dinoprost and Pregnancy--Tubal

Improvements in diagnostic measures have contributed to the earlier diagnosis of ectopic pregnancy which in turn has led to the development of new and alternative methods of managing tubal pregnancies. Laparoscopic salpingotomy offers advantages such as a reduction in operating time and shorter hospital stays and convalescence as compared with conventional abdominal surgery. Furthermore, neither the frequency of persistent trophoblasts nor of second operations is increased, and the subsequent fertility rate is at least equal to that after laparotomy. "Non-surgical" treatment of ectopic pregnancy, such as systemic administration of methotrexate and laparoscopic/transvaginal ultrasonic--guided local injection of methotrexate, prostaglandins or hyperosmolar glucose, are attractive alternative methods in selected cases. These methods are safe and effective and have a high success rate and promising results for fertility. Laparoscopy is preferred to conventional abdominal surgery for the treatment of ectopic pregnancy. In selected cases, "non-surgical" treatment can be an attractive alternative therapy.

Topics: Dinoprost; Dinoprostone; Fallopian Tubes; Female; Glucose; Humans; Injections, Intralesional; Laparoscopy; Methotrexate; Pregnancy; Pregnancy, Tubal; Prenatal Diagnosis; Time Factors

Nowadays, ectopic pregnancy is often diagnosed in an intact unruptured condition. This has stimulated various investigators to attempt nonsurgical methods of therapy. Under laparoscopic or ultrasonographic guidance, local injection of methotrexate, prostaglandins, hyperosmolar glucose, potassium chloride or RU 486 are employed. These preparations are also administered systemically. Taking into account specific criteria, most of these nonsurgical measures are comparable with conservative surgical methods. Expectant management proved to be equally successful. The most important prerequisite for nonsurgical therapy of ectopic pregnancy is careful selection.

Topics: Dactinomycin; Dinoprost; Female; Glucose Solution, Hypertonic; Humans; Laparoscopy; Methotrexate; Mifepristone; Potassium Chloride; Pregnancy; Pregnancy, Tubal

The incidence of ectopic pregnancy is definitely increasing. Ectopic pregnancies are diagnosed earlier these days because of the improvement in diagnostic means and the increasing awareness of the condition. It seems that there is a dramatic change in the clinical presentation of this disease; it used to be a grave and life-threatening condition, and now it is a more benign presentation. The vast majority of the diagnosed ectopic pregnancies are unruptured. This has stimulated various investigators to attempt nonsurgical methods of treatment such as systemic administration of methotrexate or RU 486 (mifepristone) or local injection of methotrexate, potassium chloride, or prostaglandins under laparoscopic or ultrasonographic guidance. Most of these conservative, nonsurgical measures proved efficient in 80% to 90% of cases. Expectant management, which was practiced in some cases, proved to be equally successful. We believe that the ideal mode of treatment in early unruptured ectopic pregnancy is still to be determined. The answer probably lies in proper selection.

Topics: Dactinomycin; Dinoprost; Female; Humans; Laparoscopy; Methotrexate; Mifepristone; Potassium Chloride; Pregnancy; Pregnancy, Tubal

A total of 60 patients underwent injection of prostaglandin (PG)F2 alpha into the affected tube and corpus luteum. Two serum samples, with a mean interval of 2.1 days, were taken pre-operatively and human chorionic gonadotrophin (HCG) and progesterone were determined by fluoroimmunoassay retrospectively. Cases requiring a second intervention (n = 8) were compared with uncomplicated cases (n = 52). The receiver-operator characteristic curve was used to determine optimal discriminatory levels of each diagnostic test. Among the complicated cases, 75% had progesterone values > 20 nmol/l and 100% had a daily HCG increase > 50 IU/l. The corresponding figures for the uncomplicated cases were 17% and 23% respectively. A 'high-risk' group representing 12% of the patient material was identified, and was biochemically profiled by serum progesterone values > 20 nmol/l, together with daily HCG changes > +50 IU/l/day. These patients had an 86% risk for a second intervention. Conversely, 88% of patients had only a 4% risk for such an intervention. We conclude that the combined use of two sequential serum HCG samples and one serum progesterone sample, the last of each taken not more than 24 h pre-operatively, can predict the risk for a complicated course following local injection of 15-methyl-PGF2 alpha for small tubal pregnancies.

Topics: Chorionic Gonadotropin; Combined Modality Therapy; Dinoprost; Female; Humans; Injections; Postoperative Complications; Predictive Value of Tests; Pregnancy; Pregnancy, Tubal; Preoperative Care; Progesterone; Risk Factors; Trophoblasts

A spontaneous intrauterine pregnancy occurred after instillation of prostaglandin-F2 alpha into the solitary tube and systemic prostaglandin administration for treatment of an ectopic gestation. This is the first unequivocal proof of intact function of the affected tube after non-surgical treatment of a tubal pregnancy with prostaglandins.

