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Query: UNIPROT:P01178 (oxytocin)
 15,767 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Midtrimester abortion was successfully induced in 13 of 22 patients by serial intravaginal administration of 15(S)-15-methyl-prostaglandin F2alpha (THAM) suppositories. Nine patients, 4 nulliparas and 5 multiparas, failed to abort after 24 hours of prostaglandin administration and a concomitant infusion of oxytocin was initiated. Seven of the nine patients aborted within 7 hours of the combined therapy and one patient on methadone maintainence aborted after 17.5 hours of combined therapy, 41.5 hours after the first dose of prostaglandin. A single patient failed to abort, despite the concomitant prostaglandin-oxytocin administration and underwent surgical evacuation. The mean abortion time for the 21 successful abortions was 22.56 hours. Nulliparous patients aborted somewhat faster, mean 21.79 hours, than multiparous patients, mean 23.80 hours, but this difference was not statistically significant. In this study, one patient aborted in less than 12 hours, and 62% of the successful cases aborted within 24 hours. The plasma levels of 15-ME-PGF2alpha were analyzed by radioimmunoassay in 10 patients. Plasma prostaglandin levels rose significantly 30 minutes after the insertion of the first suppository, but there was a wide variation in levels from patient to patient. It was observed that the 2 patients with the highest levels had the fastest abortion times and episodes of gastro-intestinal side effects appeared related to a rise in prostaglandin levels. Sixty-four percent of the patients in this study had no gastro-intestinal side effect related to prostaglandin administration.
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PMID:Induction of midtrimester abortion by serial intravaginal administration of 15(S)-15-methyl-prostaglandin F2alpha (THAM) suppositories. 120 82

The complications accompanying the various methods of abortion as studied in different surveys are reported. In studies of dilation and curettage (D and C) and vaccuum aspiration (VA), lethality ranges from .5 to 2.9 deaths/100,000 cases. Metrorrhagia occurred in 2.5-6% of the D and C cases studied and in 2.9-3.5% of the VA cases. The bleeding was accompanied by infection in most cases where abortive tissue remained in the uterus, which occured in .4-.8% of the D and C cases and in .6-.9% of the VA cases studied. Postabortive bleeding occurred through the 10th day in up to 25% of the patients and was related to the length of the gestation period before abortion. Pelvic infection, mostly of the endometrium, occurred in about 1.4% of the D and C patients and in .3-1.2% of the VA patients. 1.4% of the D and C patients and .6% of the VA patients experienced a rise in body temperature as the only complication of abortion. Perforation of the uterus occurred in about .8% of the D and C patients and in .1-.6% of VA patients. Lesions of the cervix had to be sutured in .1% of the D and C group and .3% of the VA group. Saline instillation, used for abortions in the second trimest er, had a mortality rate of about 20/100,000 cases. Since the success rate of saline instillation is 90-98%, complications are more frequent, often requiring treatment with oxytocin or curettage. Extensive bleeding occurred in 2.3-4%. Curettage of the placenta was required in about 2.1-16.9% of the cases. Pelvic inflammation occurred in about 2.5% and temperature elevation in 1-3.4%. Abdominal hysterotomies had a lethality of 208/100,000. Pelvic hemorrhage occurred in 31%, inflammation in 4.7%, temperature elevation in 13%, and febrile reactions in 31% of the abdominal hysterotomies studied. It is necessary to establish international definitions of abortion complications for better documentation, and postoperative observations should be recorded more conscientiously.
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PMID:[Acute complications of abortion]. 125 2

