dinoprost and Uterine-Hemorrhage

When medical abortion was first introduced in China, prostaglandins (PGs) were used alone or in combination with Chinese herbs or steroid drugs, but the results were not satisfactory. Mifepristone is now produced in three companies in China and is commonly used with PGs for medical abortion.. We performed a Chinese- and English-language literature review of medical abortion in early pregnancy in China.. A large multicenter trial conducted in China showed that, when used with a PGF(2alpha) analogue, the complete abortion rate in women given multiple doses of mifepristone (total, 150 mg) was significantly higher than that in women given a single dose of 200 mg of mifepristone. Oral misoprostol (0.6 mg) with mifepristone is now the most commonly used regimen, with a complete abortion rate of over 93%. In China, medical abortion is currently restricted to pregnancies before 49 days, but some hospitals have recently extended the use of medical abortion to pregnancies beyond 49 days. Prolonged bleeding is the main medical abortion side effect and is more likely to occur if the blood levels of human chorionic gonadotrophin fall slowly or when the gestational sac is big. Prescription of testosterone propionate may reduce the duration of bleeding. Over 80% of Chinese women are satisfied with current medical abortion regimens and will choose medical abortion again if they need to terminate a future unwanted pregnancy.. Currently, medical abortion is a safe, efficient and acceptable method for the termination of early pregnancy in China.

Topics: Abortifacient Agents, Steroidal; Abortion, Induced; China; Chorionic Gonadotropin; Dinoprost; Female; Gestational Age; History, 20th Century; Humans; Mifepristone; Pregnancy; Uterine Hemorrhage

Postpartum atony with haemorrhage is a life-threatening condition which may necessitate surgical intervention with ligation of the ascending arterial branches or hysterectomy. On the basis of the literature, recent medical treatment with the prostaglandins F2 alpha and E2 is reviewed. When this treatment was employed, surgical intervention could be avoided in 60-100% of the cases which did not respond to ordinary treatment for atony. The forms of administration, which may be intravenous, intramuscular, intravaginal or injection into the myometrium, are discussed. In addition, the dosage, choice of prostaglandin and the contraindications of treatment are reviewed. It is concluded that prostaglandin treatment should be considered prior to surgical treatment and that the possibilities of obtaining prostaglandin rapidly should be present in all maternity departments.

Topics: Dinoprost; Dinoprostone; Female; Humans; Pregnancy; Puerperal Disorders; Uterine Contraction; 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

The comparative safety of methods used to perform second-trimester abortion is an important public health concern. Morbidity and mortality studies have indicated that dilation and evacuation (D&E) is safer than instillation abortion, which is safer than hysterotomy and hysterectomy. In the third phase of the Joint Program for the Study of Abortion, the adjusted relative risk of serious complications associated with the intraamniotic instillation of urea and prostaglandin F2 alpha (the safest abortifacient regimen) was 1.9 times that associated with D&E (95% confidence interval, 1.2-3.1). An analysis of abortion mortality in the United States from 1972 to 1981 revealed a death-to-case rate of 4.9 per 100,000 abortions associated with D&E, 9.6 with instillation methods and over 60 with hysterotomy and hysterectomy. Little information exists concerning potential late sequelae of second-trimester abortion. D&E appears to be the safest method of second-trimester abortion available in the United States.. The comparative safety of methods used to perform 2nd-trimester abortion is an important public health concern. Morbidity and mortality studies have indicated that dilation and evacuation (D&E) is safer than instillation abortion, which is safer than hysterotomy and hysterectomy. In the 3rd phase of the Joint Program for the Study of Abortion, the adjusted relative risk of serious complications associated with the intraamniotic instillation of urea and prostaglandin F2alpha (the safest abortifacient regimen) was 1.9 times that associated with D&E (95% confidence interval, 1.2-3.1). An analysis of abortion mortality in the US from 1972-81 revealed a death-to-case rate of 4.9/100,000 abortions associated with D&E, 9.6 with instillation methods and over 60 with hysterotomy and hysterectomy. Little information exists concerning potential late sequelae of 2nd-trimester abortion. D&E appears to be the safest method of 2nd-trimester abortion available in the US.

