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PubMed2003

Local oestrogen for vaginal atrophy in postmenopausal women.

BACKGROUND: Vaginal atrophy is a frequent complaint of postmenopausal women; symptoms include vaginal dryness, itching, discomfort and painful intercourse. Systemic treatment for these symptoms in the form of oral hormone replacement therapy is not always necessary. An alternative choice is oestrogenic preparations administered vaginally (in the form of creams, pessaries, tablets and the estradiol releasing ring). OBJECTIVES: The objective of this review is to compare the effectiveness, safety and acceptability of oestrogenic preparations for women who suffer from vaginal atrophy. SEARCH STRATEGY: We searched the Cochrane Menstrual Disorders and Subfertility Group register of trials (searched January 2003), The Cochrane Library (Issue 2, 2003), MEDLINE (1966-January 2003), EMBASE (1980-January 2003), Current Contents (1993-January 2003), Biological Abstracts (1969-2002), Social Sciences Index (1980-January 2003), PsycINFO (1972-February 2003), CINAHL (1982-January 2003) and reference list of articles. We also contacted manufacturers and researchers in the field. SELECTION CRITERIA: The inclusion criteria were randomised comparisons of oestrogenic preparations administered intravaginally in postmenopausal women for the treatment of symptoms resulting from vaginal atrophy or vaginitis. DATA COLLECTION AND ANALYSIS: Twenty nine trials were identified, of these 13 were excluded. Trials were assessed for quality and two reviewers extracted data independently. Ratios for dichotomous and means for continuous outcomes were estimated. Outcomes analysed were included under the headings of efficacy, safety and acceptability. MAIN RESULTS: Sixteen trials with 2129 women were included in this review. The overall quality of the studies was good, although not all trials measured the same outcomes. All trials measured efficacy with various outcome measures. When comparing efficacy of oestrogenic preparations (in the form of creams, pessaries, tablets and the estradiol releasing vaginal ring) with each other in relieving the symptoms of vaginal atrophy, results indicated significant differences favouring the cream, ring, and tablets when compared to placebo and non-hormonal gel. Fourteen trials compared safety. Four looked at hyperplasia, four looked at endometrial overstimulation and six looked at adverse effects. One trial showed significant adverse effects of cream (conjugated equine oestrogen) when compared to tablets (estradiol) which included uterine bleeding, breast pain and perineal pain (1 RCT; OR 0.18, 95% CI 0.07 to 0.50). Two trials showed significant endometrial overstimulation as evaluated by progestagen challenge test in the cream (conjugated equine oestrogen) group when compared to the ring (OR 0.29, 95% CI 0.11 to 0.78). Although not statistically significant there was a 2% incidence of simple hyperplasia in the ring group when compared to cream (conjugated equine oestrogen) and 4% incidence of hyperplasia (one simple, one complex) in the cream group (conjugated equine oestrogen) when compared to the tablet (estradiol). Nine studies compared acceptability to the participants by comparing comfort of product, ease of use, overall product rating, delivery system and satisfaction. Results showed a significant preference for the estradiol releasing vaginal ring. REVIEWER'S CONCLUSIONS: Creams, pessaries, tablets and the estradiol vaginal ring appeared to be equally effective for the symptoms of vaginal atrophy. One trial found significant side effects noted following cream (conjugated equine oestrogen) administration when compared to tablets causing uterine bleeding, breast pain and perineal pain. Another trial found significant endometrial overstimulation following cream (conjugated equine oestrogen) when compared to the ring. As a treatment choice women appeared to favour the estradiol releasing vaginal ring for ease of use, comfort of product and overall satisfaction.

Administration, Intravaginal↗
PubMed2005

Misoprostol dose selection in a controlled-release vaginal insert for induction of labor in nulliparous women.

