oxytocin and Vomiting

Postpartum hemorrhage (PPH) increases the risk of maternal death worldwide. Heat-stable carbetocin, a long-acting oxytocin analog, is a newer uterotonic agent. Clinicians do not fully understand its side-effects, particularly the unanticipated side-effects. The aim of this study is to investigate the side-effects of carbetocin to PPH. The Cochrane Library, Web of Science, PubMed, Elsevier ScienceDirect, Embase, and ClinicalTrials.gov were searched from the inception to September 2020. Randomized controlled trials (RCTs) that considered pregnant women who received carbetocin before delivery and provided at least one adverse event were included. Statistical analysis included random or fixed-effect meta-analyses using relative risk. Stratified analyses and sensitivity analyses were also performed. Begger's and Egger's test and funnel plots were used to assess the publication bias. Seventeen RCTs involving 32,702 women were included, and all these studies ranked as medium- to high-quality. Twenty-four side-effects were reported. The use of carbetocin had a lower risk of vomiting in intravenously (0.53, 0.30 to 0.93) and cesarean birth (0.51, 0.32 to 0.81) women, and had a slightly higher risk of diarrhea (8.00, 1.02 to 62.79) compared with oxytocin intervention. No significant difference was found among other side-effects. Evidence from our systematic review and meta-analysis of 17 RCTs suggested that the risk of vomiting decreased with carbetocin use in the prevention of PPH after delivery.

Topics: Administration, Intravenous; Cesarean Section; Diarrhea; Drug-Related Side Effects and Adverse Reactions; Female; Humans; Oxytocics; Oxytocin; Postpartum Hemorrhage; Pregnancy; Randomized Controlled Trials as Topic; Vomiting

Postpartum haemorrhage (PPH) is the leading cause of maternal mortality worldwide. Prophylactic uterotonic drugs can prevent PPH, and are routinely recommended. There are several uterotonic drugs for preventing PPH but it is still debatable which drug is best.. To identify the most effective uterotonic drug(s) to prevent PPH, and generate a ranking according to their effectiveness and side-effect profile.. We searched Cochrane Pregnancy and Childbirth's Trials Register (1 June 2015), ClinicalTrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) for unpublished trial reports (30 June 2015) and reference lists of retrieved studies.. All randomised controlled comparisons or cluster trials of effectiveness or side-effects of uterotonic drugs for preventing PPH.Quasi-randomised trials and cross-over trials are not eligible for inclusion in this review.. At least three review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We estimated the relative effects and rankings for preventing PPH ≥ 500 mL and PPH ≥ 1000 mL as primary outcomes. We performed pairwise meta-analyses and network meta-analysis to determine the relative effects and rankings of all available drugs. We stratified our primary outcomes according to mode of birth, prior risk of PPH, healthcare setting, dosage, regimen and route of drug administration, to detect subgroup effects.The absolute risks in the oxytocin are based on meta-analyses of proportions from the studies included in this review and the risks in the intervention groups were based on the assumed risk in the oxytocin group and the relative effects of the interventions.. This network meta-analysis included 140 randomised trials with data from 88,947 women. There are two large ongoing studies. The trials were mostly carried out in hospital settings and recruited women who were predominantly more than 37 weeks of gestation having a vaginal birth. The majority of trials were assessed to have uncertain risk of bias due to poor reporting of study design. This primarily impacted on our confidence in comparisons involving carbetocin trials more than other uterotonics.The three most effective drugs for prevention of PPH ≥ 500 mL were ergometrine plus oxytocin combination, carbetocin, and misoprostol plus oxytocin combination. These three options were more effective at preventing PPH ≥ 500 mL compared with oxytocin, the drug currently recommended by the WHO (ergometrine plus oxytocin risk ratio (RR) 0.69 (95% confidence interval (CI) 0.57 to 0.83), moderate-quality evidence; carbetocin RR 0.72 (95% CI 0.52 to 1.00), very low-quality evidence; misoprostol plus oxytocin RR 0.73 (95% CI 0.60 to 0.90), moderate-quality evidence). Based on these results, about 10.5% women given oxytocin would experience a PPH of ≥ 500 mL compared with 7.2% given ergometrine plus oxytocin combination, 7.6% given carbetocin, and 7.7% given misoprostol plus oxytocin. Oxytocin was ranked fourth with close to 0% cumulative probability of being ranked in the top three for PPH ≥ 500 mL.The outcomes and rankings for the outcome of PPH ≥ 1000 mL were similar to those of PPH ≥ 500 mL. with the evidence for ergometrine plus oxytocin combination being more effective than oxytocin (RR 0.77 (95% CI 0.61 to 0.95), high-quality evidence) being more certain than that for carbetocin (RR 0.70 (95% CI 0.38 to 1.28), low-quality evidence), or misoprostol plus oxytocin combination (RR 0.90 (95% CI 0.72 to 1.14), moderate-quality evidence)There were no meaningful differences between all drugs for maternal deaths or severe morbidity as these outcomes were so rare in the included randomised trials.Two combination regimens had the poorest rankings for side-effects. Specifically, the ergometrine plus oxytocin combination had the higher risk for vomiting (RR 3.10 (95% CI 2.11 to 4.56), high-quality evidence; 1.9% versus 0.6%) and hypertension [RR 1.77 (95% CI 0.55 to 5.66), low-quality evidence; 1.2% versus 0.7%), while the misoprostol plus oxytocin combination had the higher risk for fever (RR 3.18 (95% CI 2.22 to 4.55), moderate-quality evidence; 11.4% versus 3.6%) when compare. Ergometrine plus oxytocin combination, carbetocin, and misoprostol plus oxytocin combination were more effective for preventing PPH ≥ 500 mL than the current standard oxytocin. Ergometrine plus oxytocin combination was more effective for preventing PPH ≥ 1000 mL than oxytocin. Misoprostol plus oxytocin combination evidence is less consistent and may relate to different routes and doses of misoprostol used in the studies. Carbetocin had the most favourable side-effect profile amongst the top three options; however, most carbetocin trials were small and at high risk of bias.Amongst the 11 ongoing studies listed in this review there are two key studies that will inform a future update of this review. The first is a WHO-led multi-centre study comparing the effectiveness of a room temperature stable carbetocin versus oxytocin (administered intramuscularly) for preventing PPH in women having a vaginal birth. The trial includes around 30,000 women from 10 countries. The other is a UK-based trial recruiting more than 6000 women to a three-arm trial comparing carbetocin, oxytocin and ergometrine plus oxytocin combination. Both trials are expected to report in 2018.Consultation with our consumer group demonstrated the need for more research into PPH outcomes identified as priorities for women and their families, such as women's views regarding the drugs used, clinical signs of excessive blood loss, neonatal unit admissions and breastfeeding at discharge. To date, trials have rarely investigated these outcomes. Consumers also considered the side-effects of uterotonic drugs to be important but these were often not reported. A forthcoming set of core outcomes relating to PPH will identify outcomes to prioritise in trial reporting and will inform futures updates of this review. We urge all trialists to consider measuring these outcomes for each drug in all future randomised trials. Lastly, future evidence synthesis research could compare the effects of different dosages and routes of administration for the most effective drugs.

Topics: Drug Therapy, Combination; Ergonovine; Female; Fever; Humans; Hypertension; Misoprostol; Network Meta-Analysis; Oxytocics; Oxytocin; Postpartum Hemorrhage; Vomiting