Topics: Abortion, Induced; Abortion, Legal; Amnion; Blood Coagulation Disorders; Dilatation; Dilatation and Curettage; Dinoprost; Embolism, Amniotic Fluid; Female; Fever; Humans; Hysterectomy; Postoperative Complications; Pregnancy; Pregnancy Trimester, Second; Prostaglandins F; Risk; Saline Solution, Hypertonic; United States; Urea; Uterine Hemorrhage

A multicentre randomized open clinical trial was conducted to compare the efficacy and side effects of two regimens of mifepristone with misoprostol, and mifepristone with PG05 for termination of early pregnancy (amenorrhoea < = 49 days). Six-hundred women in early pregnancy, who requested medical abortion were randomly allocated into 3 groups. In group 1 (n = 301), an initial dose of mifepristone 50 mg was given, followed by 25 mg every 12 hours up to a total dose of 150 mg mifepristone, plus a single oral dose of misoprostol 600 micrograms in the morning of the third day. In group 2 (n = 150), the same regimen of mifepristone was given, but dl-15-methyl PGF2 alpha (PG05) 1 mg vaginal suppository was inserted on the third day. In group 3 (n = 149), a single dose of mifepristone 200 mg was given and misoprostol 600 micrograms was used as in group 1. The complete abortion rate were 94.4%, 97.3%, and 94.6% for group 1, 2 and 3, respectively. 3.0, 2.0 and 2.7% of women had incomplete abortion, and 1.7, 0.7 and 2.0% of women in the 3 groups were treatment failures; in the remaining 1% in group 1 and 0.7% in group 3, treatment outcome could not be determined. There were no significant differences among the 3 groups. Lower abdominal pain was the main complaint which was reported by 82% of the subjects after PGs administration. The incidence of diarrhoea in PG05 group (38.7%) was significantly higher than that in the other two groups (21.6 and 20.1%) (P < 0.001), and so was vomiting. It was concluded that misoprostol, as an orally effective prostaglandin, in combination with mifepristone for induced abortion of early pregnancy was as effective as PG05 vaginal suppository. Besides, it has advantages of convenience of use, less side effects, easy storage and transfer, and low cost.

Topics: Abdominal Pain; Abortion, Induced; Administration, Oral; Adolescent; Adult; China; Diarrhea; Dinoprost; Dose-Response Relationship, Drug; Female; Humans; Mifepristone; Misoprostol; Pessaries; Pregnancy; Pregnancy Trimester, First; Uterine Hemorrhage

Because of their safety and efficacy, long-term progestin-only contraceptives (LTPOCs) are well-suited for women with restricted access to health care. However, abnormal uterine bleeding (AUB) causes half of all users to discontinue therapy within 12 months. Endometria of LTPOC-treated patients display aberrant angiogenesis with abnormally enlarged, thin-walled, fragile blood vessels, inflammation, and focal hemorrhage. In this study, similar effects were observed with a new third-generation implantable LTPOC.. We hypothesized that LTPOC reduces uterine and endometrial blood flow, leading to hypoxia/reperfusion, which triggers the generation of reactive oxygen species. The latter induce aberrant angiogenesis, causing AUB.. Endometrial perfusion was measured by laser-Doppler fluxmetry in women requesting LTPOCs. Endometrial biopsies were obtained for in vivo and in vitro experiments.. The study was conducted in the Yale University School of Medicine and Family-Planning Center in Western Australia.. Seven women 18 yr or older requesting implantable LTPOCs were recruited in Western Australia.. Women received etonorgestrel implants.. LTPOC treatment resulted in reduced endometrial perfusion and increased endometrial oxidative damage.. We propose that LTPOCs result in hypoxia reperfusion, which leads to aberrant angiogenesis resulting in AUB.