OBJECTIVE: The purpose of this study was to identify the maximum tolerable dose and to determine the efficacy of different misoprostol dose reservoirs in an intravaginal controlled-release hydrogel polymer. STUDY DESIGN: Nulliparous women at > or = 37 weeks' gestation requiring cervical ripening and induction of labor were treated with misoprostol in a controlled-release, retrievable hydrogel polymer vaginal insert. Sequential cohorts of 6 patients were to be treated with escalating dose reservoirs of 25, 50, 100, 200, and 300 mug. The insert was to be removed upon onset of active labor, at 24 hours, or earlier if treatment-related adverse events occurred. The safety end point was determination of the maximum tolerable dose (MTD) based on occurrence of hyperstimulation syndrome. Our primary efficacy end point was time to vaginal delivery. RESULTS: Increasing reservoir doses of misoprostol up to 100 microg produced more rapid increases in modified Bishop scores, less need for oxytocin, and a shorter time to vaginal delivery. Doses above 100 microg did not further enhance cervical ripening or shorten time to vaginal delivery. The median time to vaginal delivery was 14.2 hours using the 100 microg dose. Uterine hyperstimulation and adverse fetal heart rate effects occurred with the 200 and 300 microg inserts. CONCLUSION: The 100 microg vaginal insert resulted in successful cervical ripening and rapid vaginal delivery with an acceptable safety profile for future randomized clinical trials.

Administration, Intravaginal↗
PubMed1991

Chronic ulcerations following topical therapy with 5-fluorouracil for vaginal human papillomavirus-associated lesions.

Applied topically to the vagina, 5-fluorouracil (5-FU) cream is an effective therapy for human papillomavirus (HPV)-associated lesions of the vagina including condylomata acuminata and vaginal intraepithelial neoplasia. Although the acute side effects of 5-FU therapy are well recognized, long-term sequelae of intravaginal 5-FU use have not been described in detail in the literature. To assess the incidence and clinical course of 5-FU-related vaginal mucosal alterations, we studied 220 patients who underwent 5-FU therapy for HPV-associated lesions of the vagina. Eighteen women (8.2%) had epithelial ulcers 6 months after completion of the 5-FU treatment. The incidence of ulcers was higher in women who used 5-FU for longer than 10 weeks compared with those who used it for 10 weeks or less (9.6 versus 5.7%; P = .05). All but one of the mucosal defects were in the vaginal fornices and/or the periphery of the ectocervix. The ulcers were mostly singular and measured 0.5-7 cm in greatest diameter. Fourteen patients (77.8%) had symptoms related to the ulcers including a serosanguineous or watery discharge (55.6%), postcoital spotting or bleeding (44.4%), irregular bleeding unrelated to intercourse (16.7%), and pain (5.6%). Spontaneous healing of the ulcers was protracted. Office methods of therapy including estrogen creams and cauterizing agents failed to accelerate healing as compared with untreated patients. Excision of the ulcer and primary closure of the wound was curative in all four cases in which it was used. We conclude that topical 5-FU therapy may lead to troublesome chronic mucosal ulcers that tend to persist despite conservative treatment attempts.

Administration, Intravaginal↗
PubMed1990

Microdose intravaginal levonorgestrel contraception: a multicentre clinical trial. II. Expulsions and removals. World Health Organization. Task Force on Long-Acting Systemic Agents for Fertility Regulation.

This paper investigates the relationship between expulsions and removals, and demographic characteristics of 1005 women from 19 centres using a vaginal ring releasing 20 micrograms levonorgestrel per 24 hours. Emphasis is placed on discontinuations of method use due to expulsions, on the number and rate of expulsions, and the time at which the first expulsion occurred. The overall life-table discontinuation rate due to expulsion was 7.1% at one year. Life-table discontinuation rates increased with parity and were highest in Asian and lowest in European women. In respect to the number of expulsions experienced by women (expulsions did not necessarily lead to discontinuation), the women of high parity and those from Asia and Europe have the highest rates. The life-table first expulsion rate is 29% at one year. Such rates are highest in Chinese and Asian women. Following a first expulsion, the second expulsion rate is 45% by the end of the subsequent six months. The majority of first expulsions occur at defaecation (134 or 57% of 234 women), urination (12%) and during menstruation (17%). Rings were removed by 121 (12%) women on 201 occasions and for a variety of reasons. The main medical reasons were vaginal discharge and irritation, bleeding pain and dyspareunia. Others removed the ring during defaecation, intercourse or because the ring came out of place. Women also removed rings for curiosity, to show their husbands and to clean.

Administration, Intravaginal↗
PubMed1995

An evaluation of estrus synchronization programs in reproductive management of dairy herds.