Postpartum haemorrhage (PPH) is the leading cause of maternal mortality worldwide. Prophylactic uterotonic agents can prevent PPH, and are routinely recommended. The current World Health Organization (WHO) recommendation for preventing PPH is 10 IU (international units) of intramuscular or intravenous oxytocin. There are several uterotonic agents for preventing PPH but there is still uncertainty about which agent is most effective with the least side effects. This is an update of a Cochrane Review which was first published in April 2018 and was updated to incorporate results from a recent large WHO trial.. To identify the most effective uterotonic agent(s) to prevent PPH with the least side effects, and generate a ranking according to their effectiveness and side-effect profile.. We searched the Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (24 May 2018), and reference lists of retrieved studies.. All randomised controlled trials or cluster-randomised trials comparing the effectiveness and side effects of uterotonic agents with other uterotonic agents, placebo or no treatment for preventing PPH were eligible for inclusion. Quasi-randomised trials were excluded. Randomised trials published only as abstracts were eligible if sufficient information could be retrieved.. At least three review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We estimated the relative effects and rankings for preventing PPH ≥ 500 mL and PPH ≥ 1000 mL as primary outcomes. Secondary outcomes included blood loss and related outcomes, morbidity outcomes, maternal well-being and satisfaction and side effects. Primary outcomes were also reported for pre-specified subgroups, stratifying by mode of birth, prior risk of PPH, healthcare setting, dosage, regimen and route of administration. We performed pairwise meta-analyses and network meta-analysis to determine the relative effects and rankings of all available agents.. The network meta-analysis included 196 trials (135,559 women) involving seven uterotonic agents and placebo or no treatment, conducted across 53 countries (including high-, middle- and low-income countries). Most trials were performed in a hospital setting (187/196, 95.4%) with women undergoing a vaginal birth (71.5%, 140/196).Relative effects from the network meta-analysis suggested that all agents were effective for preventing PPH ≥ 500 mL when compared with placebo or no treatment. The three highest ranked uterotonic agents for prevention of PPH ≥ 500 mL were ergometrine plus oxytocin combination, misoprostol plus oxytocin combination and carbetocin. There is evidence that ergometrine plus oxytocin (RR 0.70, 95% CI 0.59 to 0.84, moderate certainty), carbetocin (RR 0.72, 95% CI 0.56 to 0.93, moderate certainty) and misoprostol plus oxytocin (RR 0.70, 95% CI 0.58 to 0.86, low certainty) may reduce PPH ≥ 500 mL compared with oxytocin. Low-certainty evidence suggests that misoprostol, injectable prostaglandins, and ergometrine may make little or no difference to this outcome compared with oxytocin.All agents except ergometrine and injectable prostaglandins were effective for preventing PPH ≥ 1000 mL when compared with placebo or no treatment. High-certainty evidence suggests that ergometrine plus oxytocin (RR 0.83, 95% CI 0.66 to 1.03) and misoprostol plus oxytocin (RR 0.88, 95% CI 0.70 to 1.11) make little or no difference in the outcome of PPH ≥ 1000 mL compared with oxytocin. Low-certainty evidence suggests that ergometrine may make little or no difference to this outcome compared with oxytocin meanwhile the evidence on carbetocin was of very low certainty. High-certainty evidence suggests that misoprostol is less effective in preventing PPH ≥ 1000 mL when compared with oxytocin (RR 1.19, 95% CI 1.01 to 1.42). Despite the comparable relative treatment effects between all uterotonics (except misoprostol) and oxytocin, ergometrine plus oxytocin, misoprostol plus oxytocin combinations and carbetocin were the highest ranked agents for PPH ≥ 1000 mL.Misoprostol plus oxytocin reduces the use of additional uterotonics (RR 0.56, 95% CI 0.42 to 0.73, high certainty) and probably also reduces the risk of blood transfusion (RR 0.51, 95% CI 0.37 to 0.70, moderate certainty) when compared with oxytocin. Carbetocin, injectable prostaglandins and ergometrine plus oxytocin may also reduce the use of additional uterotonics but the certainty of the evidence is low. No me. All agents were generally effective for preventing PPH when compared with placebo or no treatment. Ergometrine plus oxytocin combination, carbetocin, and misoprostol plus oxytocin combination may have some additional desirable effects compared with the current standard oxytocin. The two combination regimens, however, are associated with significant side effects. Carbetocin may be more effective than oxytocin for some outcomes without an increase in side effects.

Topics: Drug Therapy, Combination; Ergonovine; Female; Fever; Humans; Hypertension; Misoprostol; Network Meta-Analysis; Oxytocics; Oxytocin; Postpartum Hemorrhage; Prostaglandins; Randomized Controlled Trials as Topic; Vomiting

The objective of this study is to compare the effectiveness and safety of carbetocin vs. oxytocin in the management of atonic post partum haemorrhage (PPH) after vaginal delivery.. A prospective randomised study was conducted in which 100 pregnant women were randomised into 2 equal groups: group 1 received Carbetocin 100 µgm (Pabal(®) Ferring, UK) and group 2 received oxytocin 5 IU (Syntocinon(®), Novartis, Switzerland).. The amount of blood loss and the need for other uterotonics were significantly lower in the carbetocin group (811 ± 389.17 vs. 1010 ± 525.66 and 10/50 vs. 21/50). There was no significant difference between the carbetocin and oxytocin groups regarding occurrence of major PPH (6 vs. 11), the need for blood transfusion (6 vs. 9), the difference between blood haemoglobin levels before delivery and 24 h after delivery (0.6 ± 0.28 vs. 0.56 ± 0.25), respectively. There was no significant difference between the 2 study groups regarding both systolic and diastolic blood pressure measured immediately after the drug administration and at 30 and 60 min later. Regarding the drugs side effects, there was no significant difference between the 2 groups in the occurrence of nausea, vomiting, tachycardia, flushing, dizziness, headache, shivering, metallic taste, dyspnea, palpitations and itching.. Carbetocin is a better alternative to oxytocin in management of atonic PPH with non-significant hemodynamic changes or side effects .

Topics: Adult; Blood Pressure; Delivery, Obstetric; Dizziness; Double-Blind Method; Female; Headache; Humans; Nausea; Oxytocics; Oxytocin; Postpartum Hemorrhage; Pregnancy; Prospective Studies; Switzerland; Treatment Outcome; Vertigo; Vomiting

To compare the effects of two different regimens of intravenous hydration and oral hydration on the duration of active labor.. Two hundred and ninety-three low risk term primigravida in active labor were randomized into three groups. The first group had 99 patients who received oral fluids only, the second group of 98 patients received intravenous Ringer lactate at the rate of 125 ml/h (IV 125 ml) and the third group had 96 patients who received intravenous Ringer lactate at a rate of 250 ml/h (IV 250 ml). Amniotomy and oxytocin administration were allowed according to the physician's discretion.. The mean duration of labor in the oral fluid group was 391, 363 min in the 125 ml/h group and 343 min in the 250 ml/h group, P = 0.203. The incidence of prolonged labor more than 12 h in the oral fluid group was 7.1% in the oral fluid group, 4.1% in the 125 ml/h group and 3.1% in the 250 ml/h group, P = 0.402. The oxytocin requirement was 37% in the oral group, 32% in the 125 ml/h group and 33% in the 250 ml/h group, P = 0.68. There was a statistically significant reduction in the incidence of vomiting in patients receiving intravenous hydration, i.e. 24.2% in the oral group, 11.2% in the 125 ml/h group and 6.3% in the 250 ml/h group, P = 0.001. There was no difference in the mode of delivery, maternal or neonatal complications between the three groups.. This study establishes a trend towards decreased incidence of prolonged labor and less vomiting in patients receiving intravenous hydration.

Topics: Administration, Oral; Adult; Body Water; Female; Fluid Therapy; Humans; Infusions, Intravenous; Isotonic Solutions; Labor, Obstetric; Oxytocics; Oxytocin; Parity; Pregnancy; Ringer's Lactate; Time Factors; Vomiting; Young Adult

To compare the impact of a dinoprostone vaginal insert and intravenous oxytocin in reducing blood loss of women undergoing vaginal or cesarean delivery.. This study was conducted among term singleton pregnancies delivered vaginally or by elective cesarean section. In the vaginally delivered cases, active management of the third stage of labor was conducted. During cesarean delivery, 20 IU of intravenous oxytocin was administered. Women, who either delivered via the vaginal or abdominal route, were then randomly allocated to receive 10 mg vaginal dinoprostone insert for 12 hours (group I, n: 100) or intravenous oxytocin (group II, n: 100), respectively.. Mean blood loss and need for additional uterotonics and postpartum hemoglobin and hematocrit levels at 24 and 36 hours after delivery did not differ between the two groups. Women allocated to the dinoprostone vaginal insert arm experienced more nausea and vomiting.. Dinoprostone vaginal insert was as effective as intravenous oxytocin in the prevention of postpartum blood loss.

