dinoprost and Pregnancy--Ectopic

More than 20 years following the recognition of a possible role for eicosanoids in ovarian function a physiological role for prostaglandins and/or leukotrienes in human ovulation, corpus luteum function and tubal motility remains to be demonstrated. With respect to ovarian function, the well-characterized preovulatory rise in eicosanoid production in animal species and humans, in conjunction with the large body of experimental evidence employing inhibitors of prostaglandin synthesis and replacement of individual prostaglandins, has provided strong evidence for a role in follicular rupture independent of other LH-mediated ovulatory events. The possible mechanism of prostaglandin-induced follicle rupture may involve stimulation of proteolytic activity via substances such as plasmin and PA; however, this is controversial. A role for prostaglandins in ovarian luteal function is well established in laboratory animals and large ruminant species, where PGF2 alpha derived from the uterus has been demonstrated to be the luteolytic factor. In humans, luteal function may be influenced by local intraovarian eicosanoid production, which has been suggested to involve the paracrine interaction of local ovarian hormones such as oxytocin, noradrenaline, insulin and IGFs, to name but a few. Several lines of evidence have also implicated prostaglandins as an aetiological factor in ovarian pathological states such as seen in the OHSS. However, the bulk of clinical experimental evidence to date has failed to support this contention. Prostaglandin production has likewise been well characterized in the fallopian tube in both humans and animal species. Whereas a role for prostaglandins in tubal transport has been demonstrated with animal species such as the rabbit, several studies have failed to define a similar function in humans. More recently, direct injections of prostaglandin analogues into the fallopian tube and the corpus luteum have been shown to be efficacious as a treatment for ectopic pregnancy. Whether the primary mechanism of action involves effects on tubal musculature or corpus luteum function, or is simply a local vascular effect, remains to be demonstrated. Therefore, although the physiological role for eicosanoids in ovarian and tubal function remains unclear, particularly in the human, an increasing body of recent evidence has suggested an important paracrine function for this class of cellular mediators whose interaction with other more recently characterized

Topics: Animals; Corpus Luteum; Dinoprost; Dinoprostone; Epoprostenol; Fallopian Tubes; Female; Humans; Leukotrienes; Ovarian Follicle; Ovarian Hyperstimulation Syndrome; Ovary; Ovulation; Pregnancy; Pregnancy, Ectopic; Prostaglandins

Nonsurgical treatment of ectopic pregnancy has been potentiated by recent technologic advances including sensitive human chorionic gonadotropin (hCG) assays and high-resolution ultrasonography. Options include systemic methotrexate and salpingocentesis. Systemic methotrexate has been documented to be safe, effective, and well tolerated. Preliminary evidence suggests that fertility potential is comparable for conservative surgery.

Topics: Dinoprost; Female; Humans; Methotrexate; Potassium Chloride; Pregnancy; Pregnancy, Ectopic; Trophoblastic Neoplasms

The availability and efficacy of prostaglandin (PG) F2 alpha and E series analogues has prompted their frequent use for pregnancy interruption. In the course of evaluating our experience with PGs for interrupting early first trimester gestations, we became increasingly impressed by the absence of any with extrauterine pregnancy. A review of 63 reports encompassing 2,965 patients whose pregnancies were less than 8 weeks' gestational age dating from the last menstrual period and who were similarly treated yielded only 2 cases of ectopic pregnancy. When compared with the generally accepted ectopic gestation rates of the order of 1 in 200 pregnancies, this frequency of 1 in 1,483 is unexpectedly low. Preselection does not appear to explain this impressive discrepancy. If the observation proves correct, it implies that PGs have some form of therapeutic effect in eradicating extrauterine pregnancy by nonoperative means. The implications are obvious in terms of its potential therapeutic benefits.

Topics: Abortifacient Agents; Abortifacient Agents, Nonsteroidal; Abortion, Induced; Corpus Luteum; Dinoprost; Female; Humans; Luteolytic Agents; Pregnancy; Pregnancy, Ectopic; Prostaglandins E, Synthetic; Prostaglandins F; Prostaglandins, Synthetic

To investigate the clinical performance of local prostaglandin treatment of ectopic pregnancies (EPs) in relation to their biologic activity as determined by preoperative serum hCG levels.. Prospective study over a 2-year period of 108 patients with 127 tubal pregnancies.. A department of obstetrics and gynecology in a central county hospital.. One hundred eight patients who presented with a clinical diagnosis of EP.. Patients with EP were treated with laparoscopy-guided injection of prostaglandin F2 alpha in the surrounding tubal wall and the corpus luteum-bearing ovary. All members of the staff participated.. Success rate, hospitalization cost, and convalescence period.. Seven laparotomies (7.5%) were performed postoperatively due to increasing hCG levels or ruptures with circulatory reactions. All except one had an initial (preoperative) hCG value > 1,000 mIU/mL (conversion factor to SI unit, 1.00). The mean hospitalization period was 2.7 days and 90% of the medically treated patients returned home on the first postoperative day. The mean convalescence period was 18 days.. The procedure is simple and carries an acceptable success rate in cases with hCG levels < 1,000 mIU/mL. The approach demands minimal technical resources and it may reduce health care costs substantially.