The objectives of this experiment were to evaluate the effect of various estrus synchronization programs on estrus detection rate (EDR) and pregnancy rate (PR) in lactating cows. Spring-calving, lactating dairy cows (n = 3,096) were allocated to one of six treatments: 1) PG (n = 514), estrus detection for 10 d before the onset of the breeding season (BS), cows detected in estrus received PGF2 alpha (PGF) 8 d after estrus, and all cows to be bred by d 11 of BS; 2) PG+EBZ (n = 510), as in PG plus cows treated with PGF received 1 mg of estradiol benzoate 48 h later; 3) C (n = 522), progestogen (controlled intravaginal drug release; CIDR) inserted per vaginum 10 d before BS for 8 d, PGF treatment on the day before CIDR removal, and AI within 6 d after CIDR withdrawal; 4) C+EBZ (n = 520), as in C, plus 10 mg of estradiol benzoate 10 d before BS; 5) C+BUS (n = 517), as in C plus 10 micrograms of buserelin on the day of CIDR insertion; or 6) CON (n = 513), no treatment, and a 32-d period of AI. Relative to other CIDR-treated groups, estradiol benzoate at the time of CIDR insertion reduced (P < .05) the EDR (C, 85.0%;C+EBZ, 75.9%; C+BUS, 88.5%). The PR to first AI was reduced (P < .05) by C compared with other treatments (PG, 60.9%; PG+EBZ, 57.2%; C, 46.6%; C+EBZ, 60.5%; C+BUS, 57.9%; CON, 60.1%). The interval from the onset of BS to AI and pregnancy was reduced (P < .05) by up to 9 d by estrus synchronization relative to controls (PG, 5.5 +/- .2 d; PG+EBZ, 5.2 +/- .2 d; C 1.7 +/- .1 d; C+EBZ, 2.3 +/- .1 d; C+BUS, 106 +/- .04d, CON, 10.4 +/- .3 d). In conclusion an 8-d progestogen-buserelin-PGF treatment resulted in the best overall estrus detection and pregnancy rates, which would be beneficial to a compact calving program.

Administration, Intravaginal↗
PubMed2003

Inhibition of vaginal transmission of HIV-1 in hu-SCID mice by the non-nucleoside reverse transcriptase inhibitor TMC120 in a gel formulation.

OBJECTIVE: The development of drugs that can be used as topical microbicides is currently recognized as a priority area of research. DESIGN: A preclinical evaluation of the potential effectiveness of TMC120, a non-nucleoside reverse transcriptase inhibitor (NNRTI), as a topical microbicide to prevent vaginal HIV-1 transmission in a humanized severe combined immunodeficient (hu-SCID) mouse model. METHODS: Reconstituted mice received an intravaginal application of a TMC120-containing gel 20 min prior to a non-invasive vaginal challenge with cell-associated HIV. The possible cytotoxic effect of TMC120-containing-gel on lymphocytes was assessed and their in vivo migration was followed using fluorescently labelled human lymphocytes. Systemic infection was monitored by p24 antigen detection in culture supernatant from cocultured intraperitoneal cells using antigen capture enzyme-linked immunosorbent assay test and by the presence of integrated proviral HIV-1 DNA in DNA extracted from spleen cells. In vivo migration of labelled lymphocytes was examined by analysis of cells isolated from regional lymph nodes. RESULTS: In this model, systemic infection was successfully inhibited by the presence of TMC120-containing gel at vaginal level. The in vivo migration of human lymphocytes from the vagina to regional lymph nodes, following the deposition of TMC120-containing gel, excluded the possibility that inhibition of systemic infection was a result of NNRTI toxicity. CONCLUSIONS: Vaginal transmission of HIV was successfully prevented by the application of a gel formulation containing TMC120. This is the first evidence of the in vivo effectiveness of a microbicide preparation containing an NNRTI against cell-associated HIV.

Acrylic Resins↗
PubMedDate not supplied

Misoprostol as a labor induction agent.

