of gestation. Clinically, the diagnosis of abdominal pregnancy can be made by sounding the uterus. Laparoscopy will differentiate between abdominal and cornual pregnancy. Sonography is an additional diagnostic aid. When 2nd trimester abortion patients are given PGE2 as a vaginal suppository, 97% abort within 36 hours. Side effects such as vomiting, diarrhea, temperature elevation, and facial flush indicate adequate absorption. When these signs are present but expulsion of fetal tissue or membrane rupture do not occur, extrauterine gestation should be considered.
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PMID:Undiagnosed abdominal pregnancy with inadvertent prostaglandin administration. 90 Jan 63

The efficacy of fixed dose PGE2 (prostaglandin E2) in inducing labor was studied in 40 multiparous patients. Low amniotomy was performed, and 1 tablet of 6.5 mg PGE2 was given orally in the absence of uterine activity after 30 minutes, and hourly thereafter until the patient delivered. Successful induction was defined as the establishment of effective uterine contractions and cervical dilatation within 12 hours of amniotomy. Indications for induction are postmaturity (n=15); pre-eclampsia (n=10); essential hypertension (n=6); weight loss (n=4); bad obstetric history (n=2); and others (n=3). 38 patients (95 percent) had successful labor induction, with 37 delivering vaginally within 18 hours of amniotomy and 1 delivering by Cesarian section because of fetal distress. In the remaining 2 patients, labor did not commence within 12 hours and consequently necessitated intravenous oxytocin. Mean amniotomy-delivery interval was 7.53 hours. Maternal side effects included vomiting (12.5%); diarrhea (5%); pyrexia (15%); ketonuria (22.5%); and postpartum hemorrhage (12.5%). There were no apparent fetal side effects. Advantages of oral PGE2 for labor induction include: 1) ease of administration; 2) increased patient acceptability; 3) greater convenience for medical and nursing staff; 4) absence of complications associated with intravenous infusion such as sudden changes in infusion rate, air emboli or occasional pyrogen reactions. Advantages of using a low fixed dose are: 1) excessive administration and subsequent uterine hypertonus are less likely to occur; 2) low incidence of vomiting/diarrhea; and 3) absence of uterine hypertonus and apparent fetal side effects.
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PMID:Fixed dose prostaglandin E2 tablets in the induction of labour in multipara. 108 93

It has been reported that intra-amniotic administration of 15-methyl PGF2a (prostaglandin F2alpha) for abortion results in a high level of uterine contractility, a high rate of success, and a low incidence of side effects. This study assesses the abortifacient activity of 15-methyl PGF2alpha administered intramuscularly in 80 healthy women aged 14 to 40 with gestational ages between 8 and 22 weeks. 56 patients were nulliparious. Transabdominal intra-amniotic pressure monitoring was used to measure uterine contractility and to establish an effective dose schedule. 350 to 520 mcg of 15-methyl PGF2a were administered intramuscularly at 2-hour intervals until the onset of abortion. Intravenous oxytocin was infused in 6 cases to facilitate passage of retained placental tissue. Medications were given to reduce diarrhea, vomiting, and pain. All patients aborted. Total drug dose ranged from 900 to 8400 mcg; mean dose was 3254.32 mcg. Duration of treatment ranged from 4 to 34 hours. Induction-abortion time ranged from 5.5 to 35 hours, with mean interval of 15.70 hours. 89% of the patients experienced gastrointestinal side effects. 14 patients had temperature elevation more than or equal to 100.6 degrees F. There were no significant complications. The 15-methyl PGF2a patients were matched with 80 gravidas who had abortion using PGE2 20 mg vaginal suppositories. There were no statistical differences in interval to abortion between the 2 groups.
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PMID:Interruption of pregnancy by prostaglandin 15-methyl F2alpha. 114