Topics: Administration, Intravaginal; Adult; Delayed-Action Preparations; Delivery, Obstetric; Diarrhea; Dinoprostone; Female; Fever; Humans; Infusions, Intravenous; Nausea; Oxytocics; Oxytocin; Postpartum Hemorrhage; Pregnancy; Prospective Studies; Shivering; Vomiting

To observe the effect and safety of hemabat (H) on prevention of postpartum hemorrhage in cesarean section and after cesarean section in high risk pregnant women.. Four hundred and sixty-nine pregnant women with high hemorrhagic risk factors including twin pregnancy, polyhydramnios, fetal macrosomia, placenta previa were planned cesarean section. A total of 457 pregnant women were divided into 3 groups by operation indications. There were 239 cases of fetal macrosomia, 145 cases of twin pregnancy and polyhydramnios, and 73 cases of placenta previa. Three kinds of hysterotonics were used randomly in each group. Group oxytocin (O): 20 U oxytocin injected into the uterine plus 20 U oxytocin intravascularly, 152 women; Group oxytocin + hemabate (O + H): 20 U oxytocin and 250 microg hemabat injected into the uterine, 192 women; group H: 250 microg hemabat, injected into the uterine, 125 women. The amount of bleeding during the operation and within 2-hour after delivery were measured. The side effect of each group was observed.. The amount of bleeding during cesarean section in group O was (445 +/- 262) ml, in group O + H (332 +/- 218) ml, and in group H (375 +/- 265) ml. There was an extremely significant difference between group O and group O + H (P < 0.01). The amount of bleeding within 2 hours after delivery in group O was (176 +/- 193) ml, in group O + H was (110 +/- 114) ml, and in group H was (124 +/- 103) ml. There was a significant difference between groups O, O + H and H. Among the 469 women, 31 had total amount of bleeding more than 1000 ml during operation and within 2 hours after delivery. 48% (15 women) were in group O, 23% in group O + H and 29% in group H. The total amount of bleeding in group O was much more than group O + H and group H in the group of fetal macrosomia (P < 0.01, P < 0.01). Similar results were found in the group of twin pregnancy and polyhydramnios (P < 0.01, P < 0.01). The total amount bleeding in group O + H was much less than group O in the group of placenta previa (P < 0.05). There were 5% (12) pregnant women whose total amount of bleeding was >/= 1000 ml in the group of fetal macrosomia, 8% (11) in the group of twin pregnancy, 11% (8) in the group of placenta previa. No hysterectomy was done among the women. The incidence of side effects in the three groups was 2.6%, 11.5% and 7.0% respectively. Vomiting was frequently seen in the latter two groups, but recovered soon without treatment.. Hemabat can significantly reduce the amount of bleeding during the cesarean section in pregnant women with high hemorrhagic risk factors and can be used with oxytocin as firstline medicine to prevent hemorrhage during and after delivery.

Topics: Adult; Carboprost; Cesarean Section; Female; Humans; Oxytocin; Postoperative Hemorrhage; Postpartum Hemorrhage; Pregnancy; Prospective Studies; Risk Factors; Treatment Outcome; Uterus; Vomiting

To compare the efficacy and safety of intravenous oxytocin with intramuscular syntometrine in the management of the third stage of labour.. A prospective randomised trial.. A university teaching hospital.. A total of 991 women having a singleton pregnancy and vaginal delivery were randomised by a computer-generated number to receive either 1 ml syntometrine intramuscularly or 10 units of intravenous Syntocinon after delivery of the anterior shoulder of the fetus.. Blood loss during delivery, rate of postpartum haemorrhage, need for repeated oxytocics, haemoglobin level before and 24 hours after delivery, duration of third stage, need for manual removal of placenta and sides effects including hypertension, nausea, vomiting, headache and chest pain.. The use of intravenous oxytocin was associated with a reduction in postpartum blood loss (P < 0.001) but there was no difference in the risk of postpartum haemorrhage in the need for repeated oxytocic injections and the drop in peripartum haemoglobin level between the two groups. There was also no difference in the risk of prolonged third stage, or in the need for manual removal of placenta. The use of syntometrine was associated with a higher risk of hypertension (RR 2.39, 95% CI 1.00-5.70). Other side effects were mild in nature with no differences between the two groups.. There are no important clinical differences in the effectiveness of intramuscular syntometrine and intravenous oxytocin for the prevention of postpartum blood loss. Intravenous oxytocin is less likely to cause hypertension.

Topics: Adult; Ergonovine; Female; Hemoglobins; Humans; Hypertension; Injections, Intramuscular; Labor Stage, Third; Oxytocics; Oxytocin; Postpartum Hemorrhage; Pregnancy; Prospective Studies; Puerperal Disorders; Risk Factors; Vomiting

To determine the efficacy and safety of intradural-epidural analgesia in comparison with continuous epidural analgesia during labor and childbirth.. Forty-two women whose labor began spontaneously were enrolled and distributed randomly in two groups. The intradural-epidural analgesia group (IEA, n = 21) received 25 microgram of intradural fentanyl with 2.5 mg of isobaric bupivacaine with adrenalin, after which analgesia was maintained with epidural administration of one 8 mL bolus of 0.125% bupivacaine, followed by perfusion of a balanced concentration at a rate of 8 ml/h. Patients in the continuous epidural analgesia group (CEA, n = 21) were given 8 ml of 0.25% bupivacaine with adrenalin; the epidural perfusion of 0.125% bupivacaine and 1 microgram/ml of fentanyl was started at the same rate as in the IEA group. We recorded pain as assessed on a visual analog scale, extension of sensory and motor block, maternal hemodynamic constants, number of boluses of bupivacaine used, total doses of bupivacaine and oxytocin, instruments needed for childbirth, and side effects (pruritus, nausea and vomiting).. Analgesic efficacy during the first 30 minutes was greater in the IEA group. The total dose of bupivacaine, required top-up boluses, and the extension of sensory block at 30 minutes, one hour and two hours were also significantly less in the IEA group. The incidence of pruritus was higher in the IEA group. No significant differences were observed for other variables.. Intradural-epidural analgesia provides effective analgesia for labor, with rapid onset, reduced extension of sensory block, lower total doses of local anesthetics and few side effects.

Topics: Adult; Analgesia, Epidural; Analgesia, Obstetrical; Anesthesia Recovery Period; Bupivacaine; Cesarean Section; Epinephrine; Female; Fentanyl; Humans; Hypotension; Infant, Newborn; Labor, Obstetric; Nausea; Oxytocin; Patient Acceptance of Health Care; Pregnancy; Prospective Studies; Pruritus; Safety; Single-Blind Method; Vomiting

To compare intramuscular oxytocin alone and intramuscular oxytocin with ergometrine (Syntometrine) for their effect in reducing the risk of postpartum haemorrhage when both are used as part of the active management of the third stage of labour.. Double blind, randomised controlled trial.. Two metropolitan teaching hospitals in Perth, Western Australia.. All women who expected a vaginal birth during the period of the trial. Informed consent was obtained.. Postpartum haemorrhage, nausea, vomiting, and increased blood pressure.. 3497 women were randomly allocated to receive oxytocin-ergometrine (n = 1730) or oxytocin (n = 1753). Rates of postpartum haemorrhage (> or = 500 ml or > or = 1000 ml) were similar in both arms (odds ratio 0.90 (0.82); 95% confidence interval 0.75 to 1.07 (0.59 to 1.14) at 500 ml (1000 ml) threshold). The use of oxytocin-ergometrine was associated with nausea, vomiting, and increased blood pressure.. There are few advantages but several disadvantages for the routine use of oxytoxinergometrine when prophylactic active management of the third stage of labour is practised. Further investigation of dose-response for oxytocin may be warranted.

Topics: Blood Pressure; Drug Combinations; Ergonovine; Female; Hemoglobins; Humans; Hypertension; Injections, Intramuscular; Labor Stage, Third; Nausea; Oxytocin; Postpartum Hemorrhage; Pregnancy; Risk Factors; Vomiting

A randomised controlled clinical trial compared ergometrine 0.25 mg, syntocinon 10 mg and normal saline injected intravenously during evacuation of the uterus after spontaneous abortion showed no difference between any drug with respect to uterine contraction, change in blood pressure, blood loss or postoperative vomiting.

Topics: Abortion, Spontaneous; Blood Pressure; Clinical Trials as Topic; Curettage; Double-Blind Method; Ergonovine; Female; Humans; Intraoperative Complications; Oxytocin; Postoperative Complications; Pregnancy; Uterine Contraction; Uterine Hemorrhage; Uterus; Vomiting

Intrathecal injection of morphine was used to provide obstetric analgesia in 20 primiparous women in labor. When the cervix was at least 3 cm dilated, morphine, 1 or 2 mg, was injected intrathecally. In all parturients, labor pains were completely relieved after 15-60 min and analgesia lasted as long as eight to 11 hours. The analgesia was not associated with any alteration of pin-prick sensation or motor power, and there was no change in the arterial blood pressure or heart rate. All infants were delivered vaginally by use of episiotomy annd a low forceps, except two infants of mothers in the 2 mg of morphine group who needed cesarean section. During the second stage of labor, analgesia was supplemented by lidocaine, 2 per cent, using local perineal infiltration in 14 parturients and pudendal block in two parturients, and by epidural block in four parturients. Nineteen of the 20 newborns cried immediately at birth, and had Apgar scores o 7-9 at 1 min and 8-10 at 5 min. During the first 24 hours of life, the neurobehavioral responses of all newborns were scored as normal. Systemic maternal side effects such as somnolence, nausea, vomiting, and itching occurred in a high proportion of the parturients. However, in the majority of cases, these side effects were mild. Only two parturients of the 2 mg morphine group complained of marked somnolence, itching, and vomiting, which persisted post partum; these were effectively reversed by the specific antagonist naloxone. The analgesic effect of intrathecal morphine can be attributed to its action on the opiate receptors in the substantia gelatinosa of the dorsal horn of the spinal cord. However, supraspinal effects of morphine cannot be excluded. The low lipid solubility of morphine can explain its slow onset and prolonged duration of action. Also, this will result in minimal systemic absorption of morphine, which protects the fetus and results in selective maternal analgesia.