Topics: Adult; Dinoprost; Dinoprostone; Estrogens, Conjugated (USP); Fallopian Tubes; Female; Humans; Pregnancy; Pregnancy, Tubal; Prospective Studies; Prostaglandins

We report on a successful pregnancy after prostaglandin F2 alpha treatment for tubal pregnancy. Laparoscopic instillation of prostaglandin F2 alpha was performed in 14 cases; we had to laparotomise in only 2 cases.

Topics: Adult; Chorionic Gonadotropin; Chorionic Gonadotropin, beta Subunit, Human; Dinoprost; Female; Follow-Up Studies; Humans; Hysterosalpingography; Laparoscopy; Multicenter Studies as Topic; Peptide Fragments; Pregnancy; Pregnancy, Tubal; Prospective Studies; Randomized Controlled Trials as Topic

Twenty-six cases of unruptured tubal pregnancy were treated by laparoscope-guided injection of prostaglandin (PG) F2 alpha into the affected tube and the ovary containing the corpus luteum. Preoperative serum human chorionic gonadotropin (hCG) levels were 22 to 2,050 IU/L (mean 328 IU/L). The procedure was successful in 24 patients (92%), as indicated by reduction of hCG values to less than 20 IU/L. The remaining 2 cases showed an initial fall in hCG after injection and thereafter a plateau phase indicating the persistence of trophoblast. In both cases, a second surgical intervention was necessary. The total subsequent conception rate among 19 women desiring pregnancy was 90% (17/19). The intrauterine conception rate was 58% (11/19), and the repeat rate of ectopic pregnancy was 32% (6/19). Two-thirds (12/19) of the subsequent pregnancies occurred within 6 months "at risk" for conception. It is concluded that local injection of PGF2 alpha represents an attractive method for termination of selected cases of tubal pregnancy, preferentially in subjects with low trophoblastic activity.

Topics: Abortion, Legal; Adult; Clinical Trials as Topic; Dinoprost; Female; Fertility; Humans; Injections; Laparoscopy; Middle Aged; Pregnancy; Pregnancy, Tubal

In this prospective multi-centre-study, the new treatment of tubal pregnancies by means of local prostaglandin (PG) F2 alpha and systemic PG E2 application was compared to the usual surgical technique of eliminating the conceptus. In 71 patients treated with PG, the method proved to be successful in 81%; 21 patients (19%) required surgical intervention later. With an initial beta-hCG level of 2500 mIE/ml, the success rate increased to 88%. The duration of hospitalisation was significantly reduced in the PG group compared to the patients treated by primary operation (3 +/- 1 versus 6 +/- 2 days). In the PG-group, only 2 of 24 hysterosalpingograms showed tubal occlusions after treatment, whereas occlusion was present in 3 of 8 patients of the surgically treated group. Four subsequent intrauterine pregnancies in the PG-group occurred compared to none in the surgical group. PG treatment of tubal pregnancy in patients with a low initial beta-hCG value (less than 2500 mIE/ml) revealed promising results with regard to reduced postoperative morbidity and future fertility.. In this prospective, multicenter study, the new treatment of tubal pregnancies by means of local prostaglandin (PG) F2alpha and systemic PGE2 application was compared to the usual surgical technique of eliminating the conceptus. In 71 patients treated with PGs, the method proved to be successful in 81%; 21 patients (195) required surgical intervention at a later date. With an initial beta-hCG level of 2500 mIE/ml, the success rate increased to 88%. The duration of hospitalization was significantly reduced in the PG group compared to the patients treated by primary operation ()3 +or- 1 vs 6+or- 2 days). In the PG group, only 2 of 24 hysterosalpingograms showed tubal occlusions after treatment, whereas occlusion was present in 3 of 8 patients of the surgically treated group. 4 subsequent intrauterine pregnancies in the PG group occurred compared to none in the surgical group. PG treatment of tubal pregnancy in patients with a low initial beta-hCG value (2500 mIE/ml) revealed promising results with regard to reduced postoperative morbidity and future fertility. (author's)

Topics: Abortifacient Agents; Abortifacient Agents, Nonsteroidal; Chorionic Gonadotropin; Chorionic Gonadotropin, beta Subunit, Human; Clinical Trials as Topic; Dinoprost; Dinoprostone; Drug Therapy, Combination; Female; Humans; Injections, Intralesional; Injections, Intramuscular; Laparoscopy; Peptide Fragments; Pregnancy; Pregnancy, Tubal; Prospective Studies

