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At least 667 records · Page 37Linked to original sources
PubMed1996

A randomised study of two doses of gemeprost in combination with mifepristone for induction of abortion in the second trimester of pregnancy.

Two regimens of the prostaglandin E1 analogue, gemeprost, in combination with mifepristone were compared in a randomised trial for termination of pregnancy between 12-19 weeks. Thirty-six hours after treatment with 200 mg mifepristone, women were allocated at random to receive either 4 x 1 mg (Group I) or 4 x 0.5 mg (Group II) gemeprost by vaginal pessary every 6 hours (n = 50 in each group). If abortion had not occurred after 24 h, 5 x 1 mg of gemeprost was administered every 3 h to both groups of women. Although the median abortion interval was slightly shorter in the 1 mg group (7.8 h vs. 8.4 h, p = 0.5), the cumulative abortion rates at 24 h were similar (98% vs. 96%). Women in Group I required significantly more gemeprost to induce abortion than Group II (p < 0.0001). Parous women in both groups required significantly less of the prostaglandin to induce abortion. In Group II, the median abortion interval was significantly longer in primigravidae than multigravidae (9.5 h vs. 6.1 h; p < 0.02). There were no significant differences between the groups in the incidence of vomiting, diarrhoea or the request for analgesia. The results suggest that in parous women, the dose of gemeprost can be reduced to 0.5 mg every 6 h within the first 24 h without loss of clinical efficacy.

Abortifacient Agents, Nonsteroidal↗
PubMed1984

The challenges of vaginal atresia and stenosis: Nigerian experience.

From July 1973 to December 1980, 6942 patients were admitted to the Gynaecology unit of the University of Benin Teaching Hospital, Benin City, Nigeria. Fifty-nine patients presented with gynatresia (vaginal atresia and stenosis), an incidence of 8.5 1000. The most common causes of this condition were caustic vaginitis, secondary to local herb pessary insertion, and circumcision. The resulting vaginal adhesions were effectively treated surgically by simple adhesiolysis . There was a low incidence of congenital gynatresia . As the large proportion of cases of acquired gynatresia were preventable, improvement in health education should further reduce incidence of this condition in our community.

Adult↗
PubMed1989

Intracervical 17 beta-oestradiol before induction of second-trimester abortion with a prostaglandin E1 analogue.

28 consecutive patients (17.5 weeks pregnant, range 15-21 weeks) referred for therapeutic termination of pregnancy were randomized for pretreatment overnight with either intracervical gel containing 50 mg 17 beta-oestradiol or placebo gel. The induction-abortion time with pessaries containing 16,16-dimethyl-trans-delta 2-prostaglandin E1 methyl ester was significantly reduced in the oestrogen group (median value of 11.5 versus 15 hours). The beneficial effect of oestradiol priming was primarily caused by a reduction of the number of women with high cervical resistance and prolonged induction-abortion time (90 percentiles of 15.5 and 34 hours). Thus, oestrogen pretreatment might reduce the cervical trauma due to the prostaglandins as well as the incidence of cervical incompetence in later pregnancies.

Abortifacient Agents↗
PubMed1990

Termination of early pregnancy through a combination of the antiprogestin and prostaglandin analogue.

Termination of early pregnancy (less than 49 days of amenorrhea) was induced in 75 patients with the combination of the antigestagen mifepristone and a prostaglandin analogue, meteneprost. After 48 h a single oral dose of 600 mg of mifepristone was followed by a 10 mg meteneprost vaginal pessary. Pregnancy was confirmed by clinical and ultrasound examinations and plasma HCG assessment. Complete abortion occurred in 72 patients (96%) and the three others required a surgical uterine aspiration. Bleeding continued for 4 to 12 days (mean = 8). Uterine pain and side effects occurred during the 3 h following the use of prostaglandin. Only minor analgesic were required in 30 patients. The combination of mifepristone and meteneprost is a safe and effective method to terminate an early pregnancy.

16,16-Dimethylprostaglandin E2↗
PubMed1993

Prediction of mode of delivery and 'DisFIL score' following induction of labor by local PGE2.