The objective of this investigation was to compare the efficacy, safety, and cost of intravaginal misoprostol as a labor induction agent to a standard protocol using prostaglandin E2 (Prepidil) and intravenous oxytocin. Thirty-eight patients requiring induction of labor with an unfavorable cervix (Bishop score < or = 5) were prospectively randomized to receive either 50 mcg misoprostol every 4 hours until delivery, or a single dose of PGE2 gel (0.5 mg) followed by intravenous oxytocin infusion. Changes in Bishop scores were recorded in a blinded fashion. Clinical outcomes were compared in the two groups, including induction-to-delivery times and cesarean section rates. Seventeen women were treated with misoprostol, 19 patients received PGE2/oxytocin, and two patients dropped out of the study. The groups did not differ significantly with respect to age, parity, gestational age, weight, height, reason for induction, or initial Bishop score. There was a significant difference in the median change of the Bishop score among those treated with misoprostol (4) and those of the control group (1) (P < 0.001). Fifteen (88%) receiving misoprostol delivered within 36 hours compared with 9 (47%) of controls (P = 0.01). Significantly more women in the misoprostol arm (8) experienced tachysystole when compared with the control group (0) (P < 0.01). There were no perinatal morbidities in either group. These data support misoprostol as an effective and economical cervical-ripening and labor-inducing agent.

Administration, Intravaginal↗
PubMed2006

Local oestrogen for vaginal atrophy in postmenopausal women.

BACKGROUND: Vaginal atrophy is a frequent complaint of postmenopausal women; symptoms include vaginal dryness, itching, discomfort and painful intercourse. Systemic treatment for these symptoms in the form of oral hormone replacement therapy is not always necessary. An alternative choice is oestrogenic preparations administered vaginally (in the form of creams, pessaries, tablets and the oestradiol-releasing ring). OBJECTIVES: The objective of this review was to compare the effectiveness, safety and acceptability of oestrogenic preparations for women who suffer from vaginal atrophy. SEARCH STRATEGY: We searched the Cochrane Menstrual Disorders and Subfertility Group Register of trials (searched January 2006), The Cochrane Library (2006,Issue 2), MEDLINE (1966 to January 2006), EMBASE (1980 to January 2006), Current Contents (1993 to January 2006, Biological Abstracts (1969 to 2006), Social Sciences Index (1980 to January 2006), PsycINFO (1972 to February 2006), CINAHL (1982 to January 2006) and reference list of articles. We also contacted manufacturers and researchers in the field. SELECTION CRITERIA: The inclusion criteria were randomised comparisons of oestrogenic preparations administered intravaginally in postmenopausal women for the treatment of symptoms resulting from vaginal atrophy or vaginitis. DATA COLLECTION AND ANALYSIS: Thirty-seven trials were identified: of these 18 were excluded. Included trials were assessed for quality and two reviewer authors extracted data independently. The ratios for dichotomous outcomes and means for continuous outcomes were calculated. The outcomes analysed were categorised under the headings of: efficacy, safety and acceptability. MAIN RESULTS: Nineteen trials with 4162 women were included in this review. The overall quality of the studies was good, although not all trials measured the same outcomes. All trials measured efficacy, with various outcome measures. When comparing the efficacy of different oestrogenic preparations (in the form of creams, pessaries, tablets and the oestradiol-releasing vaginal ring) in relieving the symptoms of vaginal atrophy, results indicated significant findings favouring the cream, ring, and tablets when compared to placebo and non-hormonal gel. Fourteen trials compared safety. Four looked at hyperplasia, four looked at endometrial overstimulation and seven looked at adverse effects. One trial showed significant adverse effects of the cream (conjugated equine oestrogen) when compared to tablets (oestradiol) which included uterine bleeding, breast pain and perineal pain (1 RCT; OR 0.18, 95% CI 0.07 to 0.50). Two trials showed significant endometrial overstimulation as evaluated by a progestagen challenge test with the cream (conjugated equine oestrogen) group when compared to the ring (OR 0.29, 95% CI 0.11 to 0.78). Although not statistically significant there was a 2% incidence of simple hyperplasia in the ring group when compared to the cream (conjugated equine oestrogen) and 4% incidence of hyperplasia (one simple, one complex) in the cream group (conjugated equine oestrogen) when compared to the tablet (oestradiol). Eleven studies compared acceptability to the participants by comparing: comfort of product use, ease of use, overall product rating, delivery system and satisfaction. Results showed a significant preference for the oestradiol-releasing vaginal ring. AUTHORS' CONCLUSIONS: Creams, pessaries, tablets and the oestradiol vaginal ring appeared to be equally effective for the symptoms of vaginal atrophy. One trial found significant side effects following cream (conjugated equine oestrogen) administration when compared to tablets causing uterine bleeding, breast pain and perineal pain. Another trial found significant endometrial overstimulation following use of the cream (conjugated equine oestrogen) when compared to the ring. As a treatment choice women appeared to favour the oestradiol-releasing vaginal ring for ease of use, comfort of product and overall satisfaction.