An empirically established serum beta human chorionic gonadotropin (beta-HCG) threshold level of 2,500 IU/l is considered as the limit for successful drug therapy. The purpose of our study was to ascertain if this threshold level correlates with the histopathology. Further, we evaluated the effects of local drug therapy on the tubal wall.. Between 1988 and 1993 129 cases of tubal pregnancies were treated by local prostaglandin F2 alpha instillation. For final cure 30 patients had to undergo further surgical measures. Our study was based upon the histological samples which were excised during secondary operation.. Below 2,500 IU/l beta-HCG, intraluminal growth of the trophoblast is more frequent, whereas at higher values extraluminal spread predominates (p = 0.0045). Cells of ectopic trophoblast proliferate significantly slower than those of intrauterine pregnancies. Prostaglandin F2 alpha application selectively destroys ectopic gestational tissue and preserves the tubal wall.. The integrity of the tubal wall with its contractile potential is essential for successful therapy by local instillation of prostaglandin F2 alpha.

Topics: Abortifacient Agents, Nonsteroidal; Administration, Topical; Chorionic Gonadotropin, beta Subunit, Human; Dinoprost; Fallopian Tubes; Female; Humans; Infant, Newborn; Injections, Intralesional; Pregnancy; Pregnancy, Tubal; Retrospective Studies; Trophoblasts

beta-HCG (human chorionic gonadotropin) values of over 2500 I.U./l are associated with higher failure rates for therapy with prostaglandin F2 alpha in tubal pregnancies. The purpose of our study was to ascertain if the 2500 I.U./l limit correlates with histopathology. We therefore compared the pre-operative beta-HCG-values and intraluminal and extraluminal trophoblast growth in tubal pregnancy. Purely intraluminal trophoblast was significantly more frequent in patients of group I (beta-HCG < 2500 I.U./l), while group II patients (beta-HCG > 2500 I.U./l) almost exclusively had extraluminal growth (P = 0.0045). Since the efficacy of prostaglandin F2 alpha therapy depends on intact tubal musculature the correlation of the beta-HCG threshold level with histopathologic findings may explain the high failure rate in patients with beta-HCG values above 2500 I.U./l.

Topics: Chorionic Gonadotropin; Chorionic Gonadotropin, beta Subunit, Human; Dinoprost; Fallopian Tubes; Female; Humans; Peptide Fragments; Pregnancy; Pregnancy, Tubal; Treatment Outcome; Trophoblasts

We report on a tubal pregnancy treated with prostaglandin F2 alpha locally. Falloposcopy two years afterwards showed multiple, non obstructive adhesions of the tubal epithelium.

Topics: Adult; Dinoprost; Endoscopes; Fallopian Tubes; Female; Humans; Injections, Intralesional; Pregnancy; Pregnancy, Tubal

Concentrations of beta-human chorionic gonadotrophin (HCG) of 2500 IU/l are generally considered to be maximal for successful drug therapy of tubal pregnancies [instillation of prostaglandin-F2 alpha (PGF2 alpha) or hyperosmolar glucose]. The purpose of our study was to ascertain if there was an association between the significantly higher failure rates above this threshold value and the histologically determined anatomopathological substratum. We therefore evaluated the impact of trophoblast penetration through the basal membrane of the Fallopian tube on the efficacy of drug therapy. Pre-operative serum beta-HCG concentrations were compared with the histologically determined trophoblast penetration, distinguishing between ectopic pregnancies with intra-luminal growths up to the myosalpinx, and those with extra-luminal growths going beyond the basal membrane and penetrating the myosalpinx. Basic data were obtained from a group of patients who received primary surgical treatment but it had never been the intention for them to receive drug therapy (independently of their initial beta-HCG values; group I, n = 43). These reference data were compared with the findings in preparations from another group of patients obtained during secondary surgical intervention, performed to achieve final cure of tubal pregnancy after failure of primary PGF2 alpha instillation (group II, n = 30). Group I patients showed a significantly higher rate of intra-luminal trophoblast growths (P = 0.0001) at beta-HCG values < 2500 IU/l; above this threshold value, extra-lumina spread was found significantly more often (P = 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Chorionic Gonadotropin; Differential Threshold; Dinoprost; Female; Humans; Pregnancy; Pregnancy, Tubal; Treatment Outcome; Trophoblasts

The purpose of the study was to evaluate the effects of drug therapy on the throphoblast and on the tubal wall when protaglandin F2 alpha (PGF2 alpha) was administered in cases of tubal pregnancies. 42 patients were divided into two groups: women of group I (n = 30) were secondarily treated by surgery because of raising serum HCG levels. Group II (n = 12) consisted of patients who were operated on because of acute symptoms (abdominal pains, intraabdominal haemorrhage), despite already failing HCG values. In group I in 66% (n = 20) of the histological specimens an intact (vital) trophoblast was found. Five cases (17%) showed partly necrotic gestational tissue, whereas in another five cases (17%) the whole trophoblast was necrotic. In patients of group II all ectopic pregnancies showed histological signs of necrosis. In the histopathology of the Fallopian tubes no signs of trophic regression could be found. However, ten out of 22 cases showed ruptured tubal pregnancies. In this analysis we could show that the instillation of PGF2a electively destroys the ectopic trophoblast and does not exercise any necrotic action on the tubal wall.