Topics: Abortion, Induced; Biomarkers; Chorionic Gonadotropin; Dinoprost; Female; Humans; Injections; Laparoscopy; Pregnancy; Pregnancy, Ectopic; Prospective Studies

Topics: Dinoprost; Fallopian Tubes; Female; Humans; Pregnancy; Pregnancy, Ectopic; Prognosis

Since ectopic pregnancy may terminate in spontaneous recovery we compared treatment by means of prostaglandin (PG) application with expectant management in laparoscopically verified tubal gestations. Twelve patients received local and systemic PG, 4 patients were treated with sodium chloride and in 7 patients laparoscopy was discontinued without medical therapy. The comparison between the PG group and the placebo groups revealed a highly significant difference with regard to a subsequent necessary surgical intervention and hospitalisation. Expectant management may only be recommended in very selected cases, whereas PG treatment seems to produce favourable results in cases of early tubal pregnancy.

Topics: Chorionic Gonadotropin; Dinoprost; Dinoprostone; Female; Humans; Laparoscopy; Pregnancy; Pregnancy, Ectopic; Prostaglandins; Random Allocation; Sodium Chloride

In a prospective randomised study, 31 patients with an unruptured tubal pregnancy were treated either with local and systemic prostaglandins or with local instillation of a hyperosmolar glucose solution. Prostaglandin therapy was successful in 13 of 15 patients and glucose therapy in 16 of 16. 9 women treated with prostaglandins had cramping abdominal pains postoperatively. No side-effects were noted in those treated with glucose. At subsequent hysterosalpingography 5 of 6 patients treated with prostaglandins and 7 of 8 treated with glucose had normal tubal configuration and patency. 3 patients treated with glucose later had a normal intrauterine pregnancy, demonstrably through the affected tube in 1 case. These results suggest that local instillation of hyperosmolar glucose solution is an option in the laparoscopic management of unruptured tubal pregnancies.

Topics: Adult; Chorionic Gonadotropin; Dinoprost; Drug Evaluation; Female; Glucose; Humans; Osmolar Concentration; Pregnancy; Pregnancy, Ectopic; Prospective Studies; Randomized Controlled Trials as Topic

During the last decades the incidence of ectopic pregnancy has been steadily rising. The chosen therapy has usually been unilateral salpingectomy. Recently, different conservative (tube-preserving) treatment-modalities have been introduced in clinical practice. We have tried conservative treatment by local injection of prostaglandin F2a (total dose 2-4 mg) directly into the tubal pregnancy and, if feasible, also into the corpus luteum graviditate. The treatment was successful in 13 out of 16 patients. In one patient laparotomia was performed because of pain, and revealed a haematoma in fossa Douglasi. Reinjection of prostaglandin was necessary in one patient because of rising HCG titres. One patient was hospitalized for four days because of nausea and pain. The treatment was otherwise successful. The method may be useful as a non-surgical alternative in haemodynamically stable patients without tubal rupture. Further studies are needed to evaluate the outcome in terms of future fertility.

Topics: Chorionic Gonadotropin; Dinoprost; Female; Humans; Pregnancy; Pregnancy, Ectopic; Prognosis

Topics: Chorionic Gonadotropin; Dinoprost; Female; Glucose Solution, Hypertonic; Humans; Osmolar Concentration; Pregnancy; Pregnancy, Ectopic

Topics: Dinoprost; Female; Glucose; Humans; Methotrexate; Pregnancy; Pregnancy, Ectopic; Remission, Spontaneous

Topics: Adult; Dinoprost; Female; Humans; Ovary; Pregnancy; Pregnancy, Ectopic

A new conservative method of terminating ectopic pregnancies is described. A high degree of success was achieved by administering PG F2alpha by laparoscopy and PG E2 analogue systemically.. In vitro studies have demonstrated a marked increase in tubal muscle cell activity and pronounced constriction of tubal arteries as a result of incubation with prostaglandins, particularly prostaglandin (PG) F2 alpha and PG E2. This finding has potential implications for the termination of ectopic pregnancies. To test this approach, 22 women with laparoscopically confirmed ectopic pregnancies received local application of PG F2 alpha by means of laparoscopy as well as systemic treatment with a PG E2 analog. The pregnancy site was ampullary in 15 cases and isthmic in the remaining 7 cases. Analysis of post-treatment beta-human chorionic gonadotropin (hCG) values indicated that this regimen was successful in 18 cases; the 4 failures occurred in women with pre-treatment beta-hCG values that were above the mean. Of the 1st 9 women treated in this series, all of whom received 2-3 mg of PG F2 alpha, 3 exhibited transient tachycardia and blood pressure elevation immediately after intraluteal application and 1 of these women developed pulmonary congestion postoperatively. Thus, the PG F2 alpha dose was replaced with 25 mg of estrogen, and this change produced no side effects or reduction in effectiveness. In 8 of the 9 women on whom hysterosalpingography was performed in 1 of the ensuing menstrual cycles, there was complete tubal patency. More widespread use of this conservative yet highly effective method is recommended.