The objective of the study was to evaluate pre-induction risk factors for (i) assisted vaginal delivery (forceps or vacuum extraction), (ii) caesarean section, (iii) failed induction followed by caesarean section, and from these to evaluate a score of the 'Disadvantages Following Induction of Labour' (the DisFIL score). The study was a case-control study applied on a prospective cohort of 336 pregnant women induced by local PGE2. Assisted vaginal delivery was associated with primiparity (OR (odds ratio) = 10.7; CI, 3.6-32.0) and higher pelvic scores (Bishop score: OR = 1.9; CI, 1.4-2.6). Caesarean section was related to higher maternal age (P < 0.001) and lower pelvic scores (Bishop score: OR = 0.7; CI, 0.5-1.0, P < 0.05). When performed because of fetal distress, assisted vaginal delivery and caesarean section were both associated with lower fetal weights (P < 0.05). Failed induction followed by caesarean section was related to primiparity (P < 0.0001, Fisher's test) and lower pelvic scores (Bishop score: OR = 0.6; CI, 0.4-0.9). A higher 'DisFIL score' was associated with primiparity (OR = 4.7; CI, 2.8-8.0), higher maternal age (P < 0.01), lower pelvic scores (P < 0.01, chi 2 test) and PGE2 in intracervical gel rather than in vaginal pessaries (OR = 2.1; CI, 1.4-3.2). It is concluded that the major predictors of 'Disadvantages Following Induction of Labor' by local PGE2 are primiparity, high maternal age, low pelvic scores and the method of.

Adult↗
PubMed1979

Evaluation of female urinary incontinence device.

A new silicone rubber inflatable vaginal pessary has been evaluated in 33 patients with stress incontinence due to urethral sphincter dysfunction (genuine stress incontinence), confirmed by urodynamic assessment. Nine of 20 patients who used the device for one month showed subjective improvement and 2 patients have continued to use the device. Urodynamic changes include a marked increase in maximum urethral closure pressure and elevation of the bladder neck.

Female↗
PubMed1986

Role of progesterone in regulating uteroovarian venous concentrations of PGF2 alpha and PGE2 during the estrous cycle and early pregnancy in ewes.

The role of progesterone in regulation of uteroovarian venous concentrations of prostaglandins F2 alpha(PGF2 alpha) and E2 (PGE2) during days 13 to 16 of the ovine estrous cycle or early pregnancy was examined. At estrus, ewes were either mated to a fertile ram or unmated. On day 12 postestrus, ewes were laparotomized and a catheter was inserted into a uteroovarian vein. Six mated and 7 unmated ewes received no further treatment. Fifteen mated and 13 unmated ewes were ovariectomized on day 12 and of these, 7 mated and 5 unmated ewes were given 10 mg progesterone sc and an intravaginal pessary containing 30 mg of progesterone. Uteroovarian venous samples were collected every 15 min for 3 h on days 13 to 16 postestrus. Mating resulted in higher mean daily concentrations of PGE2 in the uteroovarian vein than in unmated ewes. Ovariectomy prevented the rise in PGE2 with day in mated ewes but had no effect in unmated ewes. Progesterone treatment restored PGE2 in ovariectomized, mated ewes with intact embryos. Mating had no effect on mean daily concentrations of PGE2 alpha or the patterns of the natural logarithm (1n) of the variance of PGF2 alpha. Ovariectomy resulted in higher mean concentrations and 1n variances of PGF2 alpha on day 13 and lower mean concentrations and 1n variances of PGF2 alpha on days 15 and 16. Replacement with progesterone prevented these changes in patterns of mean concentrations and 1n variances of PGF2 alpha following ovariectomy. It is concluded that progesterone regulates the release of PGF2 alpha from the uterus, maintaining high concentrations while also preventing the occurrence of the final peaks of PGF2 alpha which are seen with falling concentrations of progesterone. This occurs in both pregnant and non-pregnant ewes. Progesterone is also needed to maintain increasing concentrations of PGE2 in mated ewes.