Topics: Abortifacient Agents, Nonsteroidal; Adult; Combined Modality Therapy; Dinoprost; Fallopian Tubes; Female; Humans; Injections, Intralesional; Laparoscopy; Necrosis; Pregnancy; Pregnancy, Tubal; Rupture, Spontaneous; Trophoblasts

As local drug treatment grew more common, the risk of persisting trophoblast remnants increased in tubal pregnancies treated in this way. We studied the secondary surgical measures in 52 patients, who had to undergo surgery for a second time after tubal pregnancy treated with prostaglandins. The indication for revision was arrived at 30 times on the basis of laboratory parameters (increasing or constant beta-HCG) (Group I). Reoperation had to be performed 22 times because of acute clinical symptoms (Group II). Laparotomy was performed 40 times, repelviscopy 12 times. In patients of Group I, the rate of rupture, that, had already occurred at the time of secondary surgery, was significantly smaller (p < 0.0001); in that case secondary surgery was significantly more often successful (p < 0.06) in preserving the tubes. In case of constant beta-HCG values 11 patients (50% of Group II) developed acute symptoms; another 7 patients (31.8%) also had to be reoperated on due to acute complaints, although the values were already clearly reduced. The study proves, that tubal pregnancies can be reoperated with preservation of the tubes even after unsuccessful prostaglandin therapy. The starting position for secondary surgery with preservation of the tubes is much better before acute clinical symptoms occur.

Topics: Adult; Chorionic Gonadotropin; Chorionic Gonadotropin, beta Subunit, Human; Dinoprost; Female; Humans; Laparoscopy; Peptide Fragments; Pregnancy; Pregnancy, Tubal; Reoperation; Retrospective Studies; Treatment Failure

Topics: Chorionic Gonadotropin; Chorionic Gonadotropin, beta Subunit, Human; Dinoprost; Female; Humans; Laparoscopy; Peptide Fragments; Pregnancy; Pregnancy, Tubal; Retrospective Studies; Salpingostomy

Laparoscopic injection has become an important tool in tubal pregnancy. Intratubal injection of 5 mg of prostaglandin F2 alpha (PG F2 alpha) was successful at a serum human chorionic gonadotropin (hCG) level of more than 2500 mlU/ml. Intrauterine pregnancy occurred 112 days after laparoscopic treatment, during earlier removal of the contralateral tube.

Topics: Adult; Chorionic Gonadotropin; Combined Modality Therapy; Dilatation and Curettage; Dinoprost; Fallopian Tubes; Female; Humans; Infant, Newborn; Injections, Intralesional; Laparoscopy; Male; Ovarian Cysts; Ovariectomy; Postoperative Complications; Pregnancy; Pregnancy, Tubal

Topics: Dinoprost; Fallopian Tubes; Female; Humans; Pregnancy; Pregnancy, Tubal

Topics: Chorionic Gonadotropin; Chorionic Gonadotropin, beta Subunit, Human; Dinoprost; Female; Glucose Solution, Hypertonic; Humans; Injections, Intralesional; Laparoscopy; Methotrexate; Peptide Fragments; Pregnancy; Pregnancy, Tubal

Topics: Adult; Dinoprost; Endoscopes; Endoscopy; Fallopian Tubes; Female; Humans; Pregnancy; Pregnancy, Tubal; Ultrasonography

The activity of the corpus luteum, the endometrium and the trophoblast was studied after local medical treatment of 31 women with tubal pregnancy. We measured the serum concentration of progesterone, the secretory endometrial protein placental protein 14 (PP14), and human chorionic gonadotrophin (HCG) before and after treatment by injection of prostaglandin F2 alpha into the site of the gestation and into the corpus luteum. There was no significant difference in the pre-treatment serum progesterone and serum PP14 concentrations of 26 women who were treated successfully and of five women, who were operated on after failure of the treatment. After the prostaglandin treatment the serum progesterone and PP14 concentrations decreased simultaneously with the serum HCG concentration or remained at a low, constant concentration. We conclude that measurement of serum progesterone and PP14 cannot be used for selection of patients for treatment by prostaglandin F2 alpha or for monitoring the effect of the treatment. The injection of prostaglandin into the ovary has either no effect on the activity of the corpus luteum or induces only a partial luteolysis.