Topics: Adolescent; Adult; Anesthesia, Obstetrical; Clinical Trials as Topic; Dose-Response Relationship, Drug; Female; Humans; Injections, Spinal; Morphine; Nausea; Oxytocin; Parity; Pregnancy; Pruritus; Uterine Contraction; Vomiting

Blood loss and the frequency of vomiting were assessed at 88 spontaneous vertex deliveries. An i.v. injection of oxytocin 10 u was as effective as ergometrine 0.5 mg in controlling bleeding from the uterus after delivery. The continuous infusion of a dilute solution of oxytocin in the first stage of labour was not followed by an increased blood loss at delivery. Oxytocin infusions were maintained for 1 h after delivery. Vomiting or retching occurred in 13% of the mothers who received i.v. ergometrine. None of the women who received oxytocin suffered emetic sequelae.

Topics: Clinical Trials as Topic; Ergonovine; Female; Humans; Labor, Induced; Oxytocin; Postpartum Hemorrhage; Pregnancy; Random Allocation; Time Factors; Vomiting

This study was undertaken to determine a method of amino infusion that would 1) produce abortion within 12 hours; 2) be relatively free from risks of coagulapathy and electrolyte imbalance; 3) not result in delivery of liveborns; and 4) incur minimal gastrointestinal side effects from prostaglandin. Patients were randomly assigned to 1 of 3 groups unless history and examination revealed a contraindication to the use of prostaglandin. Three infusions were used: prostaglandin alone, urea alone, and a combination of urea and prostaglandin. All patients had pre-infusion laminaria inserted and all received oxytocin following infusion. There was a significant difference in instillation to abortion time when comparing the three groups and a marked reduction in gastrointestinal side effects using a lower dosage of prostaglandin. The synergistic effect of urea and prostaglandin F2alpha, previously demonstrated was further enhanced by the use of oxytocin and laminaria. This produced a mean instillation to abortion time significantly shorter than previous studies have shown and, indeed, offers a means of second trimester abortion suitable for use in ambulatory surgery facilities, precluding the high cost of inpatient care.. The purpose of this study was to determine a method of amnioinfusion which would 1) keep the instillation to abortion time (IAT) within 12 hours; 2) eliminate, as far as possible, the risk of coagulaopathy and electrolyte imbalance; 3) avoid delivery of liveborn fetuses; 4) reduce gastrointestinal side effects from prostaglandin. 89 midtrimester abortion applicants, divided into 3 groups, had laminaria inserted the afternoon prior to admission. 3 types of infusion were given: 40 mg PGF2 alpha, urea, and a combination of urea solution and 20 mg PGF2 alpha. Upon completion of the infusion the laminaria was removed. 1 hour later oxytocin was administered to all patients; the purpose of the delay was to allow time for prostaglandin impact. 21.4% of cases given urea, 47.8 of those given PGF2 alpha, and 77% of those given urea and PGF2 alpha had aborted 12 hours after infusion. 63.7% of those receiving the combination had aborted 9 hours after infusion. Gastrointestinal side effects were observed in 35% of cases given the higher prostaglandin dosage, compared to only 10% of cases given the lower dosage. The findings indicate that the synergistic effect of urea and prostaglandin was enhanced by the concurrent use of laminaria and oxytocin; the urea dosage was only half of that used in previous studies of synergism, the prostaglandin dosage half of that of prostaglandin only infusions. It seems clear that the initial prostaglandin impact is reinforced by simultaneous administration of urea. Future tests will determine whether the rate of progesterone withdrawal is increased by the synergistic activity of urea and PGF2 alpha in combination.

Topics: Abortion, Induced; Amnion; Diarrhea; Drug Synergism; Female; Humans; Infusions, Parenteral; Nausea; Oxytocin; Pregnancy; Pregnancy Trimester, Second; Prostaglandins F; Seaweed; Time Factors; Urea; Vomiting

A study comparing intra-amniotic urea plus intravenous oxytocin and intra-amniotic urea with 10 mg. prostaglandin F2 alpha was completed. In addition, the results obtained with a further 150 patients receiving urea and prostaglandin are reported. Mean injection-abortion intervals ranged from 15.75 hours for urea-prostaglandin to 18.93 hours for urea-oxytocin. The advantages of urea-prostaglandin and suggested improvements are discussed. Over all, the method appears efficacious though incomplete abortions and cervical laceration are persistent problems.

Topics: Abortion, Induced; Adult; Amnion; Cervix Uteri; Clinical Trials as Topic; Drug Evaluation; Female; Hemorrhage; Humans; Infections; Infusions, Parenteral; Injections; Oxytocin; Parity; Pregnancy; Pregnancy Trimester, Second; Prostaglandins F; Time Factors; Urea; Vomiting

Blood loss and the incidence of emetic sequelae were assessed in 148 patients undergoing midcavity forceps delivery under continuous lumbar extradural analgesia. Five units of oxytocin i.v. was found to be as effective as ergometrine 0.5 mg i.v. in reducing blood loss at delivery. Nausea, retching or vomiting occurred in 35 (46%) of the mothers who received ergometrine and in none of those who received i.v. oxytocin. The cardiovascular side-effects of ergometrine and oxytocin are reviewed and compared with special reference to patients with hypertension and heart disease. It is suggested that 5 units of oxytocin i.v. should be preferred in these high-risk patients. Because of the absence of an emetic action, i.v. oxytocin is preferable to i.v. ergometrine for patients receiving extradural analgesia.

Topics: Anesthesia, Epidural; Anesthesia, Obstetrical; Blood; Blood Pressure; Central Venous Pressure; Ergonovine; Female; Humans; Infusions, Parenteral; Obstetrical Forceps; Oxytocin; Pregnancy; Stimulation, Chemical; Uterine Hemorrhage; Vomiting

Stimulation of uterine activity after amniotomy has been carried out with prostaglandin E2 (PGE2) tablets in two dosage regimens and with intravenous oxytocin. Oxytocin stimulation was the most successful. The difference in success rate was most marked in nulliparous patients and those with low Bishop score.

Topics: Apgar Score; Female; Humans; Injections, Intravenous; Labor, Induced; Nausea; Oxytocin; Parity; Pregnancy; Prostaglandins; Tablets; Uterus; Vomiting

Topics: Acid-Base Equilibrium; Administration, Oral; Apgar Score; Clinical Trials as Topic; Dose-Response Relationship, Drug; Female; Fetal Heart; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Injections, Intravenous; Labor, Induced; Oxytocin; Pregnancy; Prostaglandins E; Prostaglandins F; Solutions; Tablets; Vomiting

Topics: Age Factors; Body Weight; Bradycardia; Cesarean Section; Clinical Trials as Topic; Delivery, Obstetric; Diarrhea; Female; Fetal Diseases; Humans; Infant, Newborn; Labor, Induced; Muscle Tonus; Nausea; Oxytocin; Parity; Phlebitis; Pregnancy; Prostaglandins; Vomiting

Topics: Adolescent; Adult; Apgar Score; Cesarean Section; Clinical Trials as Topic; Delivery, Obstetric; Female; Gestational Age; Humans; Infant, Newborn; Labor Presentation; Labor, Induced; Oxytocin; Parity; Pregnancy; Prostaglandins; Skin Manifestations; Time Factors; Vomiting

Topics: Apgar Score; Body Weight; Bradycardia; Cervix Uteri; Cesarean Section; Clinical Trials as Topic; Diarrhea; Evaluation Studies as Topic; Female; Fetal Heart; Humans; Infant, Newborn; Labor, Induced; Nausea; Obstetric Labor Complications; Oxytocin; Parity; Pregnancy; Prostaglandins; Vomiting

Oxytocin (OT) has a well-established role in reproductive behaviours; however, it recently emerged as an important regulator of energy homeostasis. In addition to central nervous system (CNS), OT is found in the plasma and OT receptors (OT-R) are found in peripheral tissues relevant to energy balance regulation. Here, we aim to determine whether peripheral OT-R activation is sufficient to alter energy intake and expenditure.. We first show that systemic OT potently reduced food intake and food-motivated behaviour for a high-fat reward in male and female rats. As it is plausible that peripherally, intraperitoneally (IP) injected OT crosses the blood-brain barrier (BBB) to produce some of the metabolic effects within the CNS, we screened, with a novel fluorescently labelled-OT (fAF546-OT, Roxy), for the presence of IP-injected Roxy in CNS tissue relevant to feeding control and compared such with BBB-impermeable fluorescent OT-B. Together our data indicate that limiting systemic OT CNS penetrance preserves the anorexic effects of the peptide and reduces the clinically undesired side effects of OT: emesis, taste avoidance and locomotor depression. Thus, therapeutic targeting of peripheral OT-R may be a viable strategy to achieve appetite suppression with better patient outcomes.

