Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UNIPROT:P01178 (oxytocin)
 15,767 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Rh-sensitization in cases of spontaneous and induced abortions is discussed. In an intact pregnancy, the average volume of fetomaternal transfusion is about .1-.2 ml. Rh antibodies occur in 2% of the cases of Rh-negative mother with Rh-positive child during the first pregnancy and 11-17% during the second pregnancy. The standard Anti-D dosage in such cases is 250-330 mcg, enough to counteract a fetomaternal transfusion of 30 ml. In the case of spontaneous abortions, the average volume of fetomaternal transfusion ranges from .l-1.0 ml. Fetal erythrocytes are found in 5-25% of pregnant women before the 12th week of pregnancy and 12-45% after the 12th week. The risk of Rh-sensitization ranges from 3-10% in cases of spontaneous abortion; the risk increases with the length of pregnancy. Other factors, e.g., parity, age, and the use of oxytocin during subsequent curettage, show no relationship to the volume of fetomaternal transfusion. In the case of induced abortion, the volume of fetomaternal transfusion is generally greater than .1 ml. Fetomaternal transfusions were more frequent in conjunction with salt water instillation than with vacuum aspiration in pregnancies before the 12th-16th week of pregnancy; the opposite was true for induced abortions performed after the 13th week of pregnancy. Fetomaternal transfusion is also possible in cases of ectopic pregnancy and hydatidiform mole. Anti-D prophylaxis should be used in all cases of spontaneous and induced abortion, ectopic pregnancy, and hydatidiform mole, except in cases before the 6th week of pregnancy. The standard dosage of 250-330 mg should be used, except before the 12th week of pregnancy; in this case, 50 mcg has been shown to be sufficient.
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PMID:[Anti-D prophylaxis after abortions and interruptions]. 21 9

Prostaglandin F2alpha (PGF2alpha) was administered extraamniotically for pregnancy termination in 15 cases of intrauterine fetal death between 18-39 weeks gestation and in 10 cases of fetal abnormality or hydatidiform mole between 16-28 weeks gestation. After thorough cleansing of the cervix a No. 16 Foley catheter was inserted and retained in the extraamniotic space by means of the balloon, inflated with 10 ml of saline. PGF2alpha tromethamine salt (Prostin F2alpha, Upjohn Netherland, was diluted to an aqueous solution of 0.25 mg PGF2alpha/ml and administered via the catheter at 1 hour intervals. Treatment was started with 0.5 mg (2 ml) and the initial dosage was increased by increments of 0.25 mg to a maximum of 1 mg/hour if uterine contractility did not ensue. Temperature, pulse rate, and blood pressure were checked regularly. Antibiotherapy (ampicillin) was routinely given at the beginning of the study but later abandoned. Pethidine was used as an analgesic whenever required. Abortion or delivery was achieved in all 25 cases studied. In all but 1 of the patients with intrauterine fetal death, delivery occurred within 24 hours and the placenta was delivered spontaneously and complete in 11 of the 15 patients (73%). There was no relationship between the duration of fetal death and induction delivery interval. In cases with an abnormal but living fetus or hydatidiform mole, abortion was frequently incomplete and the mean induction abortion interval (24.4 hours) was 10 hours longer than that observed in cases of intrauterine fetal death (14.5 hours). 5 of the 10 patients required intravenous oxytocin from a cervical dilatation of 3-6 cm onwards and from 14-30 hours after the start of PGF2alpha administration. In these cases abortion always followed within 3 hours of starting the oxytocin infusion. Side effects were moderate in both groups of patients and pyrexia of 38 degrees Centigrade or more was never encountered. None of the patients showed any signs of intrauterine infection. Blood loss exceeded 500 ml in 4 of the 25 patients studied (16%), but only 1 patient, with a molar pregnancy, lost as much as 1000 ml. Discontinuous extraamniotic prostaglandin therapy constitutes a safe and effective approach for the active management of intrauterine fetal death.
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PMID:Extraamniotic prostaglandin F2 alpha for intrauterine death and fetal abnormality. 29 60