Topics: Adult; Chorionic Gonadotropin; Corpus Luteum; Dinoprost; Endometrium; Female; Glycodelin; Glycoproteins; Humans; Kinetics; Pregnancy; Pregnancy Proteins; Pregnancy, Tubal; Progesterone; Trophoblasts

Nineteen patients with confirmed tubal pregnancy and constant or rising plasma beta-human chorionic gonadotropin (beta-hCG) levels were treated with laparoscopically guided injection of prostaglandin F2 alpha into the oviduct. Fifteen patients received additional prostaglandin E2 during three consecutive postoperative days. One patient was excluded from the study. The treatment was defined as successful when plasma beta-hCG levels declined below the lower detection limit and no further intervention other than prostaglandin application was required. The treatment was successful in 12 patients (66.7%). Given a beta-hCG level greater than 2,500 mU/mL as an exclusion criterion for treatment with prostaglandin, the success rate was 84.6%. Six patients underwent salpingotomy because of rising beta-hCG levels following treatment. The outcome was not related to the postoperative treatment with prostaglandin E2. None of the treated patients displayed any adverse reactions following prostaglandin F2 alpha application. Postoperative hysterosalpingography was performed on six successfully treated patients, demonstrating bilaterally patent fallopian tubes in all of them. Prostaglandin therapy in tubal pregnancy has been proven effective in selected cases.

Topics: Chorionic Gonadotropin; Dinoprost; Dinoprostone; Drug Therapy, Combination; Female; Humans; Hysterosalpingography; Laparoscopy; Postoperative Care; Pregnancy; Pregnancy, Tubal; Prospective Studies; Treatment Outcome

Topics: Adult; Dinoprost; Dose-Response Relationship, Drug; Drug Administration Schedule; Fallopian Tubes; Female; Humans; Injections; Insemination, Artificial, Homologous; Laparoscopy; Methotrexate; Pregnancy; Pregnancy, Tubal; Rupture, Spontaneous

Topics: Blood Flow Velocity; Dinoprost; Fallopian Tubes; Female; Humans; Injections, Intralesional; Laparoscopy; Pregnancy; Pregnancy, Tubal; Ultrasonography

Topics: Chorionic Gonadotropin; Chorionic Gonadotropin, beta Subunit, Human; Dinoprost; Dinoprostone; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Therapy, Combination; Fallopian Tubes; Female; Humans; Injections; Injections, Intramuscular; Peptide Fragments; Pregnancy; Pregnancy, Tubal

Over the past years laparoscopic surgery has become widely accepted in the treatment of tubal pregnancy and instillation of prostaglandin is well established. However, the failure rate is around 20%. This report describes a case of tubal pregnancy treated according to this procedure where the therapy initially seemed to be successful. Instillation of prostaglandin F2 alpha was followed by decreasing beta-HCG values, which continued to decrease after discharge. Thus, rupture of the operated tube on day 17 after surgery was completely unexpected.

Topics: Adult; Chorionic Gonadotropin; Chorionic Gonadotropin, beta Subunit, Human; Dinoprost; Dinoprostone; Fallopian Tube Diseases; Female; Humans; Injections, Intralesional; Injections, Intramuscular; Laparoscopy; Peptide Fragments; Postoperative Complications; Pregnancy; Pregnancy, Tubal; Rupture, Spontaneous

The present study reports on new treatment of tubal pregnancies by laparoscope-guided intratubal injection of prostaglandin F2 alpha into the affected tube. In 9 cases treated with PG, the method proved to be successful in 89%, as indicated by reduction of human chorionic gonadotropin (hCG) serum values to less than 20 IU/l. Preoperative serum hCG levels were 137 to 2520 IU/l (mean 1170 IU/l). In 8 women the serum concentration of beta hCG decreased to less than 20 IU/l in a mean time of 12.3 days. One woman needed surgical intervention 8 days after treatment as she continued to have abdominal pain. Hysterosalpingography 3 to 6 months after treatment showed tubal patency on the side of the pregnancy in two of three women who were examined. It is concluded that local prostaglandin F2 alpha treatment is a suitable method for termination of some tubal pregnancies.

Topics: Adult; Chorionic Gonadotropin; Dinoprost; Female; Humans; Laparoscopy; Pregnancy; Pregnancy, Tubal

The injection of different substances into early, unruptured tubal pregnancies is increasingly advocated. In this study, fertility was evaluated after treatment of tubal pregnancy by means of prostaglandins. The overall tubal patency rate was 86.4% and 14 of 20 patients (70%) could subsequently achieve pregnancy.