125 nulliparous women were divided into 5 groups of 25 each to study the efficacy of various prostaglandin (PG) analogs for cervical dilatation preparato to medical termination of pregnancy. All subjects were in the first trimester of pregnancy, and abortions were to be performed vaginally. All patients received their dosages and analogs as a single extraamniotic infusion 14-16 hours prior to evacuation of uterine contents. The 125 women, 62% of whom were teen-agers, were randomly divided into the following groups: 1) 25 mcg of 15(S)-methyl PGE2 (free acid); 2) 25 mcg of 15(S)-methyl PGE2 methyl ester; 3) 250 mcg of 15(S)-methyl PGF2 alpha (free acid); 4) 250 mcg of 15(S)-methyl PGF2 alpha methyl ester; and 5) a mixture of 125 mcg of 15(S)-methyl PGF2 alpha methyl ester plus 12.5 mcg of 15(S)-methyl PGE2 methyl ester. Overall, cervical dilatation was achieved in 111 patients (90%) for aspiration or curettage of the uterine contents. 10 more required mechanical dilatation as a supplement. More patients treated with 15-methyl PGF2 alpha analogs (groups 3 and 4) expelled the fetus before the scheduled time of evacuation compared with those treated with PGE2 analogs (groups 1 and 2) (42% and 22%, respectively). Only 8% (2 patients) of the mixture group (group 5) aborted. Side effects included vomiting, diarrhea, cold and shivering, and pyrexia. Incidence varied with analog; the mixture group (Group 5) had the lowest incidence of gastrointestinal side effects and pyrexia.
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PMID:Cervical dilatation with prostaglandin analogues prior to vaginal termination of first trimester pregnancy in nulliparous patients. 115 13

Mid-trimester abortion was successfully induced in 70 of 71 patients by administration of vaginal PGE2 suppositories. The one patient who failed to abort with this method was pregnant in the blind horn of a duplex uterus. The mean abortion time for the successful inductions was 11.88 hours. Multiparous patients aborted somewhat faster than nulliparous patients, but the difference was not significant. Among the 70 successful inductions 42 patients aborted in 12 hours or less and only one patient had an abortion time of more than 24 hours. The drug appeared effective throughout the stages of gestation included in this series--from 8 to 27 weeks. Eight patients were monitored throughout the abortion procedure and uterine activity was calculated and analyzed. The development of uterine activity was gradual without the sudden rise in frequency of contractions and intrauterine baseline tonus that characterized prostaglandin administered by other methods. The most frequently encountered side effect of vaginal PGE2 suppositories was a temperature elevation, which returned to normal within a few hours of the last dose of the drug. Gastrointestinal disturbances--vomiting and diarrhea--were also common, despite a low initial dose of PGE2 and premedication with antiemetic and antidiarrheal agents. These side effects were in general well tolerated by the patients and never required termination of therapy. The cardiovascular effects of PGE2 in this series could be considered minimal. In a single patient surgical intervention was required to remove the placenta. In seven patients the placenta was removed by sponge forceps and in five patients the placenta was removed manually. There was an estimated blood loss exceeding 250 ml. in 10 patients, but transfusion was not required. Although white blood cell count rose significantly during the abortion period there were no significant changes in hematocrit or platelet count. Mid-trimester abortion with intravaginal administration of PGE2 suppositories appears to offer a valid alternative to the presently available techniques, with a rapid abortion time, high success rate, and low incidence of complications.
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PMID:Mid-trimester abortion induced by intravaginal administration of prostaglandin E2 suppositories. 115 30

Prostaglandin E2 was administered orally in doses of 0.5 mg. to 2.0 mg. every 2 hours to 169 women for induction of labour. Induction was successful in 153 women (90%). In 99 of these women, low amniotomy was performed at the beginning. Performance of amniotomy at the beginning of induction did not alter the incidence of successful induction but did lead to a mean induction-delivery interval shorter than that in women who had amniotomy performed in the active phase of labour. Vomiting and/or diarrhoea occurred in 34 women (20%). Uterine hypertonus of only transient nature occurred in 3 women. One woman suffered from atonic post-partum haemorrhage. No adverse effects on the fetus were apparent. The presence of fetopelvic disproportion was associated with a slow rate of cervical dilatation and unsuccessful induction.
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PMID:The role of amniotomy in induction of labour with oral administration of prostaglandin E2. 118 22

