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At least 937 records · Page 52Linked to original sources
PubMed1998

The comparative trial of TCu 380A IUD and progesterone-releasing vaginal ring used by lactating women.

The objective of this paper was to compare the efficacy, acceptability, safety, and bleeding pattern of TCu 380A intrauterine device (IUD) and progesterone-releasing vaginal ring used by breastfeeding women. The study population included 97 breastfeeding women using IUD and 100 women using vaginal ring. Of the IUD users, no insertion failure, perforation, or accidental pregnancy occurred in 12 months. There was one IUD expulsion. There were no discontinuations of IUD due to medical reasons other than expulsion. The total discontinuation rate was 2.3%. In the ring group, no accidental pregnancy occurred. The major reasons for discontinuation were ring use-related problems and vaginal problems. The total discontinuation rate was 65.4% within 1 year. The frequency of any one complaint among the ring users was higher than that among the IUD users. There were no differences in the proportion of women having no sexual activity and in the weight of their babies between the two groups. Compared with the IUD users, the median number of bleeding/spotting (B/S) episodes and B/S days of the vaginal ring users were fewer; consequently, the mean length of B/S-free interval was longer in all four reference periods; the mean length of B/S episode and segment were the same; the occurrence of amenorrhea was more frequent; in contrast, the proportions of normal bleeding patterns were fewer. The frequencies of prolonged bleeding, frequent bleeding, and infrequent bleeding patterns did not differ between the two groups. The percentage of irregular bleeding was fewer only in the first two reference periods. It is concluded that the TCu 380A IUD and progesterone-releasing vaginal ring used by breastfeeding women are safe and effective. The higher discontinuation rate of the ring users was mainly because of use-related problems. Breastfeeding women with TCu 380A IUD had better tolerance and acceptability. The TCu 380A IUD does not, but the progesterone-releasing vaginal ring does, suppress the recovery of ovarian function. However, once return of menstruation occurred, there were no differences in bleeding patterns between the two contraceptive methods.

Administration, Intravaginal↗
PubMed1993

Improvement of pregnancy rates with oocyte donation in older recipients with the addition of progesterone vaginal suppositories.

Pregnancy rates and implantation rates with oocyte donation in recipients 40 years of age and older were significantly lower than those obtained in recipients under the age of 40. This difference was eliminated when P vaginal suppositories were added to the luteal regimen in older recipients. Our experience suggests that uterine aging may play a role in the successful initiation of a pregnancy, but this may be overcome with the preparation of the uterus with P vaginal suppositories.

Adult↗
PubMed1993

The value of luteal support with progesterone in gonadotropin-induced cycles.

OBJECTIVE: To evaluate the effect of luteal support with vaginal P suppositories in hMG- and hCG-induced cycles. DESIGN: Between March 1988 and February 1989 patients did not receive luteal support, while between March 1989 and January 1990 P was given routinely in the luteal phase. Induction protocol and patient selection remained otherwise unchanged. SETTING: Infertility clinic of a tertiary care hospital. PATIENTS: Twenty-seven patients with hypogonadotropic amenorrhea (World Health Organization [WHO] group I) (11 women with luteal support, 16 women without) and 102 patients with euprolactinemic clomiphene citrate (CC)-resistant anovulation (WHO group II) (52 women with luteal support, 50 women without). INTERVENTION: Vaginal P suppositories 200 mg/d in the luteal support group. MAIN OUTCOME MEASURES: Pregnancy rate (PR), pregnancy outcome. RESULTS: The overall PR in 118 cycles with luteal support was 26.3% whereas 10.4% pregnancies were achieved in 115 cycles of the control group. The influence of luteal support was more pronounced in patients with CC-resistant anovulation (25.2% versus 6.9%) than in patients with hypogonadotropic amenorrhea (33.3% versus 21.4%, not significant). The abortion rate was not significantly changed. CONCLUSION: Luteal support with P increases the PR after hMG and hCG induction. The need for supplementary P seems to be related to the underlying cause of ovarian disturbance.

Abortion, Spontaneous↗
PubMed1994

The use of vaginal tablets as a vehicle for steroid replacement in a donor oocyte program.

