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At least 991 records · Page 55Linked to original sources
PubMed1995

Effects of gemeprost and mifepristone on the mechanical properties of the cervix prior to first trimester termination of pregnancy.

OBJECTIVE: To study the effects of oral mifepristone and vaginal gemeprost on the mechanical properties of the cervix prior to first trimester termination of pregnancy by vacuum aspiration. DESIGN: A comparative study. Each patient served as her own control. SETTING: The Royal Infirmary of Edinburgh, Scotland, UK. SUBJECTS: Forty nulliparous women at six to twelve weeks of pregnancy. INTERVENTIONS: The women received either gemeprost (1 mg) 3 h prior to termination of pregnancy or mifepristone (200 mg) 48 h before operation. MAIN OUTCOME MEASURES: Two different objective methods of assessment of the mechanical properties of the cervix, one measuring the distensibility of the cervix before drug administration and immediately before the operation, and the other measuring the force necessary to dilate the cervix; incidence of new symptoms following drug intake; immediate complications and estimated blood loss. RESULTS: Both treatments significantly increased cervical distensibility. Baseline dilatation was greater in the mifepristone group. The force required to dilate the cervix was significantly reduced in mifepristone-treated patients. There was a good correlation between the two different methods of assessment of the mechanical properties of the cervix only in the gemeprost group. CONCLUSION: Cervagem and mifepristone can be used to increase cervical distensibility. Cervical dilatation is easier with a 48 h regimen of mifepristone than with gemeprost.

Abortifacient Agents, Nonsteroidal↗
PubMed2001

In vivo controlled release of PGE2 from a vaginal insert (0.8 mm, 10 mg) during induction of labour.

OBJECTIVE: To measure the release rate of prostaglandin E2 (PGE2) in vivo from a controlled-release vaginal insert used for cervical ripening and induction of labour at term in women with intact membranes or pre-labour rupture of membranes (PROM). DESIGN: Open-label, single centre study. POPULATION: Women at term (> or = 37 gestational weeks) with unripe cervices (Bishop score < or = 6) scheduled for labour induction for mainly medical reasons. METHODS: sixty-eight women (47 with intact membranes and 21 with PROM) had the PGE2 vaginal insert placed in the posterior fornix of the vagina. Each insert was removed from the women at a predetermined time interval between 0.5 h and 24 h, or earlier if labour was induced, fetal distress was detected or maternal complications occurred. After removal, the vaginal insert was frozen and stored for subsequent assay of residual PGE2. Blood samples were collected immediately before insertion and at 4-hour intervals until removal of the vaginal insert to determine plasma concentrations of PGE2 and the major PGE metabolite, 15-Keto-13, 14-dihydro-PGF2alpha (PGEm). Vaginal pH was measured immediately before insertion and directly after removal of the vaginal insert. Bishop score was assessed before induction, after 8 h, 12 h and immediately after removal of the vaginal insert. RESULTS: There was a positive linear relationship between the amount of PGE2 released from the insert and the duration of treatment in women with intact membranes (rp = 0.95, P = 0.0001), with a calculated PGE2 release rate of 0.52 +/- 0.33 mg/h over 24 h. The PGE2 release rate in women with PROM was not linear. The PGE2 release rate was dependent on vaginal pH, with a faster release rate at higher vaginal pH. Forty-seven women (69.1%) had the insert removed due to the successful induction of labour and consequently discontinued study treatment before their allocated time period. At vaginal delivery, the released amount of PGE2 at onset of labour was 4.0 +/- 3.0 mg and 2.4 +/- 2.1 mg for nulliparous women with PROM and intact membranes, respectively (P = 0.1). In multiparous women, the equivalent mean released amount was 3.2 +/- 2.6 mg and 1.9 +/- 1.4 mg, respectively (P = 0.14). In women with intact membranes, the mean plasma concentrations of PGE2 and PGEm after treatment were not statistically different to those women with PROM (P = 0.27 and 0.64, respectively). In women who were delivered vaginally, the median induction to delivery time interval was 17.0 h (range 4-42) in nulliparous women and 8.7 h (range 5-19) in multiparous women (P = 0.003). Ten (14.7%) women, who were all nulliparous, were delivered by caesarean section. CONCLUSIONS: In women with intact membranes, the PGE2 release rate was linear over 24 hours. There was a positive linear relationship between vaginal pH and PGE2 release rate. The metabolite analysis revealed no evidence of dose dumping neither in women with intact membranes or in women with PROM.

