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 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

14 nulliparas and 28 multiparas were induced at term by combined low amniotomy and oral prostaglandin E2 (PGE2) solution. Doses, after a .5 mg test dose, were 1, 1.5, or 2.0 mg at 2-hour intervals. There were 37 successful deliveries, 3 Caesarean sections, and 2 failures, later successful with oxytocin. Induction delivery intervals averaged 12.6 hours in nulliparas and 8.9 hours in multiparas, and were inversely proportional to pelvic score. Fetal distress occurred in 2 cases. No other fetal side effects were reported, but vomiting was frequent (28.5%) and sometimes severe.
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PMID:Experiences with oral prostaglandin E2 and amniotomy in the induction of labour. 90 16

To determine the practicability of administering 15(S)-15-methyl-prostaglandin F2alpha-tromethamine (15(S)-15-Me-PGF2alpha) intra-amniotically for the induction of midtrimester abortion, initially 2.5 mg. of 15(S)-15-Me-PGF2alpha was administered to 20 physically healthy gravid women, and was repeated after 24 hours in those patients who had not aborted. Within 24 hours, 65% aborted, and within 36 hours, 95% aborted. Although 67% experienced emesis, no serious complications occurred. This abortion rate is similar to that obtained with the recommended dose schedule of the dosage of prostaglandin F2alpha approved by the Food and Drug Administration and those reported with intra-amniotic administration of either hypertonic saline or urea when augmented with high, continuous, intravenous infusions of oxytocin. While the study intra-amniotic dose schedule appeared to be practicable, large, comparative studies will be necessary to determine the most satisfactory dose schedule and whether this method is more acceptable than other available methods.
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PMID:Intra-amniotic administration of 15(S)-15-methyl-prostaglandin F2alpha for the induction of midtrimester abortion. 93 8

Blood loss and the incidence of emetic sequelae were assessed in 148 patients undergoing midcavity forceps delivery under continuous lumbar extradural analgesia. Five units of oxytocin i.v. was found to be as effective as ergometrine 0.5 mg i.v. in reducing blood loss at delivery. Nausea, retching or vomiting occurred in 35 (46%) of the mothers who received ergometrine and in none of those who received i.v. oxytocin. The cardiovascular side-effects of ergometrine and oxytocin are reviewed and compared with special reference to patients with hypertension and heart disease. It is suggested that 5 units of oxytocin i.v. should be preferred in these high-risk patients. Because of the absence of an emetic action, i.v. oxytocin is preferable to i.v. ergometrine for patients receiving extradural analgesia.
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PMID:Ergometrine, oxytocin and extradural analgesia. 95 92

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

A series of 100 consecutive patients seeking pregnancy termination in pregnancy weeks 7-20 were treated with a schedule of 20-mg vaginal suppositories containing prostaglandin E2 (PGE2); the schedule was being tested for its efficacy, specifically reduction of total dose and related side effects. 94 of the 100 patients were aborted within an arbitrary time span of 36 hours. Total drug dose ranged from 40-160 mg. 31 patients received augmentative intravenous oxytocin. Induction-abortion interval varied from 6-32.5 hours. Of the 97 successes, 76 were classified as complete abortions. No significant differences were noted in midtrimester groups based on increasing parity, although parous patients in gestation week 13-15 seemed to have the best results, based on average interval time. No sepsis or need for transfusion was encountered. Side effects were emesis (n-75), diarrhea (n=17), and drug fever (n=66); less frequent side effects included headache, breast tenderness, and vasomotor symptoms (n=13, 1, and 1, respectively). The midtrimester patient results compared favorably with results of studies using saline for abortifacient. The number of first trimester patients was too small to yield any conclusion.
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PMID:Vaginally administered prostaglandin E2 as a first and second trimester abortifacient. 111 58

This study determines whether induction of second trimester abortions with intraamniotic prostaglandin F2alpha (PgF2a) could be facilitated by use of intravenous oxytocin, and whether side effects of prostaglandin administration could be minimized by using lower doses of prostaglandin in conjunction with oxytocin. 26 healthy pregnant females aged 16 to 39 years (16 to 26 weeks gestation) were divided into 2 groups: group 1 consisting of 12 patients who had intraamniotic injection of PGF2a 25 mg. followed by additional doses of 5 to 25 mg. injected at intervals of 8 to 10 hours (mean dose, 40.2 mg.), and group 2, consisting of 14 patients who had intravenous infusion of oxytocin 2 hours after intraamniotic injection of 25 mg. PGF2a (mean dose, 28.2 hours). 9 out of 12 patients in group 1 aborted within 36 hours (mean abortion time, 24 hours and 41 minutes) while all patients in group 2 aborted within 28 hours (mean abortion time, 15 hours and 37 minutes). Nausea, vomiting, and diarrhea occured in 9 group 1 patients while 2 patients in group vomited. There were no significant changes in blood pressure, heart rate, respiration or metabolic parameters. This study shows that under carefully controlled conditions, administration of intravenous infusion of oxytocin following intraamniotic administration of PgF2a shortens injection to abortion time.
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PMID:Mid-trimester abortion with intra-amniotic prostaglandin F2 alpha and intravenous oxytocin infusion. 113 39

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

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

Obstetrician/gynecologists compared the efficacy, side effects, and complications of the 3-hour regimen of 1 mg gemeprost for inducing abortion with those of the 6-hour regimen of 1 mg gemeprost in 100 women of at least 16 years of age and of 12-18 weeks gestational age at the Simpson Memorial Maternity Pavilion in Edinburgh, Scotland. The 3-hour regimen decreased the induction-abortion interval by 1 hour (15.9 vs. 16.9), but this reduction was insignificant. All 50 women who received gemeprost vaginal pessaries every 3 hours aborted within 48 hours, while 10% who received them every 6 hours did not abort. The cumulative abortion rate at 24 hours was essentially the same for both groups (88% vs. 82%). Women who expelled the conceptus within 24 hours, and on the 6-hour regimen, required considerably fewer pessaries than those on the 3-hour regimen (median 3 vs. 5; p .01). Multiparous women needed fewer pessaries than did primiparous women, but the difference was not significant. Further, women in the 6-hour gemeprost group required significantly fewer pessaries than those in the 3-hour group (p .01). Women in the 3-hour group were just as likely as those in the 6-hour group to experience diarrhea (0.7 vs. 0.98), vomiting (0.7 vs. 0.6), or ask for pain killers (0.9 vs. 1.1). Women in the 3-hour group were twice as likely to retain the placenta than those in the 6-hour group (40% vs. 20%; p .05). Considerably more women in the 6-hour group needed intravenous oxytocin to induce abortion (16% vs. 4%; p .05). These results suggested that physicians should administer gemeprost pessaries every 6 hours within the first 24 hours as a clinically efficacious and cost-efficacious and cost-effective means to induce abortion.
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PMID:An open study comparing two regimens of gemeprost for the termination of pregnancy in the second trimester. 131 41


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