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

Medical termination of abnormal pregnancy requires specific techniques since some conditions make therapy more effective, e.g., missed abortion intrauterine death and molar pregnancy, and others less so, e.g. anencephalic pregnancy. In all cases it is best to terminate the pregnancy as soon as possible to reduce anguish and risks of complications such as consumptive coagulopathy. Oxytocin is not consistently effective, but intraamniotic rivanol has oxytocic properties, and prostaglandins (PGs) are effective by several routes. Surgical methods are more popular in Japan and the US. A diagnostic flow chart is included and described. For missed abortion and fetal death vacuum aspiration or dilatation and evacuation are appropriate for early pregnancy, or PGs are used for later pregnancy, unless there are medical contraindications. Anencephalic pregnancy, usually diagnoses in 2nd or 3rd trimester, is resistant to medical therapy and must often be terminated by cesarean section. Molar pregnancy can be managed with vacuum aspiration at any length of gestation, but must be completed by curettage. Intraamniotic PGs are not advised for mole or fetal death. PG analogs can be administered intramuscularly, or vaginally in gel form. Other types of abnormal pregnancy that can be managed with PGs are spina bifida, hydrocephalus, hydrops fetalis, Dandy-Walker syndrome and Down's syndrome. Tubal pregnancy can be evacuated with intratubally administered PGs under laparoscopic control, thereby preserving tubal integrity.
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PMID:Medical management of abnormal pregnancy. 222 5

Studies of prostaglandins (PGs) used for term labor induction are reviewed, and aside from a slight tendency toward developing hypertonus with PGF2 alpha, evidence suggests that prostaglandins for labor induction, while no better than oxytocin, are equally efficacious. After the discovery of PGF2 alpha in the decidua of term pregnant uterus, impetus for research was found. Research first tended to record uterine activity, and next dose-response studies were performed. For labor induction studies, a double-blind study of 300 patients found a comparative advantage in efficacy of PGE2 over PGF2 alpha combined with oxytocin. Other double-blind studies reported an apparent synergism between oxytocin and PGE2 or, on the contrary, reported no difference in efficacy. Anderson's protocol design, using a double-blind protocol with Bishop score-classified patients before induction, has been modified but remains the basis of most protocols. Only in special situations has PGF2 alpha been found more efficacious than oxytocin; such situations are missed abortion, intrauterine death, molar gestations, and anencephalic pregnancy. 1 researcher suggests PGF2 alpha is indicated in patients with very low Bishop scores. Studies on the safety of prostaglandins for labor induction, for both child and mother, have generally concluded that if uterine hyperstimulation is avoided, there will be no serious sequelae. Hypertonus can be avoided by using step-wise dose increases based on labor progression, rather than fixed dose amounts. Also, in terms of safety, there is a possible advantage of PGF2 alpha over oxytocin in the area of antidiuresis, since 1 study has shown that PGF2 alpha has no antidiuretic effect.
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PMID:Induction of term labor with intravenous PGF2 alpha: a review. 478 20

Prostaglandins (PGs) are fatty acids containing a cyclopentane ring. They occur in relatively high concentrations in sperm and in lower concentrations in the endometrium, amniotic fluid, and menstrual blood. In addition, PGs have been demonstrated in a number of tissues other than the reproductive organs. PGs increase the activity of the myometrium both during pregnancy and in the nonpregnancy state. Among the various forms of PG, PGE, and PGF2alpha in particular have been investigated. These PGs act equally potently on the nonpregnant uterus but PGE acts approximately 8-10 times as potently as PGF2alpha on the pregnant uterus. PGs may be employed to induce abortion by either intravenous, intrauterine, or intravaginal administration. The intravenous method is most useful as the dosage can be kept low enough to avoid generalized side effects. PGs may be particularly useful in the second trimester when the fetus is too large to be removed by vacuum aspiration. PGs may be employed to induce labor but no convincing evidence is available to show that the preparations have advantages over oxytocin at term. On the other hand, it will probably be possible to employ PGs for induction of labor before term when oxytocin is less effective. For the same reason, PGs are suitable for induction of abortion in cases of missed abortion and fetal death. It is probable that PGs can be developed as a contraceptive measure to be employed in the 2nd 1/2 of the cycle or as a very early abortion-producing preparation in the 1st days after a missed menstrual period. The significance of PGs in connection with infertility is not yet clear but reduced PG values in sperm have been found in the male of infertile couples. (Author's modified)
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PMID:[Utilization of prostaglandins in gynecology and obstetrics]. 502 2