Animals↗
PubMed1990

Clinical effects and cervical tissue changes after treatment with 16,16 dimethyl-trans delta 2 PGE1 methylester in the first trimester.

Cervagem pessaries, containing 1 mg of 16,16-dimethyl-trans delta 2-PGE1 methylester, was administered in the posterior vaginal fornix 4 h before vacuum aspiration in the 1st trimester. The effects of cervical dilatation, cervical collagen metabolism and cervical smooth muscle activity were investigated. In treated women the mean cervical dilatation was 7.9 mm as compared with 3.9 mm in controls. The in vitro incorporation of 14C proline in cervical tissue as well as the hydrolytic activity against a synthetic "collagen-like" polypeptide was increased after treatment with cervagem. The cervical smooth muscle sensitivity to prostaglandins, as revealed by inhibition of muscle activity, was higher in treated women than in controls. It is concluded that cervical dilatation, as induced by cervagem, involves an adaptation of both connective tissue and smooth muscle components.

Abortifacient Agents↗
PubMed1990

Human menopausal gonadotropin induces ovulation in sheep, but embryo recovery after prostaglandin F2alpha synchronization is compromised by premature luteal regression.

Using pregnant mares' serum gonadotropin (PMSG) and follicle stimulating hormone (FSH-P) as conventional gonadotropins, human menopausal gonadotropin (hMG) was tested for its comparative ability to induce multiple ovulations in sheep. Estrous cycles were synchronized using either prostaglandin F2alpha (PGF2alpha) or progestogen (MAP)-impregnated pessaries. During the mid-luteal phase, control ewes received serial saline injections, whereas test females (which also served as embryo donors) received either a single PMSG injection (1200 IU) or serial injections of FSH-P (total, 21 mg) or hMG (total, 1350 IU) over 3.5 d. These sheep were naturally mated and artificially inseminated (AI) in utero. Number of CL and transferable-quality embryos 5 d after AI was greater (P<0.05) in FSH-P-and hMG-treated donors than in PMSG-treated ewes. The lower number of transferable-quality embryos produced by PMSG-treated donors was attributed to a reduced (P<0.05) fertilization rate compared with that of the other treatment groups. There were no differences (P>0.05) in daily circulating estradiol-17beta and progesterone concentrations among the gonadotropin treatment groups. Gonadotropin-treated ewes demonstrated estrus approximately 24 h earlier than control ewes and, therefore, exhibited an accelerated estradiol-17beta surge and rise in circulating progesterone. Progesterone production in gonadotropin-treated ewes was also more variable than in the controls; this was due, in part, to premature luteal regression which occurred in 4 of 10 PMSG-, 3 of 10 FSH-P- and 6 of 10 hMG-treated ewes also given PGF2alpha. Ewes with prematurely regressing CL experienced transient luteal tissue development within 4 d of ovulation and produced no embryos. Overall results 1) demonstrate that serial administration of hMG induces multiple ovulations in sheep comparable to FSH-P, and 2) suggest that PGF2alpha treatment during ovulation induction adversely affects newly formed luteal tissue compromising subsequent embryo recovery.

Journal Article↗
PubMed1993

Cryopreservation of embryos as a means of germ plasm conservation in sheep.

Embryos were collected from 4 lines of Targhee sheep between 1986 and 1990. The lines were selected for preweaning growth rate (Lines DH and HW) or for multiple births (Line HT); Line C served as an unselected control group. Estrus was synchronized using fluorogestone acetate-impregnated vaginal pessaries, and ewes were superovulated with FSH. Embryos at the morula or blastocyst stage were surgically recovered from mature ewes at Days 5 to 6 and were frozen following morphological evaluation. The overall average number of freezable embryos per collection was 2.9, and did not differ significantly among years or among lines. Of the embryos collected between 1986 and 1988, 92 were transferred to 53 recipients in 1989, producing 53 lambs. Survival rates were 60.9 and 47.8%, respectively, for embryos evaluated as good and fair after thawing. Good-quality blastocysts yielded the highest survival rate (64.4%). Analyses indicated no significant effects of line, developmental stage or embryo evaluation on the incidence of lambing. It was concluded that embryos of morula or blastocyst stage can be successfully frozen for extended periods. The data on embryo yield and survival following cryopreservation were used to calculate numbers of donors needed to preserve and reconstitute a population of specified size.