Nine women enrolled in the donor egg program received in a preparatory cycle 6 mg of E2 by vaginal tablets two times per day for the first 14 days, followed by a combined preparation of 6 mg of E2 and 50 mg of P as vaginal tablets, two times per day for another 14 days. Adequate serum levels of E2 and P and favorable sonographic endometrial thickness were achieved throughout the cycle in all patients. Eight endometrial biopsies taken on days 25 to 26 were independently assessed as being representative of day 25 +/- 2. One endometrial biopsy was out of phase. It is concluded that vaginal tablets of E2, followed by a combined preparation of vaginal tablets of E2 and P, is an effective method for establishing an appropriately developed endometrium in a donor oocyte program. Endometrial preparation in donor oocyte programs can be simplified by the use of these tablets.

Biopsy↗
PubMed2000

Topical treatment of vaginal candidosis with sertaconazole and econazole sustained-release suppositories.

OBJECTIVE: To compare the efficacy and safety of sertaconazole and econazole sustained-release suppositories in the treatment of vulvovaginal candidosis. STUDY DESIGN: 369 women with symptoms and signs of vulvovaginitis were enrolled in this multicenter, randomized, double-blind study. After clinical examination and vaginal sampling, 183 women were treated with a 300-mg sertaconazole suppository and the other 186 with a 150-mg econazole suppository. They were evaluated 1 week after treatment and those who were clinically uncured received a second suppository and were re-assessed 1 week later. All women were evaluated 1 month after the last administration. At each follow-up visit, clinical efficacy was assessed and a vaginal sampling was performed for microscopic examination and culture. RESULTS: Of the 369 women included, only the 310 who had a positive culture for a strain of Candida were taken into account for efficacy analysis: 150 in the sertaconazole group and 160 in the econazole group. One hundred and five women (49 in the sertaconazole group and 56 in the econazole group) were not clinically cured after 1 week and received a second suppository. There were no differences between the two groups for the rates of clinical recovery (disappearance of signs and symptoms) and mycological recovery (negative culture), 1 week after the first application (62.1 and 67.7%, respectively), 1 week after the second application for women treated twice (72.3 and 80.6%, respectively) and for all patients 1 month after the last application (65.3 and 62.0%, respectively). Among the patients cured 1 week after the last application, the mycological recurrence rate after 1 month was significantly higher in the econazole group (32.7 vs. 19.8%, P=0.035). There was a trend towards better efficacy of sertaconazole after the first application, whereas the two treatments had similar efficacy in women treated twice. There were no serious adverse events and only local irritation was reported, without any statistically significant difference between the two groups. CONCLUSION: Single topical administration of sertaconazole and econazole had similar efficacy and safety but the former is associated with a lower rate of mycological recurrence one month after achieving a negative culture.

Administration, Intravaginal↗
PubMed1998

Second trimester abortion using prostaglandin E2 suppositories with or without intracervical Laminaria japonica: a randomized study.

OBJECTIVE: To compare the abortifacient efficacy of vaginal prostaglandin (PG) E2 suppositories with and without pretreatment with intracervical PGE2 gel and Laminaria japonica. METHODS: One hundred seventy-five women between 16 and 20 weeks' gestation requesting abortion were divided randomly into three groups. Forty-one received PGE2 vaginal suppositories alone to induce abortion, 72 had Laminaria placed 24 hours before vaginal PGE2, and 62 were given intracervical 0.5 mg PGE2 gel plus Laminaria 24 hours before vaginal PGE2. Maternal demographic characteristics, induction to delivery time, number of suppositories required, and complications were analyzed. RESULTS: The mean maternal age, gravidity, parity, race, and gestational age were similar among groups. Ninety-five percent of all women delivered within 24 hours. The induction to delivery time was significantly longer in the PGE2-only women (mean +/- standard deviation 689+/-319 minutes) compared with that of those receiving PGE2 plus Laminaria (487+/-321 minutes) and PGE2 plus Laminaria plus gel (547 +/-374 minutes, P = .01). There was a statistically significant difference in the number of suppositories needed to complete the abortion process. The PGE2-only group required more suppositories (median three, range 1-8) compared with PGE2 plus Laminaria (median 3, range 1-3) and PGE2 plus Laminaria plus gel (median 2.5, range 1-9; P = .001). Patients in the PGE2 plus Laminaria plus gel group reported more pain associated with placement (median pain score 4, range 0-10) compared with PGE2 plus Laminaria (median 2, range 0-9; P = .003). There was a lower incidence of febrile episodes in the PGE2-only group (29%) compared with PGE2 plus Laminaria (68%) and PGE2 plus Laminaria plus gel (54%, P = .002). CONCLUSION: Placement of Laminaria japonica 24 hours before PGE2 vaginal suppository-induced abortion resulted in a significantly shorter induction-to-delivery time, and pretreatment with Laminaria japonica decreased the number of suppositories required to complete abortion. Pretreatment with intracervical PGE2 gel increased pain associated with Laminaria placement and did not improve the efficacy of the procedure.