Literature on the etiology, diagnosis, and treatment of missed abortion is reviewed. Missed abortion during the 1st 28 weeks of gestation is defined as retention in the uterus of an abortus. The incidence of missed abortion among spontaneous miscarriages is 2.6-9.4%. Etiology of missed abortion is associated with intrauterine infections, severe abnormalities, inhibition of uterine contraction, or impairment of the hormonal balance. Prolonged retention of an abortus can result in fetal maceration or mummification. Clinical manifestations of missed abortion include absence of fetal heart tone, discharge from the breasts and diminution of their size, general fatigue, fever, and sometimes skin itch. Diagnosis of missed abortion is based upon the results of general and gynecologic examinations. Missed abortion is characterized by cessation of growth of the uterus, decrease in cyanosis of the cervix uteri, decrease in urinary excretion of estriol (up to 0-5 mg/day), drastic decrease in excretion of chorionic gonadotropin, decrease in blood level of placental lactogen, and decrease in pregnadiol excretion. Echographic signs of missed abortion during the 1st trimester include absence of heart activity, absence of fetal movements, and changes in the size of the uterus, amniotic cavity, and embryo. The most frequent complications of missed abortion are uterine hemorrhage, infection, and malignant transformation. Treatment of women with missed abortion consists of administration of abortifacient agents and curettage. The most frequently used abortifacient agents are oxytocin in large dosages, intravenous infusions of prostaglandin e2 (PGE2) or single intraamniotic injection of 15-methyl-PGF2alpha. The women with threatening uterine hemmorrage can be subjected to hysterectomy.
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PMID:[Diagnosis and treatment of missed abortion]. 661 58

Clinical studies throughout the world will probably result in the use of prostaglandins (PGs) in the near future for treatment of some cardiovascular, gastrointestinal, and respiratory diseases in addition to their present use in gynecology and obstetrics. The discovery in 1971 that acetylsalicylic acid and a series of other nonsteroidal anti-inflammatory drugs inhibit the biosynthesis of PGs provided an explanation for the analgetic, antipyretic, and anti-inflammatory activity of these drugs and formed a rational base for their use in a variety of pathological situations believed to involve PGs. The most important indications for the use of PGs in human reproduction include induction of labor; cervical priming; termination of pregnancy in the 2nd or 1st trimester; management of fetal death, missed abortion, intrauterine death near term, hydatidiform mole, and anencephaly; and postpartum hypotonus. 1 of the main contributions of PGs in obstetrics is their ability to stimulate the uterus throughout pregnancy and their suitability in cases in which the uterus is not receptive to oxytocin. Work is underway to develop more satisfactory routes of administration, perhaps vaginally, to achieve more satisfactory control of side effects, and to increase the duration of action through development and substitution of synthetic androgens. PG biosynthesis inhibitors have been used successfully in treatment of premature labor in some cases. PGs of the E series have been used for temporary treatment of cardiac malfunction such as transposition of the main arteries or pulmonary atresia, the vasodilating PGs such as PGI2 or PGE1 have been used in peripheral vascular disease such as arteriosclerosis obliterans and Raynaud's disease, and are currently under investigation in the treatment of pulmonary hypertension, spontaneous angina, and toxemia. Prostacyclin has recently become available in Great Britain as an antiaggregating agent for use during charcoal hemoperfusion, hemodialysis, and extracorporeal circulation in open heart surgery. The antisecretory activity of PGs, partially mediated through a stimulation of mucus secretion, has led to their use in treatment of stomach ulcers. Clinical application of PGs in respiratory problems has not progressed far, but recently synthesized analogues could become useful in treatment of some asthmatic disorders.
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PMID:Clinical use of prostaglandins in perspective. 686 38

Abortifacient effects of 16,16-dimethyl-trans delta 2-PGE1 methyl ester (ONO-802) were studied clinically. The uterine contractile effect of the agent was compared with those of PGF2 alpha and oxytocin (OXY) in the unanesthetized rabbit. 1. Intermittent intravaginal administration of ONO-802 was applied to 32 cases of legal abortion, 15 of missed abortion and 17 of hydatid mole. Eighty eight, 100 and 81 per cent of these patients resulted in abortion, respectively, with fewer side effects than those of natural PGs. 2. In the five groups of non- or pseudo-pregnant rabbits and those in their 7-9, 14-16 and 19-28 days in pregnancy, uterine contractile effects of these agents were assessed by both the contractile patterns and area of contractile curves of initial 5 minutes. The results are as follows: 1) In the non-pregnant rabbits, all of these agents revealed marked uterine contractile effect. 2) ONO-802 induced uterine contraction characterized by its wedge-shaped curves continued considerably longer than that induced by others. 3) ONO-802 revealed much stronger effect on uterine contraction in 7-9 day-of-pregnant rabbits. 4) Fourteen-16-day-of-pregnant rabbits were least influenced by the three agents as regards their uterine contraction in accordance with the highest progesterone levels in their sera among the three groups of pregnant rabbits.
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PMID:[A study on the uterine contractile effect of 16, 16-dimethyl-trans-delta 2-PGE1 methyl ester (ONO-802) (author's transl)]. 695 Sep 90