Topics: Adult; Biopsy; Contraceptive Agents, Female; Desogestrel; Dinoprost; Endometrium; Endothelial Cells; Female; Humans; Immunohistochemistry; Laser-Doppler Flowmetry; Oxidative Stress; Progesterone Congeners; Tyrosine; Uterine Hemorrhage

We report the case of a 31-year-old woman who delivered twins by Caesarean section in whom atonic uterine haemorrhage developed 6 h postoperatively. During conservative treatment with the high-dose prostaglandin analogs sulprostone (PGE(2)) and dinoprost (PGF(2alpha)), acute pulmonary oedema and cardiac decompensation developed and, subsequently, the patient suffered cardiopulmonary arrest. After a 2h-period of cardiopulmonary resuscitation (CPR), it was possible to restore and stabilize circulation under the highest dose of catecholamines. Despite 2h of CPR, the patient was discharged from hospital 3 months later without any major physical or neurocognitive deficit.

Topics: Adult; Cardiopulmonary Resuscitation; Cesarean Section; Dinoprost; Dinoprostone; Female; Heart Arrest; Heart Failure; Heart Massage; Humans; Oxytocics; Postoperative Hemorrhage; Pregnancy; Pulmonary Edema; Uterine Contraction; Uterine Hemorrhage

The effects of uterotonic agents (oxytocin and enzaprost) on platelet aggregation in pregnant and nonpregnant women were studied by low-angle light scattering. In nonpregnant women oxytocin produced different effects on ADP-induced platelet aggregation: potentiation at low (<200 nM) and inhibition at high (>400 nM) ADP concentrations. In pregnant women oxytocin did not modulate ADP-induced platelet aggregation or this effect was negligible. Enzaprost competitively inhibited ADP-induced platelet aggregation in all examined women (inhibition constant 84.8+/-25.7 nM).

Topics: Adenosine Diphosphate; Dinoprost; Female; Humans; In Vitro Techniques; Labor, Obstetric; Oxytocics; Oxytocin; Platelet Activation; Platelet Aggregation; Pregnancy; Uterine Hemorrhage

This article is about usage prostaglandins to fight against bleeding and haemorrhage from uterus in climacteric period. Prostaglandins are used widely by gynecologist and obstetrics as most powerful contracting drugs, namely in this situations when we observe returning, plentiful bleeding from uterus. Women with climacteric bleeding had administer prostaglandins intravenous or immediate intra-cervix. They are very good drug, strongly and a long time hold up bleeding. This method give us time to better preparing patients to operation and diminish losses of blood. Side effects are small and not trouble. Prostaglandins are very simply in usage and characterise very good haemostatic effect, recognised faster then in typical methods like hormonal, mechanical antifibrinolytic etc.

Topics: Climacteric; Dinoprost; Female; Hemostasis, Surgical; Humans; Middle Aged; Uterine Hemorrhage

