carboprost and Uterine-Hemorrhage

This article outlines the current modalities of pregnancy termination, as well as their risks and complications, in 3 phases of pregnancy: 1) up to 49 days past the last menstrual period, 2) 8-15 weeks, and 3) 16-24 weeks. Before 8 weeks of pregnancy, suction dilatation and curettage (D and C) is the preferred method. However, a medical approach, possibly self-administered, is viewed as more satisfactory and requires only an improvement in side effects. From 8-15 weeks' gestation, suction D and C and dilatation and evacuation (D and E) are the methods of choice. The use of laminaria tents improves both the facility and safety of these procedures in nulliparous patients and perhaps in multiparous patients. Priming of the cervix with prostaglandin could further decrease the difficulty and risks of these procedures. The use of a hydrogel compound is especially worthy of consideration. There is controversy about the preferred method between 16-20 weeks' gestation. D and E appears to have fewer complications and to be more cost-effective than hypertonic saline injection. Urea-prostaglandin has fewer and less severe complications than saline injection, and seems to be more cost-effective than saline injection in terms of duration of hospitalization. The high frequency of failure and side effects, combined with the possibility of expulsion of a live fetus, make prostaglandin-only injection less desirable. After 20 weeks' gestation, urea-prostaglandin injection is probably the safer method. Given the rapid increase in complications with passing weeks, any delay in providing late abortion services should be avoided. 2nd trimester pregnancy terminations, especially those after 18 weeks' gestation, are associated with increased mortality and morbidity and should be performed at specialized centers where providers are better equipped to manage complications.

Topics: 16,16-Dimethylprostaglandin E2; Abortifacient Agents; Abortion, Induced; Alprostadil; Amnion; Anesthesia; Animals; Arbaprostil; Bacterial Infections; Carboprost; Cervix Uteri; Dilatation and Curettage; Dinoprost; Dinoprostone; Female; Humans; Hypertonic Solutions; Oxytocin; Pregnancy; Pregnancy Trimester, First; Pregnancy Trimester, Second; Progestins; Prostaglandins E; Prostaglandins E, Synthetic; Prostaglandins F; Pulmonary Embolism; Risk; Saline Solution, Hypertonic; Time Factors; Urea; Uterine Hemorrhage; Uterine Perforation

Topics: Adult; Blood Transfusion; Carboprost; Ergonovine; Female; Fetal Death; Gestational Age; Humans; Oxytocics; Postoperative Complications; Pregnancy; Suture Techniques; Uterine Hemorrhage; Vacuum Curettage

Four hundred and fifty pregnant women were recruited for termination of early gestation by mifepristone combined with dl-15-methyl PGF2 alpha or misoprostol. Eight-four out of 450 subjects received curettage because of heavy or prolonged vaginal bleeding and slow decline of urinary hCG levels. Histopathology examinations of specimens obtained during curettage revealed denatured, necrotic and obscure villi and trophoblasts in 77 specimens, which accounted for 91.7%. Among them, 68 samples were mingled with inflammatory cell infiltration, and 15 with decidual cells, only 3 were villi and trophoblasts alone. The remaining 7 specimens were decidua in 6 and inflammatory infiltration in 1, which accounted for 7.1% and 1.2% respectively. This study suggested that the major cause resulting in heavy or prolonged vaginal bleeding after medical abortion by mifepristone and prostaglandin analogue was residual villi and trophoblasts with inflammatory cell infiltration.