Journal Article↗
PubMed1991

Uterine contractility and induction of abortion in early pregnancy by misoprostol and mifepristone.

A combination of the antiprogestagen mifepristone and an exogenous prostaglandin given by intramuscular injection or intravaginal pessary is a highly effective means of inducing abortion in early pregnancy. However, the search for a stable oral prostaglandin preparation has been largely unsuccessful. The effect of misoprostol, an orally active prostaglandin used to treat peptic ulcer, on uterine contractility was investigated in 33 women in early pregnancy (under 56 days' amenorrhoea). After administration of misoprostol in doses ranging from 200 micrograms to 600 micrograms, there was a significant increase in uterine pressure. In a second group of women who were given 200-1000 micrograms misoprostol 48 h after the administration of 200 mg mifepristone, there was a significant increase in the amplitude and frequency of uterine contractions. Complete abortion took place in 18 of the 21 women who received misoprostol after mifepristone, but in only 2 of 40 women given misoprostol alone. Our findings show that misoprostol increases uterine activity in early pregnancy and suggest that, in combination with mifepristone, it may be a highly effective method of inducing therapeutic abortion.

Abortion, Therapeutic↗
PubMed1996

Handling hormone replacement therapy: key issues for the prescriber.

OBJECTIVES: To examine the key considerations for physicians when prescribing hormone replacement therapy (HRT). METHODS: A review of the literature, including some unpublished data. RESULTS: As far as oral HRT is concerned, relatively large doses may have to be given because of the first-pass effect involving metabolism by the liver following absorption from the G1 tract. Alternatives include percutaneous gels, impregnated pessaries, subcutaneous implants and transdermal patches. The last of these offers the possibility of delivering oestrogen accurately in convenient form and many patients regard this as a more 'natural' way of treating the menopause. Provided equivalent doses of hormone are given, all these routes of administration are equally effective in preventing osteoporosis. The situation with respect to cardiovascular disease is more complex and different types of oestrogen or progestogen and different routes of administration can have different effects on metabolic risk factors. Certain oral HRT can adversely affect glucose tolerance and insulin metabolism while transdermal HRT has very little effect. CONCLUSIONS: The first issue for the physician is the choice of route of administration. To some extent this may depend on the patient's other clinical conditions such as raised triglycerides HRT. Patient preference is very important since this will affect compliance. One approach is to start with a fixed combination of oestrogen and progestogen which is usually easier for the patient to remember and use. Side-effects are usually due to the progestogen component. The variety of progestogens available in Europe means that switching to other combinations is not difficult if side effects occur. Patients satisfaction is the ultimate determinant.

Carbohydrate Metabolism↗
PubMed1981

Clinical, cytological and biological study of the intra-vaginal administration of oestriol (Ortho-Gynest) in post-menopausal patients.

Although some well-defined conditions require a replacement oestrogen therapy, local trophic disorders associated with the decrease of oestriol concentrations after surgical castration or menopause are corrected in a very satisfactory way by local oestrogen therapy. An initial treatment with 0.5 mg oestriol per day for 3 wk followed by a 4-wk maintenance therapy of 2 pessaries per week (2 x 0.5 mg) brings about a clinical cure and normalization of the maturation index in more than 95% of the 48 patients with surgical or natural menopause who received this treatment. The authors insist on the efficacy of this therapeutic approach.

Administration, Topical↗
PubMed1995

The estradiol vaginal ring--a study of existing clinical data.