Topics: Animals; Central Nervous System; Eating; Female; Male; Motivation; Oxytocin; Rats; Taste; Vomiting

Posterior pituitary hormone secretion and central neural expression of the immediate-early gene product c-Fos was examined in adult ferrets after intravenous administration of CCK octapeptide. Pharmacological doses of CCK (1, 5, 10, or 50 microg/kg) did not induce emesis, but elicited behavioral signs of nausea and dose-related increases in plasma vasopressin (AVP) levels without significant increases in plasma oxytocin (OT) levels. CCK activated neuronal c-Fos expression in several brain stem viscerosensory regions, including a dose-related activation of neurons in the dorsal vagal complex (DVC). Activated brain stem neurons included catecholaminergic and glucagon-like peptide-1-positive cells in the DVC and ventrolateral medulla. In the forebrain, activated neurons were prevalent in the paraventricular and supraoptic nuclei of the hypothalamus and also were observed in the central nucleus of the amygdala and bed nucleus of the stria terminalis. Activated hypothalamic neurons included cells that were immunoreactive for AVP, OT, and corticotropin-releasing factor. Comparable patterns of brain stem and forebrain c-Fos activation were observed in ferrets after intraperitoneal injection of lithium chloride (LiCl; 86 mg/kg), a classic emetic agent. However, LiCl activated more neurons in the area postrema and fewer neurons in the nucleus of the solitary tract compared with CCK. Together with results from previous studies in rodents, our findings support the view that nauseogenic treatments activate similar central neural circuits in emetic and nonemetic species, despite differences in treatment-induced emesis and pituitary hormone secretion.

Topics: Animals; Arginine Vasopressin; Behavior, Animal; Brain Stem; Cell Count; Cholecystokinin; Dose-Response Relationship, Drug; Ferrets; Glucagon; Glucagon-Like Peptide 1; Infusions, Intravenous; Injections, Intraperitoneal; Lithium Chloride; Male; Neurons; Organ Specificity; Oxytocin; Peptide Fragments; Pituitary Hormones, Posterior; Prosencephalon; Protein Precursors; Proto-Oncogene Proteins c-fos; Vomiting

To determine the maximum tolerated dose (MTD) of carbetocin (a long-acting synthetic analogue of oxytocin), when administered immediately after vaginal delivery at term.. Carbetocin was given as an intramuscular injection immediately after the birth of the infant in 45 healthy women with normal singleton pregnancies who delivered vaginally at term. Dosage groups of 15, 30, 50, 75, 100, 125, 150, 175 or 200 microg carbetocin were assigned to blocks of three women according to the continual reassessment method (CRM).. All dosage groups consisted of three women, except those with 100 microg (n=6) and 200 microg (n=18). Recorded were dose-limiting adverse events: hyper- or hypotension (three), severe abdominal pain (0), vomiting (0) and retained placenta (four). Serious adverse events occurred in seven women: six cases with blood loss > or = 1000 ml, four cases of manual placenta removal, five cases of additional oxytocics administration and five cases of blood transfusion. Maximum blood loss was greatest at the upper and lower dose levels, and lowest in the 70-125 microg dose range. Four out of six cases with blood loss > or = 1000 ml occurred in the 200 microg group. The majority of additional administration of oxytocics (4/5) and blood transfusion (3/5) occurred in the dose groups of 200 microg. All retained placentae were found in the group of 200 microg.. The MTD was calculated to be at 200 microg carbetocin.

Topics: Abdominal Pain; Female; Humans; Hypertension; Hypotension; Injections, Intramuscular; Oxytocics; Oxytocin; Placenta, Retained; Postpartum Hemorrhage; Pregnancy; Vomiting

Topics: Female; Humans; Oxytocin; Postpartum Hemorrhage; Pregnancy; Vomiting

Apomorphine, a centrally-acting emetic, was administered subcutaneously (50 micrograms/kg) to nine normal subjects (four male, five female; aged 22-36 years) and four patients with idiopathic diabetes insipidus (DI) (one male, three female; aged 24-49 years). In the normal subjects this stimulus caused nausea (and vomiting in seven of nine) with a latency of 9.5 +/- 0.9 min which was followed by a large increase in plasma arginine vasopressin (AVP) concentration (from 0.9 +/- 0.2 pmol/l to 249 +/- 104 pmol/l at 15 min after the onset of symptoms; mean +/- SEM, P less than 0.01). There was a small but significant increase in plasma oxytocin (OXT) concentration (from 1.6 +/- 0.4 pmol/l to 6.2 +/- 3.4 pmol/l; P less than 0.05). Mean arterial pressure (MAP) fell slightly (from 87 +/- 1.9 mm Hg to 71 +/- 4.4 mm Hg; P less than 0.05) 15 min after the onset of nausea; there was no change in blood haematocrit or plasma osmolality and sodium concentration. In the DI patients apomorphine produced nausea (with vomiting in three of four) with a latency of 10.0 +/- 1.4 min but failed to cause an increase in either plasma AVP or OXT. In the DI patients the fall in MAP did not reach statistical significance (83 +/- 4 mm Hg to 71 +/- 11 mm Hg); there was also no change in haematocrit, osmolality or sodium concentration. Ipecacuanha, an emetic with both peripheral and central actions, was administered orally to seven normal subjects (three male, four female; aged 22-36 years) six of whom also underwent apomorphine tests.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Apomorphine; Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Ipecac; Male; Middle Aged; Nausea; Oxytocin; Vomiting

Administration of lithium chloride and copper sulfate to adult monkeys caused marked elevations in plasma vasopressin (AVP) levels without significant increases in plasma oxytocin (OT) levels. Emesis was produced in five of the seven animals given these agents, in support of nausea as the main stimulus to AVP release. A similar pattern of AVP release without OT release was found after administration of cholecystokinin (CCK). Although most monkeys vomited in response to 10 micrograms/kg of CCK, a significant increase in plasma AVP levels also was produced with a dose of 1 microgram/kg, which did not produce emesis in any animal. These findings are in marked contrast with previous results in rats, which indicated that lithium chloride, copper sulfate, and CCK each stimulated OT rather than AVP release. Despite this interspecies difference, the significant neurohypophysial hormone secretion in response to both nausea-producing agents and CCK suggests that AVP secretion in monkeys, similar to OT secretion in rats, might reflect activation of central pathways mediating nausea and/or inhibition of food intake, even when overt illness is not produced.

Topics: Animals; Arginine Vasopressin; Chlorides; Cholecystokinin; Copper; Copper Sulfate; Haplorhini; Lithium; Lithium Chloride; Nausea; Oxytocin; Rats; Vomiting

Intra-amniotic hyperosmolar urea (59.7 per cent) augmented by intravenous oxytocin (332 millimicron per minute), prostaglandin F2alpha (20 mg.), prostaglandin F2alpha (10 mg.), or prostaglandin F2alpha (5 mg.) was utilized for 1,913 patients requesting elective midtrimester abortion. Injection-abortion intervals ranging from 13.70 to 21.49 hours were achieved with failure rates of 0.7 to 6.7 per cent. Despite frequent pre-existing medical conditions, the complication rate compared favorably with those of other methods for terminating midtrimester pregnancy such as saline amnioinfusion or dilatation and evacuation.