Obstetric hemorrhage may occur throughout pregnancy and the puerperium. The purpose of this study was to investigate the reactivity of isolated, suffused uterine arteries from obstetric patients with uncontrollable uterine bleeding and to compare those blood vessels with uterine arteries from patients undergoing cesarean hysterectomy for other medical reasons (control patients). The uterine arteries from the control patients (n = 9) responded with maximal or near-maximal constriction to norepinephrine (30 mumol/L, 3.6 +/- 1 gm), potassium chloride (75 mmol/L, 10.2 +/- 3 gm), prostaglandin F2 alpha (30 mumol/L, 1.8 +/- 1 gm), and arginine vasopressin (1 mumol/L, 18.8 +/- 2.6 gm). In uterine arteries from five patients with uncontrollable bleeding, the constrictor responses to the same drugs were markedly depressed: norepinephrine (30 mumol/L, 0.5 +/- 0.2 gm), potassium chloride (75 mmol/L, 1.9 +/- 0.8 gm); prostaglandin F2 alpha (30 mumol/L, 0 gm), and arginine vasopressin (1 mumol/L, 0.2 +/- 0.05 gm). Uterine arteries from two patients exhibited no constrictor responses to norepinephrine (30 mumol/L), potassium chloride (75 mmol/L), prostaglandin F2 alpha (30 mumol/L), or arginine vasopressin (1 mumol/L). The impaired responses to the vasoconstrictor drugs were not reversed by indomethacin (1 mumol/L), which is an inhibitor of prostaglandin synthetase; methylene blue (10 mumol/L), which is a blocker of endothelium-derived relaxing factor activation of guanylate cyclase; or propranolol (1 mumol/L), a beta-adrenergic receptor antagonist. The levels of adenosine 3':5'-cyclic monophosphate were not elevated in the uterine arteries from the patients with obstetric hemorrhage. The impaired reactivity to the multiple vasoconstrictors implies that a mechanism involved in constriction common to all of the constrictors is depressed or blocked. Furthermore, the depression or lack of reactivity of these isolated uterine arteries is not mediated by vasodilatory prostaglandins, endothelium-derived relaxing factor, beta-adrenergic receptors, or elevated levels of adenosine 3':5'-cyclic monophosphate. The results suggest that obstetric hemorrhage involves, in part, a lack of constrictor reactivity of the uterine vasculature.

Topics: Adult; Arginine Vasopressin; Arteries; Cesarean Section; Cyclic AMP; Dinoprost; Female; Humans; Hysterectomy; Norepinephrine; Potassium Chloride; Pregnancy; Pregnancy Complications, Cardiovascular; Uterine Hemorrhage; Uterus; Vasoconstriction

A woman underwent cesarean delivery for premature labor, breech presentation, and ruptured membranes. Placenta accreta associated with uterine atony and severe hemorrhage was diagnosed. Prostaglandin E1 instead of prostaglandin F2 alpha was inadvertently administered in an effort to control the hemorrhage. The resulting complications included profound hypotension, disseminated intravascular coagulation, and ventricular tachycardia.

Topics: Adult; Alprostadil; Dinoprost; Female; Humans; Medication Errors; Obstetric Labor, Premature; Placenta Accreta; Pregnancy; Uterine Hemorrhage; Uterine Inertia

Topics: Dinoprost; Dinoprostone; Embolization, Therapeutic; Female; Humans; Ligation; Ovary; Postpartum Hemorrhage; Pregnancy; Prostaglandins E; Prostaglandins F; Uterine Hemorrhage; Uterus

Topics: Abortifacient Agents; Alprostadil; Dinoprost; Dinoprostone; Female; Humans; Intestines; Pregnancy; Prostaglandins E; Prostaglandins E, Synthetic; Prostaglandins F; Prostaglandins, Synthetic; Urinary Bladder; Uterine Contraction; Uterine Hemorrhage

Although dilatation and evacuation (D&E) is currently the most common method of midtrimester abortion in the United States, the intra-amniotic instillation of hyperosmolar urea and prostaglandin F2 alpha combined (U-P) has been proposed as a safer technique. To evaluate the comparative safety of U-P and D&E, we analyzed 2,805 U-P and 9,572 D&E abortions at 13 to 24 menstrual weeks' gestation. The U-P procedure resulted in significantly more serious complications than D&E (1.03 v 0.49 per 100 abortions). After adjusting for patient age, race, parity, follow-up information, and preexisting conditions, the relative risk of serious complications associated with U-P was 1.9 (95% confidence interval, 1.2 to 3.1). This advantage for D&E stems from its applicability to the 13- to 16-week interval. Although D&E appears to be safer overall in the midtrimester, for women obtaining abortion after 16 weeks, the rates of serious complications were comparable, with a relative risk of 1.0 (95% confidence interval, 0.4 to 2.5).