Administration, Intravaginal↗
PubMed2004

Urinary nitric oxide metabolite changes in spontaneous and induced onset active labor.

BACKGROUND: The aim of this prospective, randomized study was to investigate the changes in urinary nitric oxide (NO) metabolite between the latent and the active phases of spontaneous and either prostaglandin E(1) (PGE(1)) or prostaglandin E(2) (PGE(2))-induced labors. METHODS: Eighty-eight singleton pregnant women at 36-41(+) weeks' gestation without signs of fetal distress were enrolled. The first group consisted of 29 pregnant women in whom labor was induced by PGE(1) applied intravaginally. The second group consisted of 29 pregnant women with labor induced by PGE(2) applied intracervically. The third group consisted of 30 women, who had spontaneous active labor. Clinical data of the three groups were assessed as labor progressed. RESULTS: Urinary nitric oxide/creatinine (U NO/Cr) decreased significantly after the onset of active labor in all three groups (p < 0.005), with the percentage decline of 42.2%, 28.6% and 10.1%, respectively. The magnitude of the difference in decline in U NO/Cr after active labor between the PGE(1)-induced and the spontaneous labor group was significantly reduced (p = 0.0047) after adjustment for potential confounders using the generalized estimating equations test (GEE). The duration of the latent phase was significantly shortened in the PGE(1)-induced group as compared with the spontaneous labor group (p < 0.01). CONCLUSIONS: Decreased U NO/Cr may facilitate transition from the latent to the active phase either in spontaneous or induced labors. Our results indicate that U NO/Cr can serve as an easily obtained marker for use in controlling myometrial contractility and cervical ripening at the onset of active labor. The nitric oxide system is present in the human uterus and may contribute to uterine quiescence during pregnancy and show down-regulation in U NO/Cr at the initiation of active labor.

Administration, Intravaginal↗
PubMed2005

Randomised trial of intravaginal misoprostol and intracervical Foley catheter for cervical ripening and induction of labour.

Induction of labour may be indicated despite an unripe cervix. The purpose of this study was to compare the safety and efficacy of intravaginal misoprostol and an intracervical Foley's balloon catheter for preinduction cervical ripening and labour induction. A total of 120 patients requiring indicated induction of labour with an unfavourable cervix (Bishop's score < or =4) were randomised prospectively to receive either 50 mug intravaginal misoprostol every 6 h for a maximum of two doses, or an intracervical Foley balloon catheter for 12 h followed by an intravenous oxytocin infusion. The two arms of the study were comparable with respect to maternal age, parity, gestational age, indication for induction, and initial Bishop's scores. There were significant change in the Bishop's score in the two groups (5.9 +/- 0.2 and 4.0 +/- 0.2, respectively, p < 0.001) but no inter group differences. Oxytocin induction or augmentation of labour occurred more in the catheter group (95%) than in the misoprostol group (43.3%) (p < 0.0001). Induction to delivery interval was significantly shorter in the misoprostol group than in the catheter group (8.7 +/- 2.4 vs 11.9 +/- 2.7 h p < 0.0001). There was no significant difference noted in the caesarean or other operative delivery rates among patients in the two treatment groups. There was a higher incidence of tachysystole and hyperstimulation in the misoprostol group than in the catheter group (p < 0.03). No differences were observed between groups for meconium passage, 1- or 5-min Apgar scores < 7 and admission into the neonatal intensive care unit. In conclusion, the maternal and perinatal outcomes in this study have shown no difference confirming the efficacy and safety of both methods, however we observe a decrease in the induction-to-delivery interval when misoprostol is used for this purpose.

Administration, Intravaginal↗
PubMed2004

Effect of fluorogestone acetate on embryo recovery and quality in eCG-superovulated goats with premature luteal regression.