Topics: Abortion, Induced; Carboprost; Dilatation and Curettage; Drug Synergism; Endometrium; Female; Humans; Mifepristone; Misoprostol; Pregnancy; Pregnancy Trimester, First; Uterine Hemorrhage

To evaluate whether a double prostaglandin impact enhances the effectiveness of the 15S-15-methyl prostaglandin (PG) F2 alpha methyl ester analogue in 1st and 2nd trimester abortion, 2 vaginal suppositories spaced 3 hours apart were administered to 10 patients. The patients' ranged from 19-39 years; length of gestation ranged from 44-56 weeks. Uterine contraceptions began from 40-190 minutes after suppository insertion, and bleeding was seen within 120-610 minutes. 3 of the 10 subjects expelled products of conception during the 10-hour observation period. All subjects reported persistent vaginal bleeding after the procedure, and in 8 subjects the bleeding continued for 14 or more days. 6 subjects reported repeated nausea and vomiting, and 7 experienced diarrhea. Both plasma progesterone values and human chorionic gonadotropin (hCG) beta-subunit levels declined during the 10-hour observation period. The significant drop in beta-subunit hCG levels noted at the follow-up visit indicated 8 of the pregnancies had been successfully interruped showed a drop in plasma progesterone levels, showing that this measure does not predict outcome. Overall, the results in this small series do not suggest any improvement in efficacy over that reported with a single vaginal suppository. The frequency and severity of gastrointestinal side effects appeared to be greater and vaginal bleeding was more porlonged. In addition, uterine contractions began earlier and were more intense, requiring greater use of analgesic medication. It is possible, however, that more applications of smaller dosages given at shorter intervals could improve efficacy and reduce the frequency and severity of side effects.

Topics: Abortion, Induced; Adult; Carboprost; Chorionic Gonadotropin; Diarrhea; Female; Humans; Nausea; Pregnancy; Prostaglandins F, Synthetic; Suppositories; Uterine Hemorrhage

The present report describes an unusual case of recurrent puerperal uterine inversion causing major postpartum hemorrhage. Blood replacement, oxytocin, and ergot therapy along with manual reduction failed to prevent immediate recurrence, but treatment with 15(S)-15-methyl prostaglandin F2 alpha (Prostin 15M) and uterine packing were successful. It is recommended that 15(S)-15-methyl prostaglandin F2 alpha be available in all obstetric suites for the management of similar emergencies.

Topics: Adult; Carboprost; Female; Humans; Methods; Postpartum Hemorrhage; Pregnancy; Prostaglandins F, Synthetic; Puerperal Disorders; Recurrence; Uterine Diseases; Uterine Hemorrhage

Based on the assumption that excess prostaglandins (PGS) of E type (vasodilators and inhibitors of platelet aggregation) may be involved in excessive bleeding due to IUDs, PG synthetase inhibitors were administered to evaluate this hypothesis's validity. In addition, the role of PGs and its inhibitors on dysfunctional uterine bleeding was also studied. In the IUD-induced bleeding study patients were divided into 2 subgroups. Subgroup 1 included patients with menorrhagia caused by IUDs; 50 women were treated with oral indomethacin and 25 subjects were given placebo on the same schedule. In Subgroup 2, fewer cases were selected, double-blindly, and 3 different PG inhibitors were tested in a cross-over manner. Menstrual blood loss (MBL) was measured. 2 subgroups were also used in the dysfunctional uterine bleeding study, the first of which received intravenous infusions of PGF2 alpha or 15-methyl F2 alpha for 6 hours and the second of which was treated with oral indomethacin (25 mg tds) for 5 days. MBL was measured and compared to the subject's period before treatment. Results from the IUD bleeding studies showed that regardless of the method of evaluation or the drug used, administration of nonsteroidal antiinflammatory drugs (NSAID) induced drastic reductions in MBL (subjective evaluation showed 92% success with indomethacin). Quantitative MBL measurement also verified the consistent and significant reduction in MBL under treatment. Oral NSAID in cases of dysfunctional bleeding was associated with marked decrease in MBL also. However, histologic changes were observed in endometrial vessels, notably thickening of subendothelial connective tissue and prominent endothelial cells. Intravenous infusions also reduced MBL but not as significantly as oral administration. And fibrin deposition was marked after intravenous treatment.

Topics: Adult; Carboprost; Cyclooxygenase Inhibitors; Double-Blind Method; Female; Flufenamic Acid; Humans; Indomethacin; Intrauterine Devices; Placebos; Prostaglandins F; Uterine Hemorrhage