Topics: Abortion, Induced; Amnion; Cervix Uteri; Dilatation and Curettage; Dinoprost; Endometritis; Female; Fever; Gestational Age; Humans; Hypertonic Solutions; Laminaria; Pregnancy; Pregnancy Trimester, Second; Prostaglandins F; Urea; Uterine Hemorrhage

The topography of prostaglandin (PG) E and F2 alpha receptors in uteri of premenopausal women was investigated by dividing uteri into six equal longitudinal strips and further dividing each strip into approximately 1-cm segments. Tissue for determination of smooth muscle content using the Trichrome stain was taken from each section, and the remainder was homogenized for binding studies with 3H-labeled PGs. The [3H] PGE1 binding (mean, 41.5 fmol/mg protein; range, 23.1-58.3) was about 8-fold greater in the fundus than [3H]PGF2 alpha binding (mean, 4.8 fmol/mg protein; range, 1.3-13.0), and this trend was found in most uterine sections. The binding of both 3H-labeled PGs decreased from fundus to cervix, and this decrease was similar to the decrease in smooth muscle content. Scatchard analysis revealed apparent dissociation constants (Kds) of 1.4 and 76 nM and apparent specific binding capacities (Ns) of 25 and 488 fmol/mg protein for [3H]PGE2, and Kd values of 11.5 and 81 nM and Ns values of 19.4 and 58 fmol/mg protein for [3H]PGF2 alpha in the uterine fundus. The Kd values for [3H]PGE2 were similar in other sections of the uterus, but the Ns values were smaller in the lower uterine body and cervical end. While the phase of the menstrual cycle did not influence [3H]PG binding, the diagnosis of abnormal uterine bleeding compared to dysmenorrhea was associated with an increase in [3H]PGE1 binding (P less than 0.05).

Topics: Adult; Dinoprost; Dysmenorrhea; Female; Genital Diseases, Female; Humans; Menstruation; Middle Aged; Muscle, Smooth; Prostaglandins E; Prostaglandins F; Receptors, Cell Surface; Receptors, Prostaglandin; Receptors, Prostaglandin E; Tissue Distribution; Urinary Incontinence, Stress; Uterine Hemorrhage; Uterus

By the application of the priming with 2.5 mg Minprostin F2 alpha a statistically provable dilatation of the cervix in comparison with another group can be achieved. But the priming does not yet effect the occurrence of early complications of the interruption in comparison with conventional methods. In is to be supposed that this method has got a protecting effect on the occurrence of latent late complications of the interruption. Because of the secondary effects of prostaglandins the indication for softening of the cervix should be applied to a very limited range of patients only.

Topics: Abortion, Induced; Adolescent; Adult; Cervix Uteri; Dinoprost; Female; Humans; Parity; Pregnancy; Prostaglandins F; Uterine Contraction; Uterine Hemorrhage; Vomiting

Authorities have suggested use of a combination of hyperosmolar urea and low-dose prostaglandin F2 alpha as a second-trimester intra-amniotic abortifacient to avoid the disadvantages of hypertonic saline solution. To examine the safety and efficacy of urea-prostaglandin compared with the instillation of saline solution, we analyzed data from a prospective multicenter study conducted in the United States between 1975 and 1978. Both agents were highly effective in producing an abortion. However, urea-prostaglandin had a significantly lower rate of serious complications when compared with saline solution (1.03 versus 2.18 per 100 abortions; p less than 0.001). Urea-prostaglandin also had a significantly shorter induction-to-abortion time (14.2 versus 25.6 hours; p less than 0.001). Urea-prostaglandin, therefore, appears to be superior to hypertonic saline solution as an abortifacient.