The objective of this study was to evaluate if treatment of eCG-superovulated goats with fluorogestone acetate (FGA) would increase the number and quality of embryos recovered. Goats (n = 25) were given an intravaginal sponge containing 45 mg FGA for 12 days, with 1000 IU eCG and 7.5mg of Luprostiol (a PGF(2 alpha) analog) given -48 and 0 h relative to sponge removal. Goats were mated by natural service every 12h during estrus and surgical embryo collection was done 6 days after the last mating. There were two treatment groups; those in the FGA group (n = 13) had a FGA sponge from 8h after mating to embryo collection, whereas goats in the control group (n = 12) did not receive any post-mating treatment. Premature luteal regression occurred in 61.5% (8/13) and 83.3% (10/12) of the goats in the FGA and the control groups, respectively (P > 0.05). Corpus luteum life span averaged 4 days in goats with premature luteolysis. The mean (+/- S.E.) number of transferable embryos was 5.7 +/- 1.6 in the FGA group and 0.1 +/- 0.1 in the control group (P < 0.05). Within the FGA group, the embryo recovery rate was similar in goats with premature luteal regression compared to those with normal luteal function, although non-transferable embryos were only found in goats with premature luteal regression. In conclusion, post-breeding treatment with FGA increased embryonic survival in eCG-superovulated goats, even though it did not prevent premature luteal regression.

Administration, Intravaginal↗
PubMed2006

Is misoprostol safe for labor induction in twin gestations?

OBJECTIVE: To compare the safety and efficacy of intravaginal misoprostol to oxytocin for the induction of labor in twin gestations. METHODS: All twin gestations that underwent induction of labor with misoprostol or oxytocin during a 4-year period were identified from the Mount Sinai obstetrical database. Only twins > or = 34 weeks with a vertex presenting twin A were included. Labor and delivery characteristics, maternal complications and neonatal outcomes were compared between the two groups. RESULTS: Of 134 patients with twins, 57 initially received misoprostol and 77 received oxytocin. These groups had similar demographics, but women who received misoprostol had less cervical dilation (0.8 vs. 2.2 cm, p < 0.0001) and were less likely to be multiparous (19% vs. 44%, p = 0.003). There was a shorter length of induction to delivery (7.8 hours vs. 15.1 hours, p = 0.001) and a trend toward a lower cesarean section rate (16.9% vs. 31.6%, p = 0.06) in the oxytocin-only group. There were no cases of uterine rupture or maternal mortality in this series. There were no significant differences in neonatal outcomes between the two groups, but the sample size was underpowered to detect significant differences between the groups. CONCLUSIONS: Misoprostol and oxytocin both appear to be safe and efficacious for use in inductions of labor in twins in this limited retrospective investigation. The safety of these agents with regard to neonatal outcomes should be confirmed by larger studies.

Administration, Intravaginal↗
PubMed2006

Economic comparison of timed artificial insemination and exogenous progesterone as treatments for ovarian cysts.

The objective of this study was to compare the economic benefits of timed artificial insemination (AI) and a progesterone insert as therapeutic treatments for cows diagnosed with cystic ovarian disease (COD). A secondary objective was to illustrate the use of a stochastic dynamic simulation model to fully account for all changes in revenues and costs affected by differences in treatments. First, 4 herds of 1,000 cows each were simulated until steady state. These cows were free from COD and inseminated based on estrus only. Herds differed by probability of estrus detection (46 or 70%) and days in milk (DIM) when nonpregnant cows were culled (330 or 400 d). Second, 3 herds were created with 1,000 nonpregnant cows at 90, 170, or 250 DIM. These cows were considered diagnosed with COD at the start of the simulation (d 0); no new cases of COD developed after d 0. Cows spontaneously recovered or were treated. Treatments were either timed AI or intravaginal device containing progesterone followed by PGF(2alpha) and then AI if estrus was detected. Effects of treatments were evaluated in 48 scenarios based on compliance of timed AI (82 or 100%), probability of estrus detection (46 or 70%), and DIM when nonpregnant cows were culled (330 or 400 d). As cows became pregnant or were replaced, the herd evolved into the associated steady-state herd. Seven scenarios resulted in less than 50% of cows conceiving before they were culled. The percentage of cows diagnosed with COD that calved again ranged from 14.0 to 74.4% and was significantly reduced when COD was diagnosed later in lactation. Treatments in all cases were more valuable than waiting for spontaneous recovery. The average values of timed AI (82 or 100% compliance) and the progesterone insert were 83.29 dollars, 86.83 dollars, and 71.89 dollars, respectively, compared with waiting for spontaneous recovery. Treatments were least beneficial at 90 DIM. The benefits of timed AI (82 or 100% compliance) compared with the progesterone insert, adjusted for DIM and days to culling, were 14.98 dollars and 21.53 dollars when the probability of estrus detection was 46%. At 70% probability of estrus detection, the benefits were 7.81 dollars and 8.34 dollars, respectively. Overall benefit of treatment by timed AI was 11.39 dollars greater than by progesterone insert.