Topics: Abortifacient Agents; Abortifacient Agents, Nonsteroidal; Abortion, Induced; Amnion; Endometritis; Female; Humans; Injections; Nausea; Osmolar Concentration; Oxytocin; Postoperative Complications; Pregnancy; Pregnancy Trimester, Second; Prostaglandins F; Time Factors; Urea; Uterine Hemorrhage; Vomiting

Midtrimester abortion was succesfully induced within 30 hours in 62 out of 90 patients by intraamniotic administration of 16-phenoxy-omega-17,18,19, 20-tetranor-prostaglandine-E2-methylsulfonamide. The Pg-analogue was tested in 5 groups of patients which received 1,2 or 3 mg. In group IV, 2 mg of the analogue was combined with oxytocin. In group V, 3 mg of the analogue was combined with 2.75 grams of calcium gluconate. The success rate was significantly influenced by the amount of the drug administered. Side effects were minimal. Multiparous women respond better to the therapy than nulliparous patients. The combination with oxytocin was more effective than the Pg-analogue alone and the combination of sulprostone with calcium gluconate was 87% succesful within 30 hours and 100% succesful within 36 hours.. A prostaglandin analog, 16-phenoxy-delta-17,18,19,20-tetranor-prostaglandin-E2-methylsulfonamide, was tested in 5 groups of patients which received 1, 2, or 3 mg of the analog intraamniotically. 29/46 (Groups 1-3) patients receiving only the analog expelled the fetus within 30 hours. In Group 4, 2 mg of the analog was combined with oxytocin. 22/28 expelled the fetus within 30 hours. In Group 5, 15 nulliparous and 1 multiparous woman received 3 mg of the analog together with calcium gluconate, injected intraamniotically. Although the mean induction-abortion time was not significantly influenced, the success rate was higher: 87% aborted within 30 hours and 100% within 36 hours. Clinically, the contractions in this group (5) started earlier and were stronger than in other groups. In all groups, side effects were minimal. Multiparous women responded better to therapy than nulliparous patients. Since the amount of drug influenced both the success rate and the induction-abortion interval considerably and the side effects were few, a new study using 4-mg doses is in progress.

Topics: Abortion, Induced; Adolescent; Adult; Amnion; Calcium Gluconate; Chemical Phenomena; Chemistry; Dinoprostone; Drug Therapy, Combination; Female; Gluconates; Humans; Injections; Oxytocin; Parity; Pregnancy; Pregnancy Trimester, Second; Prostaglandins E, Synthetic; Time Factors; Vomiting

Induction of midtrimester abortion using 40 mg intra-amniotic prostaglandin F2alpha was performed on 276 patients. Gestational age and fetal status had no effect on injection-to-abortion time while multiparity and the concomitant use of laminaria appeared to decrease the abortion time. The side effect and complication rates were acceptable and the results compare favorably with those of other midtrimester abortion techniques.

Topics: Abortion, Induced; Adolescent; Adult; Amnion; Female; Humans; Injections; Nausea; Oxytocin; Plants, Medicinal; Pregnancy; Pregnancy Trimester, Second; Prostaglandins F; Vomiting

The successful termination of 19 consecutive late 1st and 2nd trimester pregnancies using a combination of intravenous prostaglandin E2 (PGE2) and oxytocin (Syntocinon) is reported. PGE2 (5 mg in 500 ml of 5% glucose) was initially infused at the rate of 2.5 mcg/minute and then increased to 5 mcg/minute after half an hour. The infusion was increased to a maximum of 10 mcg/minute. Oxytocin was infused 2 hours after the PGE2 at a constant rate of 128 mU/minute. Mean total dose of PGE2 used was 5.9 mg at an overall rate of 6.1 mcg/minute. Average induction/delivery interval was 16 hours, with only 1 patient taking more than 24 hours. Abortion was complete in 13 cases (68%). Vomiting occurred in 13 women; pain was minor and was controlled by pethidine. Mild and transient thrombophlebitis was also reported. There were no reported cases of diarrhea and or cervical damage. Compared to the use of intravenous PG alone, PG given intraamniotically alone or with intravenous oxytocin, and PG given extraamniotically alone or with intravenous oxytocin, this study shows that a combination of intravenous PGE2 and oxytocin at the dose level described is closer to meeting all the desired criteria for the acceptability of any abortion method (ease and safety of administration, side effects, lengths of induction delivery interval, and effectiveness in terms of success rate and uterine evacuation).

Topics: Abortion, Induced; Drug Therapy, Combination; Female; Humans; Infusions, Parenteral; Oxytocin; Parity; Pregnancy; Pregnancy Trimester, Second; Prostaglandins; Vomiting

One hundred women seeking interruption of pregnancy between 7-20 weeks were given prostaglandin E2 as a 20 mg vaginal suppository every four hours. Abortion was achieved within an arbitrary time limit of 36 hours in 97 patients and was complete in 76. Mean abortion intervals according to gestational length and parity ranged between 7.67 and 14.93 hours. Augmentive intravenous oxytocin, usually for placental expulsion, was given to 31 patients. Side-effects such as vomiting, diarrhea, and drug fever were encountered in the majority of patients but no sepsis was noted and no patient was transfused. The results are discussed with particular reference to other prostaglandin and hypertonic saline regimens for pregnancy interruption.. A series of 100 consecutive patients seeking pregnancy termination in pregnancy weeks 7-20 were treated with a schedule of 20-mg vaginal suppositories containing prostaglandin E2 (PGE2); the schedule was being tested for its efficacy, specifically reduction of total dose and related side effects. 94 of the 100 patients were aborted within an arbitrary time span of 36 hours. Total drug dose ranged from 40-160 mg. 31 patients received augmentative intravenous oxytocin. Induction-abortion interval varied from 6-32.5 hours. Of the 97 successes, 76 were classified as complete abortions. No significant differences were noted in midtrimester groups based on increasing parity, although parous patients in gestation week 13-15 seemed to have the best results, based on average interval time. No sepsis or need for transfusion was encountered. Side effects were emesis (n-75), diarrhea (n=17), and drug fever (n=66); less frequent side effects included headache, breast tenderness, and vasomotor symptoms (n=13, 1, and 1, respectively). The midtrimester patient results compared favorably with results of studies using saline for abortifacient. The number of first trimester patients was too small to yield any conclusion.

Topics: Abortion, Induced; Diarrhea; Female; Fever; Gestational Age; Humans; Oxytocin; Pregnancy; Pregnancy Trimester, First; Pregnancy Trimester, Second; Prostaglandins; Vagina; Vomiting

Seventy-four patients, from 16 to 20 weeks pregnant, received intra-amniotic urea (80 Gm.) and intravenous oxytocin for the purpose of inducing abortion. Seventy-one of the 74 patients were successfully aborted by the primary method with a mean injection-to-abortion interval of 18.33 hours. There were no serious side effects, and the mean hospital stay was 32 hours. Following urea injection, the mean serum urea nitrogen rose to 33 mg. per cent at 4 hours. Maximum changes in serum electrolytes occurred at 8 to 12 hours after injection and included a decrease in the mean concentrations of sodium, chloride, and carbon dioxide and an increase in serum potassium. An increase in the urinary excretion of urea began within 4 hours, but significant diuresis did not occur in the presence of intravenous oxytocin administration. There was a significant increase in the leukocyte concentration while hematocrit values remained unchanged. Beginning approximately 8 hours following urea injection, the mean plasma fibinogen concentrations decreased by approximately 15 per cent and the mean platelet count showed a drop of approximately 18 per cent. Fibrinogen-fibrin degradation products were significantly increased in 36 per cent of the patients studied.

Topics: Abortifacient Agents; Abortion, Induced; Amniocentesis; Amniotic Fluid; Blood Coagulation Factors; Blood Urea Nitrogen; Carbon Dioxide; Chlorides; Cross Infection; Diuresis; Female; Hematocrit; Humans; Injections, Intravenous; Length of Stay; Leukocyte Count; Oxytocin; Parity; Potassium; Pregnancy; Pregnancy Trimester, Second; Sodium; Specimen Handling; Time Factors; Urea; Uterine Hemorrhage; Vomiting; Water-Electrolyte Balance

Twenty-six women received intramuscular or intra-amniotic 15 (S) 15-methyl prostaglandin F2 alpha to induce midtrimester abortion. The median initial injection-abortion interval was 10 hours and 25 minutes. The advantages of intramuscular analogue are somnolence and reduced discomfort during labor. Disadvantages include severe gastrointestinal toxicity in the majority of patients and symptoms of acute respiratory distress in two patients.