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

A 30-year old primigravida with a history of drug addiction came to the Rigshospitalet in Copenhagen, Denmark for prenatal care at 15 weeks gestation. Physicians did an amniocentesis because of family history of trisomy 21. Ultrasound examinations in the 17th and 18th weeks of gestation indicated a living fetus with the placenta on the right lateral wall of the uterus, but there was an insufficient amount of amniotic fluid. Maternal alpha fetoprotein serum levels were extremely high (298 kIU/L). Physicians predicted a poor fetal prognosis and advised the woman to undergo an abortion. On the first day, they inserted 4 vaginal pessaries of 1 mg gemeprost and administered 25-30 mg bupivacain through an epidural catheter to control abdominal pain. 8 hours after first insertion, they began intravenous (IV) administration of oxytocin. Her cervix remain closed and uterine tension did not increase. 2 hours after beginning the oxytocin IV, she suffered from an abrupt severe abdominal pain which was transferred to the right shoulder. Heart rate and blood pressure remained normal. 4 hours later, her body temperature rose, so she received 500 m pivampicillin 3 times/day. She experienced no vaginal bleeding and no uterine contractions. Her cervix had still no opened. On the third day, health workers inserted 5 more pessaries. On the fourth day, they administered 75 ml isotonic saline/hour transcervically, but she still did not abort. Her temperature vacillated even though she received antibiotics and the pain continued despite epidural analgesics. On day 5, health workers administered 3.75 mcg prostaglandin F2 alpha/minute transcervically. After 6 hours of no progress, they performed a laparotomy and observed a macerated, malodorous fetus in the peritoneal cavity which continued 1200 ml of blood. The medial part of the left fallopian tube an the left uterine corner had ruptured. They removed the fetus via wedge resection; it had no malformations. Physicians should consider ectopic pregnancy when attempts at induced abortion do not succeed.
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PMID:Misdiagnosis of interstitial pregnancy followed by uterine cornual rupture during induced midtrimester abortion. 132 30

This literature review, which describes the structure of myometrial muscle and the regulation of its contractility, cites research from 1971 to 1989. The functions of the myometrium and the cervix are interrelated and coordinated during pregnancy and labor. The structure of smooth muscle, by allowing contraction in any direction, permits the uterus to assume the shape and size necessary to accommodate the fetus. Myometrial smooth muscle cells communicate via gap junctions, which synchronize myometrial function via conduction of electrophysiological stimuli during labor. These junctions increase in number prior to labor. This is regulated by estrogen, progesterone, and prostaglandins (PGs). The structures of myosin and actin and their movement during contraction are described. Estrogen, via alpha adrenergic receptors, causes a decrease in cAMP levels. It also increases the number of oxytocin receptors. Progesterone, via beta adrenergic receptors, causes an increase in cAMP levels. While estrogen leads to increased production of PGF2alpha, progesterone stimulates the production of prostacyclin synthase, Mifepristone, which blocks progesterone at the receptor level, increases uterine activity and sensitivity to PG. Human amnion and chorion produce mainly PGE2. The decidua produces PGE2 and PGF2alpha. Prostaglandins induce uterine activity at all stages of gestation when they are administered exogenously. Their production by uterine tissues increases during pregnancy, as does their concentration in amniotic fluid and in maternal blood and urine. Their roles in labor, whether natural or induced, include the softening of the cervix, the induction of gap junctions, and the direct stimulation of myometrial contractions. Although PGE2 and PGF2alpha relax cervical smooth muscle, they contract the myometrium by acting as calcium ionophpores. The production of PGE2, PGF2alpha, and other eicosanoids by the fetoplacental production of PGE2, PGF2alpha, and other eicosanoids by the fetoplacental unit is related to increased contractile activity during labor. What is produced in the eiconsanoid pathway changes dynamically with the phases of the reproductive cycle and the local concentrations of enzymes. Because of the rise in arachidonic acid in amniotic fluid during labor, fetal membranes may be involved with the initiation of regular uterine contractions. In addition, any stimulus facilitating PGE2 synthesis in the fetal membrane (hypoxia, infection, exposure to oxytocin, hypertonic solutions, prostaglandins, or arachidonic acid) would induce the same series of steps leading to formation of PGF2alpha in the decidua and the myometrium. Since natural prostaglandins are rapidly metabolized, and induction of abortion requires a longer presence, analogues have been developed for this use. These include gemeprost, sulprostone, and minprostin. Their action is more prolonged and specific to uterine tissue than their parent compounds.
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PMID:Biochemistry of myometrial contractility. 133 53