Adult↗
PubMed1994

Spontaneous abortion: a medical approach to management.

The conventional management of spontaneous abortion is surgical evacuation of the uterus to prevent complications which may arise from retained products of conception (POC). This procedure is not without complications and also demands operating theatre resources. The purpose of this study was to determine the efficacy of a medical approach to the management of spontaneous abortion using the prostaglandin analogue, gemeprost. From an initial 212 women presenting with spontaneous abortion, 4 groups were defined according to what they required in the way of initial management. A group of 20 women were excluded from conservative medical management at presentation because they were bleeding heavily and judged to be unsuitable. Sixty women initially required no further management other than determining that they had a complete abortion using transvaginal sonography (TVS). The 132 women were treated with the prostaglandin analogue, gemeprost. Sixty were judged to need no further management afterwards and were initially discharged. The remaining 72 women underwent evacuation of retained products of conception (ERPC) after the gemeprost treatment as medical evacuation of the uterus appeared to had been incomplete. In each of these 4 groups so defined, there was 1 case where an ERPC was required after the patients have been discharged because of complications attributable to retained POC. We therefore found that no ERPC was necessary in the management of 118 out of 212 (55.6%) women who presented with spontaneous abortion. This has important implications in patient management and economical use of hospital resources.

Abortifacient Agents, Nonsteroidal↗
PubMed2004

Stress urinary incontinence in women.

PURPOSE: To review and synthesize existing knowledge about the epidemiology, pathophysiology, evaluation, and management of stress urinary incontinence in women. DATA SOURCE: Selected scientific literature. CONCLUSIONS: Stress urinary incontinence is more than merely a symptom. Instead, it is a clinically relevant disease with adverse psychosocial and physical consequences. Evaluation begins with active screening and is followed by individualized assessment when urinary leakage is detected. IMPLICATIONS FOR PRACTICE: Traditional treatment modalities, including pelvic muscle rehabilitation, focus on behavioral strategies to reduce urine loss, and surgical correction of anatomic defects is completed in selected cases. Pharmacotherapeutic options have been limited, but one compound is undergoing clinical trials to determine whether it is a safe and effective alternative for the treatment of stress urinary incontinence.

Adrenergic Uptake Inhibitors↗
PubMed1995

The release of isoconazole nitrate from different suppository bases: in-vitro dissolution, physicochemical and microbiological studies.

The influence of the suppository base on the in-vitro release of isoconazole nitrate was studied by dissolution, physicochemical diffusion and microbiological disk-diffusion methods. Vaginal suppository formulations containing 25 mg isoconazole nitrate for local treatment of vaginitis were prepared by a fusion method, using different hydrophilic and lypophilic suppository bases (PEG 6000, PEG 4000, PEG 1500, Witepsol H15, Novata BD and Cremao). In-vitro release rates were examined by dissolution, physicochemical diffusion and microbiological disk-diffusion methods. In the physicochemical investigations the pH indicators (pH 1-14) erythrosin B, thymol blue, bromocresol green, chlorophenol red, phenol red, and alkali blue were added to agar gels. The discs were placed onto the agar gels and 21 h later, the coloured zone diameters were measured. In the microbiological investigations, the discs were put on the inoculated plates with the suspension of Candida albicans (Institute Pasteur 628). The inoculated plates were incubated at 37 degrees C for 3 days, then the diameters of inhibition zones were measured. In the dissolution investigations release rates were in the order PEG 6000 > PEG 4000 > PEG 1500 > > Witepsol H15 > Cremao > Novata BD. The diffusion distance of isoconazole nitrate in the physicochemical investigation was in the order polyethylene glycols > Witepsol H15 > Novata BD. In the microbiological studies release rates were found with polyethylene glycols > Witepsol H15 > Novata BD > Cremao. The findings in the in-vitro studies suggested that polyethylene glycols are suitable bases for vaginal suppositories.

Antifungal Agents↗