Topics: Abortifacient Agents, Nonsteroidal; Adolescent; Adult; Dinoprost; Dinoprostone; Drug Therapy, Combination; Fallopian Tubes; Female; Follow-Up Studies; Humans; Hysterosalpingography; Infant, Newborn; Injections, Intramuscular; Laparoscopy; Pregnancy; Pregnancy, Tubal

In a study, the clinical use of prostaglandin F2 alpha in local and systemic application in women with ectopic pregnancies were studied (1, 9). Two different treatment schedules were defined and applied. In group A, patients with a diagnosed ectopic and beta-HCG level lower than 850 mIU/ml were treated with prostaglandin F2 alpha i.m. injected only. In group B, prostaglandin F2 alpha were injected in the chorionic cavity of the ectopic by laparoscopy after localisation with a thin needle. In spite of prostaglandin F2 alpha treatment, 6 of 30 patients (20.0%) had to be operated by microsurgery because of increasing serum beta-HCG levels. A control of tubal patency 6 month later showed one closed tube only (4.5%). Up to now, 8 spontaneous intrauterine pregnancies occurred in our study groups after successful prostaglandin F2 alpha treatment; one pregnancy was seen in a women with a single fallopian tube. The conserving treatment of one ectopic pregnancy using prostaglandin F2 alpha yields positive results, if serum beta-HCG levels are below 2000 mIU/ml.

Topics: Abortifacient Agents, Nonsteroidal; Adult; Chorionic Gonadotropin; Chorionic Gonadotropin, beta Subunit, Human; Dinoprost; Dinoprostone; Drug Therapy, Combination; Fallopian Tube Patency Tests; Fallopian Tubes; Female; Follow-Up Studies; Humans; Injections; Injections, Intramuscular; Peptide Fragments; Pregnancy; Pregnancy, Tubal

Topics: Adult; Chorionic Gonadotropin; Chorionic Gonadotropin, beta Subunit, Human; Dinoprost; Female; Humans; Laparoscopy; Peptide Fragments; Pregnancy; Pregnancy, Tubal

Uncomplicated tubal pregnancies were treated by local injection of methotrexate (25 to 50 mg) and PGF2 alpha (5 to 10 mg). Trophoblastic resorption occurred in 50 (96.1%) of 52 patients within 20 days after treatment and without side effects. Three months after treatment, the affected tube was patent in 43 (91.4%) of 47 patients continuing in the study, and the subsequent intrauterine pregnancy rate was 40.4%. The combined use of methotrexate and PGF2 alpha appears to be a promising treatment for tubal pregnancy and should be evaluated further.

Topics: Dinoprost; Embryo Loss; Fallopian Tube Patency Tests; Fallopian Tubes; Female; Follow-Up Studies; Humans; Injections; Methotrexate; Pregnancy; Pregnancy, Tubal

Topics: Adult; Dinoprost; Fallopian Tubes; Female; Humans; Hysteroscopy; Injections; Pregnancy; Pregnancy, Tubal

Topics: Dinoprost; Female; Humans; Pregnancy; Pregnancy, Tubal; Risk

Thirty women who had a small unruptured tubal pregnancy were treated by laparoscopically guided injection of prostaglandin F2 alpha into the oviduct and into the corpus luteum. They had no side effects. The serum human chorionic gonadotropin (S-HCG) concentration decreased in 25 women to less than 20 IU/l in a median time of 8 days (range 1-45). Five women were operated on because of increasing S-HCG concentration. The median diameter of the oviduct at the site of the gestation, the tubal localisation and the gestational age was similar in the women treated by prostaglandin and those, who were operated on after failure of the procedure. Four of the 6 women, with S-HCG concentrations of more than 2000 IU/l, needed subsequent operative treatment, compared to only one of 24 with a lower concentration. The median duration of the hospital stay after treatment was 2 days for the group of women with a S-HCG concentration of less than 2000 IU/l. Hysterosalpingography 3 months after treatment showed patency on the side of the pregnancy in 12 of 14 women. Prostaglandin injection seems to be an appealing option for the treatment of selected ectopic pregnancies.

Topics: Animals; Chorionic Gonadotropin; Corpus Luteum; Dinoprost; Fallopian Tube Patency Tests; Fallopian Tubes; Female; Gestational Age; Humans; Injections; Laparoscopy; Pregnancy; Pregnancy, Tubal

Topics: Adult; Dinoprost; Fallopian Tubes; Female; Humans; Injections; Laparoscopy; Pregnancy; Pregnancy, Tubal; Rupture, Spontaneous

Two cases of tubal pregnancy are presented. Both were treated successfully with hysteroscopic tubal instillation of prostaglandin F2 alpha.