Topics: Abortion, Therapeutic; Dinoprost; Dinoprostone; Female; Humans; Injections; Laparoscopy; Pregnancy; Pregnancy, Ectopic

Eleven women with small unruptured tubal pregnancies were treated by laparoscopically guided injection of prostaglandin F2 alpha in the oviduct and in the ovary which contained the corpus luteum. They had no side effects of the treatment and were discharged from hospital 1-3 days later. In 10 women the serum concentration of human chorionic gonadotrophin (HCG) decreased to less than 20 IU/l in a median time of 7.5 days, the range being 1-46 days. One woman required an operation 6 days after the treatment as her serum HCG level was stationary and she continued to have abdominal pain. Hysterosalpingography 3 months after the treatment showed patency of the oviduct on the side of the pregnancy in seven of the eight women who have been examined. We conclude that the injection of prostaglandin F2 alpha seems to promote the resolution of selected tubal pregnancies.

Topics: Chorionic Gonadotropin; Dinoprost; Fallopian Tubes; Female; Humans; Hysterosalpingography; Injections; Ovary; Pregnancy; Pregnancy, Ectopic

In nine women with unruptured ectopic pregnancy, prostaglandin F2 alpha was injected under laparoscopic control into the affected oviduct and in eight patients also into the ovary containing the corpus luteum. Termination of the pregnancy was achieved in all cases (in one at the second attempt), without complications. Fertility after this procedure needs to be compared with that after conventional surgery.

Topics: Abortifacient Agents; Abortifacient Agents, Nonsteroidal; Abortion, Induced; Adult; Dinoprost; Drug Evaluation; Fallopian Tubes; Female; Humans; Injections; Pregnancy; Pregnancy, Ectopic; Pregnancy, Tubal; Prostaglandins F; Prostaglandins F, Synthetic

An in vitro model for evaluation of pharmacologic treatment of ectopic pregnancy (EP) was designed. In cases of EP, specimens from the tubal wall, the tubal artery, and the corpus luteum capsule were used for contractility studies. In addition, tissue slices from the corpus luteum of EP were incubated for determination of progesterone production. In vitro administration of prostaglandin F2 alpha (PGF 2 alpha) induced a marked increase in activity of the tubal muscle and pronounced constriction of the tubal artery. PGF2 alpha also reduced the human chorionic gonadotropin-induced increase in progesterone production from the corpus luteum. PGE2 conversely, inhibited the tubal muscle activity and had a moderate constrictive effect on the tubal artery. Furthermore PGE2 increased the progesterone formation from the corpus luteum. In theory, the demonstrated in vitro effects indicate that as opposed to PGE2 compounds, PGF2 alpha compounds may be useful for pharmacologic treatment of EP.

Topics: Corpus Luteum; Dinoprost; Dinoprostone; Fallopian Tubes; Female; Humans; In Vitro Techniques; Pregnancy; Pregnancy, Ectopic; Prostaglandins; Prostaglandins E; Prostaglandins F

Eight experiments were conducted to examine the influence of the conceptus on luteal function in mice. In uterine intact pseudopregnant mice, exogenous treatment with placental extracts or pregnant mouse plasma from Day 8 or Day 10 of gestation did not prolong the life span of the corpora lutea (CL). The interestrous interval (IEI) of hysterectomized pseudopregnant mice was extended by treatment with Day 10 placental extract and was accompanied by elevated plasma progesterone, consistent with the luteotropic nature of the Day 10 conceptus. The IEI of uterine intact pseudopregnant mice was prolonged by the presence of ectopically developing blastocysts and was further extended by a treatment with Day 10 placental extracts but not by treatment with Day 8 placental extracts. Although the ectopic blastocyst delayed the effect of the uterine luteolytic mechanism, there was no indication of luteotropic activity: the ectopic blastocysts were unable to activate the CL of the estrous cycle. In addition, plasma progesterone and 13,14-dihydro-15-keto-prostaglandin F2 alpha (PGFM) were measured in pseudopregnant, hysterectomized pseudopregnant and pregnant mice on Day 2 through 13 post-mating. The results of these experiments suggest a two-step mechanism in prolonging luteal function during pregnancy which involves two different substances. This mechanism involves an initial signal from the conceptus which blocks the uterine luteolytic mechanism and a subsequent luteotropic stimulus from the Day 10 conceptus which extends luteal life span to approximately the length of gestation.

Topics: Animals; Blastocyst; Corpus Luteum; Corpus Luteum Maintenance; Dinoprost; Estrus; Female; Mice; Models, Biological; Placenta; Pregnancy; Pregnancy Maintenance; Pregnancy, Ectopic; Progesterone; Prostaglandins F; Pseudopregnancy; Uterus