Molar pregnancy, which results from an anomaly in the development of the trophoblastic tissue, is now easy to diagnose based on clinical evidence, beta hCG level, and sonography, although it must be histologically confirmed. Treatment remains difficult because of the danger of hemorrhage or trauma during uterine evacuation. Hydatidiform mole was diagnosed in the 1st pregnancy of a 27-year-old woman on the basis of a routine 1st trimester sonogram. Clinical examination revealed a voluminous uterus and a long, closed, very tonic cervix. Sulprostone was administered to aid cervical dilatation. An initial intramuscular injection of sulprostone caused uterine contractions without cervical modifications. 5 hours later an intravenous perfusion of sulprostone was started, during which significant contractions and cervical modifications were observed. An aspiration curettage was performed, in which numerous vesicles typical of the hydatidiform mole were evacuated. There was no need for further cervical dilatation and the curettage was rapid and nonhemorrhagic. The postoperative course was uneventful, and a test of beta hCG levels 6 weeks later was negative. The patient complained of pain during uterine contractions despite use of high doses of pethidine. The frequency of hydatidiform mole varies in different countries. It has been estimated at 1/85 in Indonesia and 1/2000 in the US. The clinical picture of hydatidiform mole includes vomiting often nonresponsive to treatment and metrorrhagia of varying volume, a large uterus for the gestational age, and often bilateral ovarian cysts. A vasculorenal syndrome may also begin at 13-16 weeks of amenorrhea. Beta hCG levels are high for the gestational age. Sonography reveals no embryonic structures. Biopsy shows a complete absence of embryo and amniotic sac. The karyotype is diploid and almost always XX. The mechanism is fertilization of an ovocyte whose nucleus is absent or inactive. The 2 chromosome sets are contributed by the father, a circumstance incompatible with embryonic development. Trophoblastic proliferation occurs without embryonic development. Hydatidiform moles may be transformed to invasive moles or chorioepithelioma. Treatment includes uterine evacuation by aspiration under sonographic control if possible. Many authors recommend oxytocin and antibiotic cover. The use of prostaglandin analogs to facilitate uterine evacuation is controversial, with some authors citing the increased risk of trophoblastic embolism. The mole should be histopathologically and cytogenetically studied, and postmolar follow-up is essential.
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PMID:[Use of sulprostone in the evacuation of molar pregnancies]. 206 88

There are several medical methods of inducing 2nd trimester abortion, each with merits and drawbacks, difficult to compare, especially when supplemental techniques are used. Drugs used are hypertonic saline, urea, natural and synthetic prostaglandins (PGs), mannitol, formalin, ethacridine lactate (Rivanol) and others for intraamniotic route; saline, PGs, Rivanol, utus paste and other extraamniotically; and the above methods combined with oral antiprogestins, iv oxytocics, in or intravaginal PGs, or mechanical cervical dilators. Few double-blind studies exist comparing drugs. About 50,000 mid-trimester abortions are done in the US yearly, about 10% of all terminations, but these cause 2/3 of all complications and half of the deaths. Saline can be used after 15 weeks, can cause hypernatremia or coagulopathy, and takes up to 72 hours unless augmented with ocytocin and/or laminaria. Urea may have less risk of coagulopathy. Rivanol is considered safer than both in some countries, e.g., Scandinavia, Eastern Europe, Israel, India and Japan. It can be instilled transcervically. Various intrauterine PGs have been compared in several doses and routes by WHO Task Force research groups and others. Extraamniotic PGs require a lower dose, cause fewer cervical lacerations, and can be used when membranes are ruptured, in molar pregnancy, at Weeks 13-15, and in cases of fibroids. This route is somewhat less effective than intraamniotic PGs, and may require multiple doses. Intraamniotic PGs act slower but are more effective, after only 1 dose. Laminaria speed up the process, but adding oxytocin increases risk of injury. PGs may be safer than saline, especially if intramuscular route is used, because there is no danger of coagulation, cardiovascular, renal or hypernatremic complications or inadvertent injection. It is possible that some of the higher complications attributed to PGs are related to selection of patients with more severe medical conditions. PGs are more expensive, and require medication for side effects.
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PMID:Intrauterine administration of drugs for termination of pregnancy in the second trimester. 222 3

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

A study was conducted to determine the effect of the form of uterine evacuation (curettage or vacuum aspiration) and of the use of oxytocin on the incidence of invasive/metastatic gestational trophoblastic neoplasia among patients with a diagnosis of molar abortion. The study was conducted on 42 patients with a histopathological diagnosis of benign complete hydatidiform mole and with a uterine height of more than 12cm. Twenty-five patients were submitted to uterine evacuation by curettage and 17 to uterine evacuation by vacuum aspiration. Twenty-seven of the same 42 patients received oxytocin to promote dilation of the cervix and/or partial mole expulsion, and 15 were not treated with this drug. Statistical analysis showed that the use of oxytocin before uterine evacuation was a factor contributing to a higher risk of development of invasive neoplasia, especially when associated with curettage of the uterus.
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PMID:[Evaluation of different technics of uterine evacuation as a risk factor for invasive and metastatic trophoblastic neoplasms]. 248 13