Topics: Abortion, Induced; Diarrhea; Female; Humans; Injections, Intramuscular; Oxytocin; Pregnancy; Pregnancy Trimester, Second; Prostaglandins; Respiratory Insufficiency; Time Factors; Vomiting

The current study was formulated to investigate the abortifacient activity of prostaglandin 15-methyl F2alpha (15-methyl PGF2alpha) administered intramuscularly to 80 healthy women with gestations between 8 and 22 weeks. Goals were the establishment of an effective dosage schedule and assessment of the incidence and severity of side effects. All 80 gravidas were aborted, with a mean time to abortion of 15.70 hours (SD, 6.52). Gastrointestinal side effects occurred in 89% of the patients; temperature elevations greater than or equal to 100.6 degrees F were noted in 14 cases. No other significant complications were encountered. Transabdominal intra-amniotic pressure monitoring indicated the need to administer the drug at 2-hour intervals. The 15-methyl PGF2alpha patients were matched for parity and gestational length with 80 gravidas aborted with PGE2 20-mg vaginal suppositories. The difference in interval to abortion in the two groups was not statistically significant. While gastrointestinal side effects were more common with 15-methyl PGF2alpha, the frequency of drug-induced temperature elevations was reduced.. It has been reported that intra-amniotic administration of 15-methyl PGF2a (prostaglandin F2alpha) for abortion results in a high level of uterine contractility, a high rate of success, and a low incidence of side effects. This study assesses the abortifacient activity of 15-methyl PGF2alpha administered intramuscularly in 80 healthy women aged 14 to 40 with gestational ages between 8 and 22 weeks. 56 patients were nulliparious. Transabdominal intra-amniotic pressure monitoring was used to measure uterine contractility and to establish an effective dose schedule. 350 to 520 mcg of 15-methyl PGF2a were administered intramuscularly at 2-hour intervals until the onset of abortion. Intravenous oxytocin was infused in 6 cases to facilitate passage of retained placental tissue. Medications were given to reduce diarrhea, vomiting, and pain. All patients aborted. Total drug dose ranged from 900 to 8400 mcg; mean dose was 3254.32 mcg. Duration of treatment ranged from 4 to 34 hours. Induction-abortion time ranged from 5.5 to 35 hours, with mean interval of 15.70 hours. 89% of the patients experienced gastrointestinal side effects. 14 patients had temperature elevation more than or equal to 100.6 degrees F. There were no significant complications. The 15-methyl PGF2a patients were matched with 80 gravidas who had abortion using PGE2 20 mg vaginal suppositories. There were no statistical differences in interval to abortion between the 2 groups.

Topics: Abortion, Induced; Adolescent; Adult; Diarrhea; Female; Humans; Injections, Intramuscular; Oxytocin; Pregnancy; Pregnancy Trimester, First; Pregnancy Trimester, Second; Prostaglandins E; Prostaglandins F; Suppositories; Vacuum Curettage; Vomiting

Topics: Abortion, Induced; Administration, Oral; Drug Synergism; Female; Fetal Heart; Fetus; Humans; Injections, Intravenous; Labor, Induced; Nausea; Oxytocin; Pregnancy; Prostaglandins; Rectum; Uterus; Vomiting

Topics: Administration, Oral; Adolescent; Adult; Diarrhea; Female; Humans; Hypertension; Infusions, Parenteral; Injections, Intravenous; Labor, Induced; Meperidine; Nausea; Oxytocin; Pregnancy; Prostaglandins; Time Factors; Vomiting

PGE2 (prostaglandin E2), 20 mgm vaginal suppositories were administered to 2 groups of women seeking termination of pregnancy. 1 group had the suppository inserted inside a contraceptive diaphragm. Statistical comparisons were carried out for instillation to abortion time, side effects, and intrauterine pressure parameters. The usage of the diaphragm significantly reduced side effects, and resulted in an instillation to abortion time of 12.8 + or - 2.3 hours with no failures. The quantitative analysis of the uterine pressure recordings revealed activity significantly different than that seen with intraamniotic or extraovular PGF2alpha. The development of uterine activity simulates that of normal labor in that elevation of resting pressure does not occur and maximum active pressure evolves slowly.

Topics: Abortion, Induced; Adult; Contraceptive Devices; Diarrhea; Female; Fever; Humans; Muscle Contraction; Nausea; Oxytocin; Parity; Placenta; Pregnancy; Pressure; Progesterone; Prostaglandins; Stimulation, Chemical; Suppositories; Time Factors; Uterus; Vomiting

The efficacy of intramuscular administration of 15 methyl (15S) prostaglandin F2alpha (PGF2a) in midtrimester pregnancy termination was evaluated in 16 healthy patients (mean age, 23.3; mean parity, 1.4; mean number of menstrual weeks, 16.1) by measuring dose response; oxytocin conversion; abortion time; side effects; intrauterine dynamics and progesterone withdrawal. Labor was monitored using extraovular balloon placed transvaginally; transcervically; and connected to a Physiograph machine. Patients not aborting within 48 hours after the first dose were considered failures. Blood samples were collected at 0, 3, and 6 hours and at abortion time for plasma progesterone measurement. Average dose given was 789 +or- 60 micrograms. Only 9 of 10 patients aborted within the prescribed 48 hours: 7 were complete abortions, and 2 were incomplete and required suction curettage. Mean induction to abortion time was 20.2 +or- 2.7 hours. Nausea, vomiting and diarrhea were the main side effects. The findings suggest that 15 methyl PGF2a in the dosages and routes prescribed is not as efficient as PGF2a. It is also suggested that prostaglandin affects the myometrium at 2 levels: 1) a membrane effect, and 2) a more fundamental intracellular regulatory effect which is necessary to initiate labor.

Topics: Abortion, Induced; Action Potentials; Diarrhea; Endometritis; Female; Humans; Injections, Intramuscular; Muscle Contraction; Nausea; Oxytocin; Pregnancy; Pregnancy Trimester, Second; Pressure; Progesterone; Prostaglandins; Stimulation, Chemical; Uterus; Vomiting

20 patients underwent intraamniotic administration of PGF2alpha for termination of pregnancies ranging from 14-20 weeks gestation. Success was achieved in 18 patients (90%) with this method. The 2 failures were terminated vaginally with adjunctive use of intracervical laminaria and intravenous pitocin induction. 10 of the patients had intracervical laminaria placed 4-24 hours prior to drug administration. This latter group was noted to have a shorter induction-abortion interval, shorter onset of uterine contractions, and a decreased incidence of vaginal bleeding prior to abortion. No serious side effects occurred in either group of patients. Clinical toxicity in the form of gastrointestinal symptoms such as nausea and vomiting were common but could generally be controlled with antiemetics. No significant changes were recorded in blood counts, platelet counts, liver function tests, and renal function tests from pretreatment values and at 24 and 48 hours posttreatment. There were no instances of hemorrhage, fever, or infection which occur as complications of hypertonic saline abortion.

Topics: Abortion, Induced; Adult; Amniotic Fluid; Cervix Uteri; Female; Humans; Muscle Contraction; Nausea; Oxytocin; Plants, Medicinal; Pregnancy; Progesterone; Prostaglandins; Seaweed; Time Factors; Uterus; Vomiting

This study evaluates the efficacy of prostaglandin E2 (PGE2) as an oxytocic agent for the augmentation of delay in labor in 40 consecutive patients matched with another group of 40 patients (treated with intravenous oxytocin) as to age, parity, maturity, cervical dilation at time of augmentation, and analgesia. Delay in labor was diagnosed clinically when there was arrest in the descent of the presenting part and/or arrest of dilatation of the cervix. All patients were continuously monitored by means of a presenting part electrode and an intrauterine pressure catheter. Both oxytocin and PGE2 were administered via a constant infusion Palmer pump. Standard dosage increments were used until adequate contractions were achieved and no deleterious effect on the fetus was observed. 0.75 ml of 1 mg/ml ampoule of PGE2 in ethanol was diluted in 500 ml normal saline. Initial rate of infusion was 0.285 mcg/minute for a minimum of 30 minutes; the dose was subsequently doubled at intervals of 1 hour until adequate contractions were achieved. Initial rate for infusion for oxytocin was 2mu/minute; the dose was doubled every hour until adequate contractions were noted. Further cervical dilatation and descent of the presenting part occurred in all cases. Mean Apgar scores at 1 and 5 minutes respectively were 7.53 and 9.50 for the PG group, and 6.93 and 9.18 for the oxytocin group. No perinatal deaths occurred. Mean birthweight was 3.34 kg for the PG group and 3.39 kg for the oxytocin group. The oxytocin group exhibited significantly higher augmentation/delivery interval (7.32 hours vs. 5.2 for the PG group, p 0.001), mean basal uterine tone (13.23 vs. 7.38, p 0.001), mean frequency of contraction (4.39 vs. 3.61, p 0.01), and incidence of side effects (nausea, vomiting, and pyrexia). A fetal heart rate of less than 100 beats/minute was seen in 3 patients in the PG group and 7 in the oxytocin group.