In 1989-90 in India, physicians used 4 different methods to induce second trimester abortion (14-20 weeks gestation) in 200 women at the Lokmanya Tilak Municipal General Hospital in Sion in Bombay. In 50 women each, they introduced 200 ml of 20% hypertonic saline into the amniotic sac, after removing 35-200 ml of amniotic fluid; 150 ml of ethacridine lactate extraovularly; prostaglandin F2 intramuscularly at regular intervals; and a cupful of 5% povidone-iodine topical solution in 150 ml of sterile normal saline extraamniotically. Intravenous oxytocin drip was started the morning after induction in all but those women receiving prostaglandin F2 to reduce the induction-abortion interval. 5% povidone-iodine solution successfully induced abortion in 100% of cases. The success rates for ethacridine lactate, hypertonic solution, and prostaglandin F2 were 98, 96 and 90%, respectively. Ethacridine lactate had the highest complete abortion rate (42%) followed closely by 5% povidone-iodine (39%). Prostaglandin F2 resulted in the shortest mean induction-abortion interval (20 hours vs. 38 hours for hypertonic solution, 30 hours for ethacridine lactate, and 32 hours for 5% povidone-iodine solution. 4 (8%) of the 50 women who underwent an abortion induced by hypertonic solution required a blood transfusion. Another woman undergoing hypertonic solution abortion developed disseminated intravascular coagulation and died. The only women who experienced vomiting and loose stools were women receiving prostaglandin F2 (30 women [60%]). The most cost-effective abortion method was 5% povidone-iodine solution in normal saline, indicating that this is the preferred method for poor patients.
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PMID:Comparative study of midtrimester termination of pregnancy using hypertonic saline, ethacridine lactate, prostaglandin analogue and iodine-saline. 146 Mar 14

In 1991, the abortion literature comprised articles on epidemiologic issues in abortion care advances in abortifacient such as mifepristone (RU-486) and cervical ripening prior to abortion with the use of both mifepristone and prostaglandins. A comprehensive analysis of American women having abortions indicated that although the overall abortion rate had declined since 1980, the rate of unintended pregnancies had remained the same since 1982. Among married, white women over age 30 and white, unmarried women in their twenties abortion rates declined. A prospective cohort study showed no overall differences in nonviable pregnancy outcome, birth weight, and length of gestation between 6188 women who had an abortion and 7073 who did not. In most developed countries prostaglandins are widely used for termination of pregnancy in the 2nd trimester, either as an intra-amniotic or extra-amniotic preparation. In a retrospective analysis, oxytocin was quite effective in achieving rapid, uncomplicated fetoplacental expulsion. It had a mean induction-to-delivery interval of 8.2 (+ or - 5.1) hours, which was significantly better than a mean induction-to-delivery interval of 13.1 (+ or - 7.8) hours in the group that had received prostaglandin E2 suppositories. The World Health Organization estimated that 22-56% of maternal mortality is directly attributable to abortion. In Enugu, Nigeria, the mortality rate from incomplete abortion amounted to 17.9%, and septicemia was documented in 49% of cases. Cervical pretreatment prior to a 2nd-trimester abortion has become standard in many institutions. In a double-blind, double-randomized trial both mifepristone and gemeprost resulted in a cervix that required less force to dilate to 9 mm (P 0.001). The gemeprost group had significantly more side effects than the mifepristone group. Mifepristone is a safe alternative for the termination of pregnancy when the beta human chorionic gonadotropin is below 20,000 IU/L. In spite of the small sample size (n = 50) and a rather high 12% rate of postabortal pelvic inflammatory disease, when the beta human chorionic gonadotropin decreased by at least 40% in the 1st week after receiving mifepristone, the abortion procedure was invariable complete.
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PMID:Abortion: epidemiology, safety, and technique. 150 70