Eleven reports on clinical trials with the estradiol vaginal ring have been completed to date. In five of these, the ring was compared with other vaginally-applied estrogen preparations while in the other six trials there were no parallel controls. Three trials with no parallel controls were carried out on patients who had participated in previously controlled studies. In the controlled studies, reference therapy included an estriol pessary in two, conjugated estrogen cream in two and an estriol vaginal cream in one. After 3 and 12 weeks of treatment in the non-controlled studies, vaginal maturation by cytologic as well as physician assessment was documented. These urogenital maturation changes were associated with improvement or elimination of patient symptoms in 67%-100% of the subjects. Average plasma levels of estradiol, with first and second ring, indicated a transient Cmax of 232 and 162 pmol/l, respectively, but with steady-state concentrations at 28 and 21 pmol/l, respectively. In the five controlled studies, patients were randomized to the agents mentioned above or to the ring, and the dependent variables were vaginal and urinary symptoms reported by subjects and physician and cytopathologic evaluation of the urogenital tissue. These variables were vaginal dryness, pruritus, dyspareunia, dysuria, urinary urgency and stress incontinence. Physician assessment of overall improvement in vaginal and urinary status and cytologic maturation value and vaginal pH were also recorded. Statistical analysis of each trial revealed no significant difference between treatments, and good patient acceptance of the ring. The longer term studies (over 1 year) indicated good to excellent patient acceptance of this low dose estradiol-releasing vaginal ring in the treatment of symptoms associated with urogenital ageing. In summary, clinical experience from 946 postmenopausal women treated with the ring for up to 96 weeks indicates a good response with respect to patient complaints and physical and cytologic examination, without serious adverse reactions.

Administration, Intravaginal↗
PubMed1991

Changes in the concentration of mRNAs for the inhibin subunits in ovarian follicles after administration of gonadotropins to progestin treated ewes.

RNA was extracted from single or small groups of ovine ovarian follicles after treatment of ewes with FSH and/or LH. The content of mRNA for the alpha-inhibin and beta A-inhibin subunits was analyzed by hybridization with specific cDNA probes. All ewes were treated with progestin vaginal pessaries to suppress spontaneous preovulatory follicle maturation and ewes were given three intramuscular injections of gonadotropins at 8-hr intervals starting 24 hr prior to collection of ovaries. In experiment I, both Schering-FSH and NIDDK-oFSH-17 (oFSH) significantly increased alpha- and beta A-inhibin mRNA per ewe in 2-5 mm follicles and tended to increase alpha- and beta A-inhibin mRNA in large (greater than 5 mm) follicles. In experiment II, oFSH and NIDDK-oLH-25 (oLH) were administered in a 2X2 factorial arrangement. Separate administration of oFSH or oLH increased (P less than .05) the alpha-inhibin mRNA concentration in large follicles. alpha-inhibin mRNA concentration in 4-5 mm follicles was also increased by oFSH but was decreased by oLH. Concomitant treatment with oFSH and oLH did not change alpha-inhibin mRNA concentrations from those measured in oFSH treated ewes. In experiment II, beta A mRNA concentrations followed a pattern similar to that of alpha A mRNA, but the differences were not statistically significant. We conclude that, in the ewe, exogenous FSH increases the concentration of inhibin mRNA in the whole follicle. The ability of exogenous oLH to alter expression of the inhibin subunit genes may depend upon the stage of follicle maturation.

Animals↗
PubMed1992

The measurement of the main PGE metabolite, 13,14-dihydro-15-keto prostaglandin E by radioimmunoassay using methyl oxime stabilization.

The measurement of 13,14-dihydro-15-keto prostaglandin E2 [PGEM] is complicated by the artefactual formation of compounds of the corresponding A series which are reactive towards protein. Existing methods of assay depend on the deliberate dehydration to the 'A' form followed by cyclization in alkaline solution to a bicyclic derivative which is stable and can be measured by radioimmunoassay. We report an alternative approach using methyl oximation of the 9- and 15-keto groups which confer stability on the molecule. This derivatization is simple and does not involve an active intermediate such as those of the PGA series. The antiserum for radioimmunoassay is raised against the methyl oxime form. The label is the methyl oxime of PGEM coupled to a tripeptide Pro-gly-tyr through the nitrogen in the proline ring. This is a linkage distinct from that used to raise the antiserum and thus is not preferentially recognized over the endogenous analyte; this results in a high sensitivity assay. The results correlated well with those from the bicyclic assay when both assays were used to measure the same samples of peripheral blood from women receiving a sustained release PGE pessary for ripening the cervix. The technique provides a rapid and reliable method for determining prostaglandin E metabolites.