Topics: Abortifacient Agents; Abortion, Induced; Abortion, Legal; Adult; Dinoprost; Female; Humans; Pregnancy; Pregnancy Trimester, Second; Prospective Studies; Prostaglandins F; Saline Solution, Hypertonic; Sodium Chloride; Time Factors; Urea; Uterine Hemorrhage

Abortifacient effects of 16,16-dimethyl-trans delta 2-PGE1 methyl ester (ONO-802) were studied clinically. The uterine contractile effect of the agent was compared with those of PGF2 alpha and oxytocin (OXY) in the unanesthetized rabbit. 1. Intermittent intravaginal administration of ONO-802 was applied to 32 cases of legal abortion, 15 of missed abortion and 17 of hydatid mole. Eighty eight, 100 and 81 per cent of these patients resulted in abortion, respectively, with fewer side effects than those of natural PGs. 2. In the five groups of non- or pseudo-pregnant rabbits and those in their 7-9, 14-16 and 19-28 days in pregnancy, uterine contractile effects of these agents were assessed by both the contractile patterns and area of contractile curves of initial 5 minutes. The results are as follows: 1) In the non-pregnant rabbits, all of these agents revealed marked uterine contractile effect. 2) ONO-802 induced uterine contraction characterized by its wedge-shaped curves continued considerably longer than that induced by others. 3) ONO-802 revealed much stronger effect on uterine contraction in 7-9 day-of-pregnant rabbits. 4) Fourteen-16-day-of-pregnant rabbits were least influenced by the three agents as regards their uterine contraction in accordance with the highest progesterone levels in their sera among the three groups of pregnant rabbits.

Topics: Abortion, Missed; Abortion, Therapeutic; Alprostadil; Animals; Dinoprost; Female; Humans; Oxytocin; Pregnancy; Prostaglandins E, Synthetic; Prostaglandins F; Rabbits; Uterine Contraction; Uterine Hemorrhage

Prostaglandin F2 alpha, in doses varying from 1 to 5 mg was injected transabdominally, transvaginally or intraabdominally (during caesarean section) into the myometrium in ten patients affected by metrorrhagias not responsive to conventional uterotonic drugs. In all cases but one the result was excellent. Important side effects were observed in only one patient, because of the inadvertent intravascular injection of 5 mg Prostaglandin into the endocervix. An adequate treatment of this patient brought her to complete recovery in a short time. According to our experience, the intramyometrial injection of PGF2 alpha, in doses varying from 1 to 2 mg, is a simple, safe and effective method in the control of severe hemorrhage due to uterine atony not responding to conventional treatment.

Topics: Adolescent; Adult; Dinoprost; Female; Humans; Methylergonovine; Middle Aged; Myometrium; Oxytocin; Pregnancy; Pregnancy Complications, Cardiovascular; Prostaglandins F; Uterine Contraction; Uterine Hemorrhage

Early morbidity was studied in 466 primigravidae, following induced abortion by intermittent intra-uterine extra-amniotic application of PG F2 alpha. The rate of inflammatory complications was reduced from 8.2 to 3.4 per cent by reduced indwelling of the intra-uterine application probe. Correlations were found to exist also between time and method to complete interruption and infectious morbidity. Variation in application time depressed the number of incomplete abortions and called more often for additional mechanical dilatation of the cervix. The modified method proved to be sufficiently effective, the more as cost, need for personnel, and inflammatory morbidity were favourably affected.. Early morbidity was studied in 466 primigravidae following induced abortion by intermittent intrauterine extraamniotic application of prostaglandin F2alpha (PGF2alpha). The rate of inflammatory complications was reduced from 8.2-3.4% by reduced indwelling of the intrauterine application probe. Correlations were found to exist between time and method to complete interruption and infectious morbidity. Variation in application time depressed the number of incomplete abortions and resulted in more frequent need for mechanical dilatation of the cervix. The modified method proved to be sufficiently effective; cost, need for personnel, and inflammatory morbidity were favorably affected. (author's)

Topics: Abortifacient Agents; Abortifacient Agents, Nonsteroidal; Abortion, Induced; Adolescent; Adult; Cervix Uteri; Dinoprost; Endometritis; Female; Humans; Pregnancy; Prostaglandins F; Uterine Hemorrhage