A retrospective study of 932 second trimester terminations between 12-27 weeks gestation was carried out to determine the efficacy of gemeprost for second trimester termination. A single course of 5 x 1 mg gemeprost pessaries was administered every three hours. If abortion had not occurred after the first course of pessaries, a further course of 5 x 1 mg pessaries was administered. Intravenous oxytocin was administered after 36 hours if abortion had not occurred. Eighty per cent and ninety five per cent of patients aborted within 24 and 48 hours respectively. Of the remaining 5 per cent of women, 3 per cent aborted with escalating doses of oxytocin. In the remaining 18 (2 per cent) women, the pregnancies were electively terminated with an alternative method. The median induction-abortion interval was 18.0 hours and 15.0 hours in nulliparous and parous women respectively (P less than 0.0001). The number of pessaries required to induce abortion was not influenced by parity. Significantly more parous women bled more than 500 ml. The incidence of pelvic sepsis (0.1 per cent) and cervical tear (0.1 per cent) was low. Twenty six per cent of women had diarrhoea and 23 per cent vomited following administration of prostaglandin. This study confirmed the efficacy of gemeprost for second trimester termination of pregnancy. This method of termination is safe, non-invasive, simple and has a low complication rate.
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PMID:A retrospective study of 932 second trimester terminations using gemeprost (16,16 dimethyl-trans delta 2 PGE1 methyl ester). 164 4

Intrauterine prostaglandin (PG) F2 alpha infusion and intravenous (IV) oxytocin infusion were compared to evaluate the effectiveness of the two methods for termination of pregnancies with second-trimester rupture of membranes. Twenty-two women with this complication were randomly allocated to receive either 20 mg PGF2 alpha, diluted in 500 mL of NaCl 0.9% and administered through a Foley catheter inserted through the cervix, or IV oxytocin infusion in increasing doses. All subjects in the PGF2 alpha group aborted after the first administration. Repeat infusion was necessary in three oxytocin-treated subjects. The mean (+/- SD) induction-abortion interval was significantly shorter in those receiving PGF2 alpha (6.7 +/- 1.2 hours) than in those receiving oxytocin (8.8 +/- 2.7 hours). Minor side effects, such as nausea and vomiting, were observed in three women during PGF2 alpha infusion and were treated symptomatically and by temporary interruption of the infusion. Uterine hypertonus, observed in one subject in each group, was treated by temporary cessation of the infusion. We conclude that intrauterine PGF2 alpha infusion seems more effective than IV oxytocin for termination of pregnancies with second-trimester rupture of membranes.
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PMID:Intrauterine PGF2 alpha infusion for termination of pregnancies with second-trimester rupture of membranes. 172 81

A method for reducing complications from retained tissue requiring readmission after a legally induced 1st trimester abortion is evaluated. Prior attempts had been made to ascertain the reason for an annual 6% of 22,000 readmission rate. 117 women ages 18-42 years requesting legal abortion participated in this study at Bispebjerg Hospital, Copenhagen, Denmark. 47% were primagravida and the median age was 29.5 years. This study determined gestational age of 77-12 weeks by ultrasound for measuring crown-rump length. The abortion was performed by vacuum aspiration, followed by curettage and iv administration of oxytocin 10. Aspirated tissue was measured, after removal of blood clots, in a tube contain g 50 ml of water to eliminate air bubbles. Readmission due to infection or bleeding within the nest month was recorded. Tissue removed in a reevacuation was examined microscopically to ascertain placental or decidua tissue. The results of the analysis using Mann- Whitney's rank sum test for unpaired data revealed a significant difference in amount of aspirated tissue between 7-8 and 9-10 weeks (p.01) and also between 9-10 and 11-12 weeks (p.01). 5% or 6 patients were readmitted of whom 4.2% or 5 required a recurettage because of excessive bleeding. In 3 cases (2.5%) villi chorii were found on histological examination. 2 had a retroverted uterus and all 3 were 8-9 weeks gestation, 25 years, and primagravida. The retroversion would create more difficulty in emptying. It is recommended that retained tissue should be suspected when the amount of tissue after aspiration is 15 ml in the weeks 7-8, 25 ml in the weeks 9-10 and 35 ml in the weeks 11-12 of gestation.
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PMID:First-trimester legally induced abortions. The amount of aspirated tissue in relation to gestational age. 177 67


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