The practicability of an intramuscular dose schedule of 10 mug of 15(S) 15 methyl prostaglandin E2 methyl ester [15(S) Me PGE2] administered every 4 hours was evaluated in 42 subjects from 7 to 20 menstrual weeks' gestation. Half of the subjects served as controls (Group I) and half of the subjects (Group II) were treated with a medication regimen of prochlorperazine, acetylsalicylic acid, diphenoxylate hydrochloride, and atropine sulfate to evaluate the regimen's effects. Although the 15(S) Me PGE2 dose schedule appeared to be effective (74 per cent aborted in 24 hours and 95 per cent aborted within 48 hours in a mean time of 18.9 hours), Group I (control) subjects frequently had side effects: 62 per cent had emesis, 86 per cent had diarrhea, 76 per cent had shivering, and 76 per cent had fever (greater than 100 degrees F.). Fewer Group II (medicated) subjects had side effects: 43 per cent had emesis, 19 per cent had diarrhea, 52 per cent had shivering, and 43 per cent had fever. The medication regimen did not appear to interfere with the abortifacient or oxytocic effects of the 15(S) Me PGE2 dose schedule, since Group I and Group II subjects had similar cumulative abortion rates, mean abortion times, and uterine activity. Although this 15(S) Me PGE2 dose schedule is effective in first-trimester patients, it is probably less satisfactory than the conventional method of vacuum aspiration. While intramuscularly administered 15(S) Me PGE2 with medications to attenuate side effects may be practicable for inducing midtrimester abortion, especially between 12 and 16 weeks' gestation, large controlled comparative studies of the intramuscular 15(S) Me PGE2 method and other experimental and conventional methods will be necessary to determine the most satisfactory method of performing midtrimester abortions.
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PMID:The efficacy and safety of intramuscularly administered 15(S) 15 methyl prostaglandin E2 methyl ester for induction of artificial abortion. 119 Feb 75

Schulman et al reported reduction in interval-abortion time and decreased side effects when prostaglandin (PG) E2 vaginal suppositories were administered within a contraceptive diaphragm. The authors conducted a study to confirm Schulman et al' finding. 2 groups of 20 patients with gestational ages ranging from 13 to 20 weeks were matched. 1 group (non-diaphragm) had a 20 mg. suppository inserted every 4 hours high in the vaginal fornix. The other group (diaphragm) had a contraceptive diaphragm containing the suppository inserted at 4-hour intervals. The authors' protocol differed from that of Schulman's in that oxytocin sensitivity was not sought and PGE2 alone was used. Oxytocin, however, was used to promote placental expulsion following fetal delivery in 4 cases. There were no statistically significant differences observed between the groups with respect to total drug dose (84 mg. for diaphragm group and 80 mg. for non-diaphragm), abortion-interval time (15.2 hours vs. 14.3 respectively), or frequency of side effects (vomiting, diarrhea). Schulman's reduced side effects may have followed the decreased absorption rate of PGE2 and avoidance of plasma peaks secondary to reduction in drug-mucosal interface. Schulman also reported onset of uterine activity in the diaphragm group (mean, 41 minutes) versus the control group's mean of 79.4 minutes. There is no known physiologic explanation for such findings.
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PMID:Letter: PGE2 as a vaginal abortifacient - diaphragm effect. 119 86

In 5 conscious piglets with electrodes implanted on the antrum pylori and small intestine, phasic and integrated electrical activity was daily recorded. PGE2, 10 micrograms/kg/min, was infused intravenously during 1.5 h and the induced changes in electrical activity were analyzed. Clinical appearance was also studied. PGE2 induced an inhibition in both antral and intestinal activity. In the antrum this inhibition was characterized by a decrease in the frequency of electrical control activity and fast oscillations, and an increase in the duration of the inhibitory phase. Small intestinal recordings revealed an increase in the quiescence phase for the duodenum and a decrease in the integrated total activity for the duodenum, jejunum and ileum, induced by a decrease in phase II activity. PGE2 was without influence on phase III activity and the recycling of the migrating myoelectrical complexes. All piglets developed a severe diarrhea. Vomiting, sedation, fever and shivering were observed in most animals. These data suggest that the diarrheogenic effect of PGE2 is not provoked by an increase in small intestinal motility. Moreover, the direct effect of this PG is a partial inhibition of gastrointestinal electrical activity.
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PMID:Effect of infusion of a diarrheogenic dose of PGE2 on gastrointestinal electrical activity in the conscious piglet. 154 67

The effect of exogenous prostaglandin (PG) E2 ("PROSTENON") on the renal function and some metabolic parameters have been studied in 10 dogs with acute renal failure (ARF) caused by the crush-syndrome. It has been shown that intravenous PGE2 at a dose of 0.25 mg/kg 1 h after relief of soft tissue compression leads to prompt and stable recovery of all the renal functions under study, normalises metabolism and promotes the survival of animals. However, side effects of the drug have been revealed: blood pressure decrease and induction of vomiting effect and diarrhea. Critical analysis of the literature data has shown that, despite positive PGE2 effect on the renal function in ARF, prostenon, because of its immunosuppressive properties, cannot be used in the clinical practice for the treatment of this pathology. It is suggested that PGE2 be widely used in transplantology.
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PMID:[The expediency of the clinical use of prostaglandin E2 for treating acute renal failure]. 178 91


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