Topics: Adult; Dinoprost; Female; Humans; Hysteroscopy; Pregnancy; Pregnancy, Tubal

Fifteen patients with laparoscopically diagnosed tubal pregnancy and constant or rising plasma beta-hCG levels were treated with prostaglandin F2 alpha and prostaglandin E2. Prostaglandin F2 alpha (5 mgms diluted in 10 cc of isotonic sodium solution) was injected transabdominally with a 22 gauge spinal needle during laparoscopy into the Fallopian tube. Prostaglandin E2 (500 micrograms ms) was given intramuscularly during three consecutive postoperative days. The treatment was defined as successful if plasma beta-hCG levels declined below the lower limit of detection and no further intervention other than prostaglandin application was required. The treatment was successful in eight patients. Six patients underwent laparotomy and salpingotomy because of rising beta-hCG levels. None of the treated patients displayed any adverse reactions following prostaglandin F2 alpha application. One patient underwent explorative laparotomy during the second postoperative day because of lower abdominal pain. During operation, no pathological change could be found. This patient was excluded from the study. In the group treated successfully (n = 8) seven out of eight patients had beta-hCG levels below 2500 mlU/ml preoperatively. In the unsuccessfully treated group (n = 6), four out of six patients had beta-hCG levels above 2500 mlU/ml preoperatively. Mean duration of beta-hCG decline to 10 percent of the maximum preoperative value was 15.8 +/- 8.64 days (mean +/- S.D.). Postoperatively, hysterosalpingography was performed in six out of eight successfully treated patients after three menstrual cycles (one patient had an intrauterine pregnancy, one patient refused written consent). The Fallopian tubes were patent bilaterally in all six patients.

Topics: Abortifacient Agents; Abortifacient Agents, Nonsteroidal; Chorionic Gonadotropin; Chorionic Gonadotropin, beta Subunit, Human; Dinoprost; Dinoprostone; Female; Humans; Hysterosalpingography; Laparoscopy; Oximetry; Peptide Fragments; Pregnancy; Pregnancy, Tubal; Prospective Studies

The incidence of tubal pregnancy has increased markedly over the past years. Reasons for this are increased infections of and operations on the tubes and also improved diagnosis of the condition. The development of sensitive pregnancy tests, a constant improvement in ultrasound, introduction of laparoscopy and last, but not least, an increase in the degree of awareness amongst the general public have led to a much earlier diagnosis of tubal pregnancies. Therefore, it is possible to treat tubal pregnancies in a more conservative fashion operatively but also medically.

Topics: Dinoprost; Fallopian Tubes; Female; Humans; Injections; Laparoscopy; Luteolytic Agents; Pregnancy; Pregnancy Tests; Pregnancy, Tubal; Time Factors; Ultrasonography

Topics: Dinoprost; Female; Humans; Pregnancy; Pregnancy, Tubal

Topics: Dinoprost; Dose-Response Relationship, Drug; Female; Humans; Pregnancy; Pregnancy, Tubal; Risk Factors

The present paper reports on the treatment of 30 tubal pregnancies verified by laparoscopy by means of intratubal prostaglandin (PG) F2a and systemic PG E2. Tubal pregnancy was successfully treated in 25 patients; three patients exhibited side effects. The comparison with surgical management showed better results concerning the tubal patency in the PG-treated group. Further studies should clarify whether this technically simple procedure is superior to the existing methods.

Topics: Chorionic Gonadotropin; Chorionic Gonadotropin, beta Subunit, Human; Dinoprost; Dinoprostone; Fallopian Tubes; Female; Humans; Injections; Laparoscopy; Peptide Fragments; Pregnancy; Pregnancy, Tubal

Topics: Corpus Luteum; Dinoprost; Dinoprostone; Drug Therapy, Combination; Estrogens, Conjugated (USP); Fallopian Tubes; Female; Humans; Injections, Intramuscular; Laparoscopy; Pregnancy; Pregnancy, Tubal

Due to improved diagnosis most tubal pregnancies are detected today before tubal rupture. Therefore various conservative treatment modalities have been described lately. In the present study 73 cases of unruptured tubal pregnancies are described that where treated with local and systemic PG application. With an initial beta-hCG level of below 2,500 mIU/ml serum, 45 of 53 cases could be treated successfully without classical operation. With an initial beta-hCG above 2,500 mIU/ml serum the results were less satisfactory. Hysterosalpingography controls showed that almost all pertinent tubes are patent after such treatment.