Alprostadil↗
PubMed2006

Association between numbers of ovarian follicles in the first follicle wave and superovulatory response in ewes.

The aim of this study was to examine the variability in the number of ovarian follicles in sheep and to determine if the average number of follicles per day influences the response to superovulation and resulting embryo quality. Ewes (n=83) were synchronized and the number of follicles (> or =2 mm diameter) in the ovaries were counted daily between Days 0 and 4 of the oestrous cycle using transrectal ultrasonography. Fourteen to 21 days later, 47 ewes were randomly chosen from the group and were treated with an intravaginal progestagen pessary for 12 days and superovulated with 1500 IU eCG administered as a single injection 10 days after sponge insertion. Ewes were mated and reproductive tracts were recovered after slaughter on Day 6 of pregnancy. The number of corpora lutea was counted, uterine horns were flushed and the morphology and developmental stage of the recovered oocytes/embryos was assessed. The mean daily number (+/-S.D.) (> or =2 mm diameter) of follicles per ewe was 8.5+/-2.8 (ranging between 3 and 16). After superovulation animals with few follicles (Low group: <8 follicles/day; n=21) had fewer (P<0.005) corpora lutea, total structures (unfertilized oocytes and embryos), good quality and total embryos compared to animals with many follicles (High group: > or =8 follicles/day; n=23). No difference was found in the proportion of good quality embryos (relative to the total number; Low 0.68+/-0.11 versus High 0.79+/-0.08; P=0.21) between the two groups, or the recovery rate, the number of unfertilized oocytes or the number of poor quality embryos per animal. We conclude that ewes with a higher number of follicles (> or =8) during the first follicular wave had a better superovulatory response (in terms of corpora lutea and high quality embryos) 2-3 weeks later; however, there was no relationship between the number of follicles and the proportion of good quality embryos per animal.

Animals↗
PubMed2004

Emetine ditartrate: a possible lead for emergency contraception.

Interception of pregnancy in its initial stage is an attractive and viable approach to contraception. A chemical agent, taken within the first few days of missed menses, intercepts the conception, which is expelled with menstrual flow. The main targets of such agents are the uterus, blastocyst and the growing trophoblasts, whose nutritional requirement is inhibited. Our previous work has identified several nonsteroidal chemical entities as pregnancy interceptives in rodents and infrahuman primates. However, none reached clinical stage due to their ineffectiveness by oral route. Nevertheless, parallel to these rationally designed synthetic compounds, a program was ongoing to identify natural product(s) that can be used as interceptives. We are reporting for the first time the detailed profile of emetine ditartrate, a compound whose pregnancy interceptive efficacy has been studied in mouse, rat, hamster, guinea pig and rabbit by oral and intravaginal routes of administration. By the oral route, the compound caused 100% resorption of the fetuses in rat, hamster and guinea pig at 6.0, 5.0 and 3.0 mg/kg, respectively, on administration during peri- and early postimplantation periods of pregnancy (depending upon the day of implantation in each species). By intravaginal route, the compound was administered once in the form of a vaginal pessary on the day of implantation in respective species; interception of pregnancy was not achieved completely in rat and hamster at doses four to five times the oral dose in multi-day schedule. However, in guinea pig and rabbit it was fully effective at 7.0 and 70.0 mg/animal, respectively. The compound was devoid of estrogenic, antiestrogenic and progestational activity but possessed mild antiprogestational activity at the high dose in vivo. In in vitro assay, however, it did not show any significant binding to estrogen and progesterone receptors. The mode of action of the compound was found to be mainly on the uterus and early embryos around implantation, possibly on the trophoblasts and endometrial cells at the attachment site. The absence of 100% efficacy in rat and hamster by intravaginal route, but not by oral route, is possibly due to poor absorption of the compound through the vagina in these species. The guinea pig and rabbit, therefore, seem the better species for evaluating the efficacy of the compound administered by the vaginal route.

Administration, Intravaginal↗