Administration, Intravaginal↗
PubMed1999

Response of Corriedale ewes to the "ram effect" after priming with medroxyprogesterone, fluorogestone, or progesterone in the non-breeding season.

One hundred eighty-nine Corriedale ewes were used during the non-breeding season to study the "ram effect" stimulus after priming with progestogens. Intravaginal sponges containing either medroxyprogesterone acetate (MAP group, n = 49), fluorogestone acetate (FGA group, n = 49), or progesterone devices (CIDR group, n = 46) were inserted on Day-6 (Day 0 = introduction of the rams). Forty-five ewes were untreated and kept as a control group. On Day 0 the sponges were removed and rams provided with marking harnesses for oestrous detection were placed with the ewes. Onset of estrus was monitored until Day 25, and conception was determined by transrectal ultrasonography. Ewes came into heat during 4 periods: Days 0-3, 5-7, 17-20, and 21-23. The overall number of oestrus ewes were 29%, 53%, 35%, and 50% for the control, MAP, FGA, and CIDR groups, respectively (MAP and CIDR > control, p < 0.05). Control ewes presented oestrus only on Days 17-20 and 21-23. Oestrus in the progestogen-primed ewes was concentrated during Days 0-3 and 17-20, and some ewes came into oestrus on Days 5-7. There were no differences between different primings neither in oestrous response nor in conception rate. The conception rate from matings occurring on Days 0-3 was higher than on those occurring on Days 17-20. We conclude that MAP, FGA, and CIDR is equally effective in improving the response to the ram effect, and the pattern of oestrus in primed ewes was different than previously reported.

Administration, Intravaginal↗
PubMed1999

Misoprostol is more efficacious for labor induction than prostaglandin E2, but is it associated with more risk?

OBJECTIVE: Our purpose was to compare the efficacy and safety of misoprostol with dinoprostone (Prepidil) for labor induction. STUDY DESIGN: In a randomized, controlled trial of labor induction, patients were randomly assigned to receive either 50 microgram of intravaginal misoprostol every 4 hours or 0.5 mg of intracervical prostaglandin E2 every 6 hours. Eligibility criteria included gestation of >/=31 weeks, Bishop score <6, and fewer than 12 contractions per hour. Primary outcomes were cesarean section, induction to delivery time, oxytocin use, and fetal distress requiring delivery. RESULTS: One hundred fifty-nine women were randomly assigned to receive misoprostol (n = 81) or Prepidil (n = 78). There were no differences in the indication for induction, preinduction Bishop score, epidural use, or cesarean section rate. Mean time to delivery was significantly shorter in the misoprostol group (19 hours 50 minutes) than in the Prepidil group (28 hours 52 minutes) (P =.005). Only 58% of women in the misoprostol group required oxytocin augmentation, in comparison with 88% of women receiving Prepidil (P =.00002). However, 41% of women receiving misoprostol and 17% receiving Prepidil had late decelerations or bradycardias (P =.001), and 20% of the misoprostol group and 5% of the Prepidil group had deliveries for fetal distress (P =.05). CONCLUSIONS: Misoprostol is more efficacious than Prepidil for labor induction. However, the significantly increased incidence of abnormal fetal heart rate tracings and the trend in increased deliveries for fetal distress with misoprostol dosing of 50 microgram every 4 hours are of concern. These data suggest that either a lower dose of misoprostol or less frequent dosing of misoprostol should be considered.

Administration, Intravaginal↗
PubMed1999

Persistent dominant follicle alters pattern of oviductal secretory proteins from cows at estrus.