Topics: Abortifacient Agents, Nonsteroidal; Corpus Luteum; Dinoprost; Dinoprostone; Drug Therapy, Combination; Estrogens, Conjugated (USP); Female; Humans; Injections, Intramuscular; Injections, Intraperitoneal; Laparoscopy; Pilot Projects; Pregnancy; Pregnancy, Tubal

A variety of conservative surgical techniques is available for the termination of ectopic pregnancy with preservation of the tube. We report on a new treatment by means of intratubal prostaglandin F2 alpha application followed by intramuscular administration of a prostaglandin E2 derivative (sulprostone) for 3 days. Only 5 of the 30 patients enrolled had to undergo laparotomy later. The results were compared with those obtained by different surgical procedures during the 2 preceding years. Hysterosalpingography was performed in 12 patients of the prostaglandin treated group and 14 of the surgically treated group. Tubal patency was demonstrated in 11 patients of the PG group but only in two patients of the surgically treated group.. Injection of PGF2alpha intratubally, with other conservative management, was compared in 30 consecutive women with proven ectopic pregnancy, to 100 prior women treated surgically. The patient group were all 45 admitted after November 1987 to University of Vienna Hospital with suspected ectopic pregnancy, later proven in 30 by history, positive hCG, ultrasound and laparoscopy; the controls were 74 confirmed cases out of 101 suspected ectopic pregnancies admitted from January 1986- October 1987. They were treated with 5 or 10 mg PGF2alpha (Miniprostin F2alpha, Upjohn, Vienna), injected transabdominally with a 17-gauge needle, during laparoscopic visualization. In 6 patients, 2-3 mg Pgf2alpha was injected into the corpus luteum, but this practice was discontinued when 3 developed tachycardia, hypertension and extrasystole. 25 mg estrogen was injected into the ovary as a luteolytic subsequently. Most women also received PGE2 (Sulprostone, Schering, Berlin) twice daily im, although 4 could not tolerate side effects of nausea and vomiting. All women had hCG levels daily. 5 were treated by laparotomy because of rising hCG or clinical indications. In the control group 74 (73.3%) had laparotomy, and of these, 39 had total or partial salpingectomy, and 21 salpingotomy. Hysterosalpingography demonstrated tubal patency in 11 of 12 PG treated women tested to date; in contract, of 14 of the controls tested, none had patent tubes. 4 of the PG group have since conceived and delivered term infants. The benefits of this conservative method of treating ectopic pregnancy are apparent in the reduced morbidity, shorter hospital stay, simpler treatment technique, lower costs, and especially the higher rate of subsequent tubal patency and fertility.

Topics: Abortifacient Agents; Abortifacient Agents, Nonsteroidal; Dinoprost; Dinoprostone; Fallopian Tubes; Female; Humans; Hysterosalpingography; Pregnancy; Pregnancy, Tubal

A total of 41 patients with tubal pregnancies were treated by means of prostaglandin F2 alpha injected transabdominally into the fallopian tube. Hysterosalpingography showed tubal patency in 12 of 14 women. One intrauterine pregnancy most likely occurred via the prostaglandin-treated tube 3 months after treatment.

Topics: Dinoprost; Female; Humans; Pregnancy; Pregnancy, Tubal

Topics: Abortion, Induced; Dinoprost; Female; Humans; Pregnancy; Pregnancy, Tubal; Prostaglandins F

The recent trend towards conservative management of tubal pregnancies, as well as first reports on the efficacy of systemic or local administration of prostaglandins prompted us to investigate the therapeutic effect of PGF2 alpha injected directly into a non-ruptured tubal pregnancy, followed by systemic administration of a synthetic longer-acting PGE 2 derivative for 3 days. Serial determinations of hormone parameters in the follow up of this patient verified that this combination treatment is capable of dealing with tubal pregnancy without further surgical treatment. Hysterosalpingography performed 6 weeks afterwards showed tubal patency on both sides.

Topics: Administration, Topical; Adult; Dinoprost; Fallopian Tubes; Female; Follow-Up Studies; Humans; Laparoscopy; Pregnancy; Pregnancy, Tubal; Prostaglandins F

The present study reports on the treatment of 6 tubal pregnancies established by laparoscopy intratubal PGF2 alpha injection accompanied PGE2 applied systemically. The method was successful in all cases avoiding the usual surgical procedure. Concerning the side effects one patient exhibited higher postoperative temperature, whilst another showed hypertony and tachycardia immediately after PGF2 alpha injection which lasted a few minutes. Further studies should clarify whether this technically simple procedure is superior to the existing methods.

Topics: Corpus Luteum; Dinoprost; Dinoprostone; Drug Therapy, Combination; Fallopian Tubes; Female; Humans; Injections; Injections, Intramuscular; Laparoscopy; Pregnancy; Pregnancy, Tubal; Prostaglandins E; Prostaglandins F

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