Abortion, Induced↗
PubMed2003

Trends toward less invasive treatment of female stress urinary incontinence.

Recent improvements in our understanding of the underlying pathophysiologic mechanisms responsible for stress urinary incontinence (SUI) in women have led to the development of innovative new surgical methods. Many are less invasive than previous techniques and appear to offer improved safety and shorter hospital stays, while maintaining the efficacy of traditional open incontinence surgery. Procedures using injectable periurethral bulking agents, laparoscopic colposuspension, and insertion of tension-free vaginal tape characterize this current trend toward less invasive surgical treatments. The increasing range of available procedures allows surgical treatment of SUI to be individualized for the patient. Women of diverse ages and levels of medical fitness can increasingly be offered a choice of safe, effective treatment for SUI.

Ambulatory Surgical Procedures↗
PubMed1997

Estrus synchronization in dairy goats: use of fluorogestone acetate vaginal sponges or norgestomet ear implants.

The ultimate aim of any estrus synchronization method is to allow artificial insemination at a predetermined time after the end of treatment. This requires a very tight synchronization of estrus which is not observed in goats after administration of the usual fluorogestone acetate (FGA)/prostaglandin (PG) F2 alpha/equine chorionic gonadotrophin (eCG) treatment. The possibility to improve the synchronization of estrus and luteinizing hormone (LH) peak with different progestagens (FGA versus norgestomet) and routes of administration (vaginal sponge versus subcutaneous ear implant) was evaluated in two experiments where goats received one of three progestagen treatments: (1) a vaginal sponge impregnated with 45 mg of FGA, (2) a half-implant of norgestomet, or (3) a whole implant containing 3 mg of norgestomet. The progestagens were left in place for 11 days and intramuscular injections of 400 or 500 IU of eCG (according to milk yield) and 50 micrograms of an analogue of PGF2 alpha (cloprostenol) were given 48 h prior to progestagen removal. In Experiment 1, 117 cycling goats were checked for the time of onset of estrus, preovulatory LH peak and ovulation rate following estrus synchronization treatment. Goats treated with half-implants came into estrus earlier than those receiving vaginal sponges (27.8 +/- 5.0 h vs. 33.0 +/- 6.6 h, respectively; P < 0.05). No effect of progestagen priming was observed on the variability of the onset of estrus. However, the interval between the time of onset of estrus and LH peak was more variable (P < 0.05) in goats treated with half-implants. In Experiment 2, 170 non-cycling goats were monitored for the time of onset of estrus, percentage of females ovulating, fertility and prolificacy after estrus induction treatment and artificial insemination with frozen-thawed semen performed 24 h after the onset of estrus. No effect of progestagen treatment was observed either on the time or the variability of onset of estrus. The percentage of goats ovulating and overall fertility rate were higher (P < 0.05) in goats receiving vaginal sponges (98.2% and 75.0%, respectively) than those treated with half-implants (81.8% and 45.5%, respectively). However, no significant difference was observed, for the same parameters, in animals receiving implants (86.3% and 58.8%, respectively). In conclusion, estrus synchronization with a norgestomet implant or half-implant did not reduce the variability in the onset of estrus and LH peak. The fertility tended to be lower in goats treated with a whole implant and was significantly decreased in goats which received a half-implant.

Animals↗
PubMed1998

Nonsurgical management of pelvic floor dysfunction.

In the 50 years since pelvic muscle exercises were introduced for the nonsurgical management of pelvic floor dysfunction related to parturition, a variety of approaches have been introduced and the scope of indications has grown. This article describes the evaluation of patients with pelvic floor complaints, discusses additional techniques for performing pelvic muscle exercises including biofeedback and electrical stimulation, details a comprehensive educational program, and examines the literature on the use of pelvic muscle exercises for the treatment of stress and urge urinary incontinence.

Biofeedback, Psychology↗