The experimental objective was to compare synthesis of oviductal secretory proteins of dairy cows bearing a persistent dominant follicle (PDF) versus a fresh dominant follicle (FDF) at estrus. On Day 7 after synchronized estrus (Day 0), cows received an intravaginal progesterone device and injection of prostaglandin F2alpha (PGF2alpha). On Day 9, cows received an injection of a GnRH agonist (FDF group; n = 3) or received no injection (PDF group, n = 3). On Day 16, all cows received PGF2alpha, and progesterone devices were removed. At slaughter on Day 18 or Day 19, oviducts ipsilateral and contralateral to the dominant follicle were divided into infundibulum, ampulla, and isthmus regions. Explants from oviductal regions were cultured in minimal essential medium supplemented with [3H]leucine for 24 h. Two-dimensional fluorographs of proteins in conditioned media were analyzed by densitometry. Rate of incorporation of [3H]leucine into macromolecules was greater in the infundibulum, ampulla, and isthmus of FDF cows (p < 0.01). Overall, intensities of radiolabeled secretory protein (P) 2 and P13 were greater for FDF than for PDF. In the ampulla, P14 was more intense for FDF while P7 was more intense for PDF. Abundance of P1 in the isthmus was greater for PDF cows. Across regions, P5, P6, P8, P9, and P11 were more intense for PDF than for FDF in the ipsilateral side. In the contralateral side, P19 was more intense for PDF than for FDF, whereas P6, P8, P9, and P11 were more intense for FDF. Differences in biosynthetic activity and in secreted oviductal proteins from cows bearing a PDF may contribute to the decrease in fertility associated with a PDF.

Administration, Intravaginal↗
PubMed1996

Lesions of experimental genital Tritrichomonas foetus infections in estrogenized BALB/c mice.

Ninety-seven BALB/c mice were inoculated intravaginally with 8.0 x 10(5) Tritrichomonas foetus organisms, using either isolate ATCC 30003 or field isolate MU Y22 2 days after estrogenization with 15 micrograms 17 beta-estradiol. Reproductive tracts were examined at several time points post-inoculation to determine gross and histologic responses to trichomonad infection as compared to estrogenized, uninfected control animals. The two isolates varied greatly in ability to maintain chronic infection; no ATCC 30003-inoculated animals remained culture-positive beyond 7 weeks post-inoculation, whereas MU Y22-inoculated animals were infected for greater than 26 weeks. Lesions were seen in 40-60% of animals prior to 10 weeks post-inoculation and included moderate uterine dilation and glandular atrophy, uterine gland abscesses, pyometra, intramural perivascular lymphoid infiltrates, and ovarian bursitis. The severity of lesions was independent of the T. foetus isolate. Lesions became more severe at 10 weeks post-inoculation, and at 10 and 26 weeks post-inoculation, lesions were seen in 60% and 75% of animals, respectively. In addition to lesions described above, epithelial changes were marked at these late necropsies, including ulceration, flattening, hypertrophy, and squamous metaplasia. The lesions seen in these mice closely resemble those described in natural bovine infection, suggesting that the estrogenized BALB/c mouse is an excellent model for study of bovine trichomoniasis.

Administration, Intravaginal↗
PubMed2004

A randomized controlled trial comparing medical and expectant management of first trimester miscarriage.

BACKGROUND: We aimed to determine whether outpatient treatment of miscarriage with vaginal misoprostol is more effective than expectant management in reducing the need for surgical evacuation of retained products of conception (ERPC). METHODS: Of 131 eligible women with first trimester miscarriage, 104 agreed to randomization to either 600 microg misoprostol or placebo intravaginally. They were assessed the following day and administered a second dose of their allocated treatment if miscarriage was not complete. Those not successful after two doses were seen on day 7, and, if miscarriage was not complete, an ERPC was performed. RESULTS: The success rate of medical management was 88.5% (46/52) compared with 44.2% (23/52) for expectant management. There was no significant difference in success rate (100 versus 85.7%) in women treated with an incomplete miscarriage. Women with early pregnancy failure had a success rate of 87% with misoprostol compared with 29% with expectant management [odds ratio (OR) 15.96; 95% confidence interval (CI) 5.26, 48.37]. The complete miscarriage rate was achieved quicker in the medical group than the expectant group by day 1 (32.7 versus 5.8%) and by day 2 (73.1 versus 13.5%) of treatment. There were no differences in side-effects, bleeding duration, analgesia use, pain score and satisfaction with treatment. Women in the expectant group made more outpatient visits (5.06 versus 4.44%; OR = -0.62, 95% CI -1.04, -0.19). More women in the medical group (90.4 versus 73.1%; OR 1.26, 95% CI 1.05, 1.50) would elect the same treatment in the future. CONCLUSIONS: Medical management using 600 microg misoprostol vaginally is more effective than expectant management of early pregnancy failure. Misoprostol did not increase the side-effect profile and patient acceptability was superior to expectant management.

Abortifacient Agents, Nonsteroidal↗