144 patients aged 18-41 were observed to study a new method of cervical perfusion of prostaglandins (PGs) to induce labor and missed abortion. 46 patients were primigravidae, 86 had a normal pregnancy, and 58 had missed abortion. Duration of gestation was 37-42 weeks, and duration of amenorrhea in case of missed abortion was 16-34 weeks. Induction of labor with oxytocin had been unsuccessful in all patients. A new technique of local perfusion of PGs directly into the cervix was attempted. In pregnant women 10 mg of PGF2alpha was diluted in 1000 ml of saline and infused; the initial concentration of 1-2 mcg/minute was increased every 2 hours. In cases of missed abortion 40 mg of PGF2alpha was diluted in 800 ml of saline; initial concentrations ranged from 5 to 10 mcg/minute and were increased every 2 hours. Mean delivery time was 6 hours 50 minutes; mean abortion time was 9 hours 55 minutes. 6 patients underwent cesarean section. When the uterine activity was analyzed in terms of amplitude and frequency of contractions it showed a maximum from 1 1/2 hours from beginning of labor, up to the 3rd hour of observation. In patients with missed abortion the maximum activity was recorded after the 2nd hour. Cardiotocographic curves, fetal heart rate, and clinical tests were normal. There were no complications, but only vomiting in 4 patients, and mild diarrhea in 9 patients. Labor was immediate in all patients, the latent phase exceeding 6 minutes in only 1 case; a contractile response was normally obtained after 30-40 seconds. In patients with incomplete abortion, the basal tone increased more rapidly than in pregnant patients while staying within the limits of safety. There were no pathologic or other changes in the genital organs at check up. Further studies on the effectiveness and safety of PGs are needed.
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PMID:A new cervical perfusion method for induction of labor with prostaglandins. 695 50

Abortion was induced in 149 women through extraamniotic administration of saline solution; 127 women had a regular pregnancy and were between 15-24 weeks of gestation, and 22 had a missed abortion and were between 12-38 weeks of gestation. Age was between 15-42 and parity 1-9. Rhythm of infusion was 16-18 drops of solution per minute; oxytocin was administered intravenously only in those cases in which uterine contractions were poor. Infusion to abortion interval was 5-72 hours of women with regular pregnancy, and 5-28 hours for women with missed abortion; 62.99% of patients with regular pregnancy aborted within the first 24 hours. Only 1.57% of women with regular pregnancy did not need oxytocin, versus 31.8% of women with missed abortion. There were no complications, and only 1 case of fever. None of the methods used for second trimester abortion is ideal; mortality rate is reputed to be about 15.3/1000.000 abortions, and delivery rate about 14.8/100.000 live births. The method presented in this article may be used in cases where other methods may be dangerous; it is without side effects, it is safe and cheap. Moreover, it is much faster than either intraamniotic saline solution, prostaglandins infusion or urea infusion. The mechanism of action of this method is still under investigation, but it is probable that saline isotonic solution provokes prostaglandins secretion, which, in turn, provokes uterine contractions.
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PMID:[Abortion in the 2d trimester by extra-amniotic infusion. Description of 149 cases]. 725 56

Methods for inducing abortion in cases of intrauterine fetal death produce complications associated with the side effects of the drugs administered and with the difficulties of performing amniocentesis in missed abortion when there is little or no fluid left in the amniotic cavity. This study avoids these 2 sources of complications by using normal saline instilled through the cervix into the extraovular space; such method avoids the use of potentially dangerous substance and the difficulties of amniocentesis. During the period 1977-1979, 36 patients (aged 20 to 33 years; 14 nulliparous and 22 parous) with midtrimester missed abortion were admitted for evacuation of the uterus. Missed abortion was diagnosed by means of clinical examination, real time ultrasonography, and urinary human chorionic gonadotrophin (nCG) or estriol estimation. Uterine size in all patients was between 14 and 22 weeks gestation. Coagulation tests were done before and after abortion. The procedure was described in detail. Gentle curettage was performed under general anesthesia following expulsion of the fetus and the placenta. All patients aborted within 30 hours from time of instillation. 72% of the patients aborted within the first 24 hours after the saline instillation. Mean instillation-to-abortion interval was 15.4 hours. No significant differences were observed between parous and nulliparous women. Coagulation tests were normal, and there was no maternal morbidity during or after the procedure. The extraovular approach has the following advantages: 1) the procedure is simple, short and requires only a few instruments; 2) amniocentesis with its related risks and complications is avoided, an important advantage when there is little or no fluid left in the amniotic cavity; and 3) use of normal saline avoids the undesirable side effects of oxytocin, prostaglandins or hypertonic saline.
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PMID:Termination of midtrimester missed abortion by extraovular instillation of normal saline. 727 66

Complications of unsuccessful pregnancy (including intrauterine fetal death, missed abortion, gross fetal abnormalities, and hydatidiform mole) and their successful management are reviewed as 21 such cases are reported retrospectively. In all cases of pregnancy complication, active management is recommended; such management is many times determined by the gestational week in which the pregnancy failed. Dilatation and evacuation are used for gestations from 12-18 weeks; and prostaglandin induction is indicated for pregnancies of greater than 18 weeks in size. In these 21 cases, 6 underwent dilatation and evacuation (using laminaria tents as well), 8 underwent laminaria insertion followed by extraamniotic prostaglandin F2 alpha and oxytocin augmentation, 4 patients were treated with prostaglandin E2 vaginal suppositories augmented by laminaria. Based on these results a preference is indicated for continuous extraamniotic infusion of PGF2 alpha vs. prostaglandin E2 suppositories. Also advocated is treatment as outpatient whenever possible.
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PMID:Protocol for management of unsuccessful pregnancy. 738 75


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