Forty-eight patients of hydatidiform mole are reviewed. Forty cases (83.3%) were between 20 and 30 years of age and 24 women (50%) were primigravidae. The most common presenting symptom was intermittent bleeding. Ultrasound which became available during the latter part of the study has helped in early and definitive diagnosis. Oxytocin drip followed by suction evacuation was the mainstay of treatment. Four of the women who were followed up had persistent high titre of HCG and were treated with cytotoxic drugs. A regular follow-up is mandatory for early diagnosis and treatment of persistent trophoblastic activity.
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PMID:Clinical behaviour of hydatidiform mole. 269 71

The number of cases of hydatidiform mole (HM) registered annually in England and Wales has risen since 1973 to 1.54 per 1000 live births in 1983. For women over 50 the risk per pregnancy was 411 times and for girls under 15 it was six times greater than that for women aged 25-29. 7.75% of patients had chemotherapy for invasive mole or choriocarcinoma. Patients who had had oxytocin-induced or prostaglandin-induced uterine evacuation or hysterotomy were more likely to need chemotherapy. Human chorionic gonadotropin (HCG) was undetectable by 56 days after evacuation in 42% of patients, none of whom required chemotherapy; a considerable reduction in follow-up time for this subgroup is proposed. For patients whose HCG values became normal more than 56 days after evacuation and stayed normal for 6 months the risk of recrudescent disease was 1 in 286. In subsequent pregnancies the risk of a second HM was 1 in 76 and that of a third was 1 in 6.5. 11 (0.2%) patients died, 2 from drug-resistant choriocarcinoma.
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PMID:Hydatidiform mole in England and Wales 1973-83. 287 45

The prostaglandins(PGs), unlike oxytocin, are powerful stimulants of uterine contractility in early, middle, and late pregnancy. This characteristic has led to the use of PGs as agents for termination of mid-trimester pregnancy. For this purpose, local routes of administration--extraamniotic or intraamniotic--have proven superior to intravenous administration. PGs have proven particularly useful in inducing labor in cases of fetal death in utero, fetal anomaly such as anencephaly, or in complications of pregnancy. PGE was administered extraamniotically to induce labor in cases of fetal death, anencephaly, and hydatidiform mole. The method was similar to that employed for 2nd trimester abortion, i.e., introduction of a Foley catheter through the cervix and retention of the catheter with a balloon. A similar method, minus the balloon, was used for 40 cases at or near term. These studies led to the conclusion that the Foley catheter might be particularly useful in inductions under unfavorable cervical conditions, i.e., cases where the cervix has not dilatated at all or hardly at all. Infusion of PGE2 in 7 cases with very low Bishop cervical scores proved successful in all cases. The exact infusion procedure is explained. The use of a Foley catheter with a balloon is known to have a ripening effect on the cervix. Combination with local PG administration seems to be particularly effective in causing cervical dilatation.
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PMID:Letter: Prostaglandins and the unfavourable cervix. 412 62

Recent research suggests that the action of prostaglandins on the pregnant uterus is more complex than that of oxytocin. Despite the fact that prostaglandins, like oxytocin, may fall short of the ideal, preliminary work makes it apparent that prostaglandins have attributes for induction of labor that will ultimately rank them as far superior to oxytocin. A 1st sign that prostaglandins might be more than just oxytocic agents came from the discovery of the effectiveness of prostaglandin F2alpha (PGF2alpha) and prostaglandin E2 (PGE2) in inducing mid-trimester abortion. For a long time it has been known that oxytocin seldom causes abortion of a normal pregnancy. Prostaglandins cause rapid dilatation of the cervix and expulsion of the conceptus despite a lesser degree of measurable uterine activity than that induced by oxytocin. Prostaglandins do something more, either to the quality of uterine contractions or to the cervix. A major problem associated with the pharmacological use of prostaglandins has been a high incidence of unpleasant side-effects when given by routes that are associated with substantial systemic uptake. In general, doses of prostaglandins that are oxytocic result in nausea, vomiting and diarrhea when administered by the intravenous, oral or intravaginal routes. The intra-amniotic and extra-ovular routes of administration for induction of mid-trimester abortion, as described by Doctors Karim and Hillier, are examples of the successful application of the principle that prostaglandins can be effective without side-effects when they are delivered close to the site of action. Prostaglandins appear particularly well suited to induction of labor in women with prolonged fetal death, anencephaly or hydatidiform mole.
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PMID:Prostaglandins: current therapeutic status in obstetrics. 443 69


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