Topics: Adult; Cesarean Section; Female; Fever; Gestational Age; Humans; Injections, Intravenous; Ketosis; Labor, Induced; Nausea; Obstetric Labor Complications; Oxytocin; Parity; Pregnancy; Prostaglandins; Statistics as Topic; Time Factors; Vomiting

Topics: Abortion, Induced; Adult; Blood Pressure; Catheterization; Cervix Uteri; Curettage; Dilatation; Female; Humans; Methods; Muscle Contraction; Ovary; Oxytocin; Pregnancy; Progesterone; Prostaglandins; Radioimmunoassay; Stimulation, Chemical; Time Factors; Vomiting

This study evaluates the efficacy and safety of PGE2 (prostaglandin E2) tablets for induction of labor in term pregnancy (38 to 42 weeks). 47 women (21 nullipara and 26 multiparae; ages 19 to 29 for nulliparae and 21 to 39 for multiparae) were studied; all were clinically normal according to the criteria of Thiery et al (1971), had intact membranes and mean Bishop scores (Bishop, 1964) of 7 for the nulliparae and 6.6 for the multiparae. In the parous group, the number of previous births ranged from 1 to 5. An initial dose of 0.5 mg PGE2 (1 tablet) was given to all except 1 patient who was given a 0.25 mg PGE2 as a test dose. A second dose of PGE2 was given if after 60 minutes, the recorded myometrial activity was less than 150 Montevideo Units. Subsequent doses of PGE2 (0.5 to 2.0 mg) were given at approximately 2-hourly intervals. Fetal scalp blood sample was collected at full cervical dilatation. 31 patients had spontaneous delivery while 16 patients (11 nulliparae and 5 multiparae) had to have vacuum extraction. The infants were assessed biochemically and clinically by Apgar scores at 1 and 5 minutes. Induction was successful in all except in a 23-year old obese nulliparous female at 40 weeks gestation who had a Bishop score of 5. This patient was given oxytocin infusion 27 hours after the first dose of PGE2; the baby was born following an easy vacuum extraction. Maternal morbidity included 1 to 3 episodes of vomiting in 8 of 21 nulliparae and 3 of 26 parous patients; elevated blood pressure during labor in 2 normotensive parous patients; postpartum hemorrhage which was easily controlled in 1 nullipara; and retained placenta in 1. Test dose to delivery interval ranged from 2 hours and 37 minutes to 18 hours and 29 minutes for the nulliparae and from 1 hour and 57 minutes to 9 hours and 13 minutes for the parous patients. The infants were in satisfactory condition at birth.

Topics: Adult; Apgar Score; Bicarbonates; Blood Pressure; Carbon Dioxide; Female; Fetal Heart; Gestational Age; Heart Rate; Humans; Hydrogen-Ion Concentration; Labor, Induced; Lactates; Oxygen; Oxytocin; Prostaglandins; Tablets; Umbilical Arteries; Vomiting

Topics: Abortion, Induced; Adolescent; Adult; Amnion; Diarrhea; Female; Fever; Gestational Age; Humans; Hypotension; Injections; Methods; Oxytocin; Pregnancy; Prostaglandins; Time Factors; Vomiting

Topics: Administration, Oral; Adult; Amnion; Female; Fetal Heart; Humans; Labor, Induced; Oxytocin; Pregnancy; Prostaglandins; Solutions; Tablets; Time Factors; Ultrasonography; Uterus; Vomiting

Topics: Administration, Oral; Adult; Delivery, Obstetric; Diarrhea; Dose-Response Relationship, Drug; Female; Fetal Heart; Heart Rate; Humans; Labor, Induced; Obstetric Labor Complications; Oxytocin; Parity; Pregnancy; Prostaglandins; Uterus; Vomiting

This paper reports on the 1st experiences with extraamniotic administration of prostaglandin F2alpha (PGF2alpha) in induced abortion. It was found that the average dose in 30 primigravidae and 32 multigravidae was approximately equal. The average time of application was 28 hours 30 minutes in the 1st group and 24 hours 40 minutes in the 2nd. In 11 cases, PG application was followed by oxytocin infusion. The method proved successful in 83.5%; partial success was achieved in 15% of the cases. As partial successes, those cases in which the cervical channel was not completely opened, the evacuation of the uterus with instruments was still achievable without difficulty. 1 failure was observed. The highest doses were needed between weeks 13-16 of pregnancy (the small numbers did not allow the computation of statistical significance). Side effects were remarkably low (e.g., nausea, vomiting, profuse perspiration). A temporary rise in temperature above 38 degrees Celsius was noted in 8 women. Compared with reports from the literature, the dose, number, and degree of side effects were lower than those found with intravenous administration. In contrast to other authors, we administered single doses up to 2000 mcg, at which time the application should be diminished. (author's)

Topics: Abortion, Induced; Female; Fever; Gestational Age; Humans; Nausea; Oxytocin; Parity; Pregnancy; Prostaglandins; Sweating; Time Factors; Vomiting

This study combined the use of preinjection laminaria, intravenous oxytocin, and 15 mg of intra-amniotic prostaglandin (PG) F2alpha in order to demonstrate a potentially improved procedure for 2nd trimester abortion. 20 patients, aged 18-27, were between the 16-20 weeks gestation, and were free of intercurrent medical or obstetrical problems. 7 of the 20 were nulliparae. A laminaria was inserted into the cervix the evening before the injection of PG. In the morning an intravenous infusion was begun using 50 units of oxytocin in 500 ml of 5% dextrose and 0.9% sodium choloride at a rate of 150 ml/hour. The amniocentesis was performed and when a free flow of clear amniotic fluid was obtained 15 mg. of PGF2alpha was injected into the amniotic cavity. Different concentrations of oxytocin were administered if contractions were increasingly painful or not. Results of the experiment were that: 1) all patients aborted within 24 hours of the prostaglandin injection, 2) the median injection-to-abortion interval was 7 hours and 25 minutes; primigravidae aborted with a median time of 15 hours 20 minutes; and multiparous patients aborted in 6 hours 20 minutes; 3) only 9 patients requested analgesia medication; 4) the average blood loss was 150-200 nl; 1 patient had a postabortion hemorrhage greater than 500 ml; 5) 3 patients underwent sharp curettage for suspected retained secundines; 6) vomiting occurred in 6 patients, 3 of whom had emesis once; and 7) no diarrhea was encountered during the study. This study demonstrates that this procedure fulfills 3 strict criteria for success, as follows: 1) single injection technic, 2) consistent abortion within 24 hours, and 3) minimal side effects.

Topics: Abortion, Therapeutic; Adolescent; Adult; Amniocentesis; Amnion; Curettage; Female; Humans; Infusions, Parenteral; Injections; Injections, Intravenous; Labor, Obstetric; Meperidine; Methods; Oxytocin; Pregnancy; Prostaglandins; Seaweed; Uterine Hemorrhage; Vomiting

Using Csapo's technique, a single dose of 24.3 +or- 1.1 mg prostaglandin F2alpha (PGF2alpha) had been delivered intraamniotically to 20 sedated pregnant patients (15.9 +or- 0.6 weeks pregnant) in order to provoke a PG impact (PGI), a consequent progesterone (P) withdrawal, and a conversion of the pharmacologically refractory normal pregnant uterus into a reactive organ. The side effects were occasional and acceptable and no further PGF2alpha treatment was needed except in 4 cases (5-10 mg). Only after the Oxytocin test showed that the uterus is becoming reactive, was 50 mU/minute oxytocin infused intravenously to facilitate the evolution of IUP to 93 +or- 3 mmHg and thus promote clinical progress. All the 20 patients aborted both the fetus and the placenta in 16.5 +or- 2.1 hours, but 8 women retained small placental residues to be removed by curettage. The Csapo score was a high 92 +or- 2. As early as 3 hours after PGI, the plasma P levels already decreased significantly. They continued to decline throughout the IAT and reached a 72% withdrawal when the fetus was aborted. 15 patients whose P withdrawal was rapid, aborted before the mean IAT, while those 5 women whose P withdrawal was slow aborted after this time. Thus, the rate of P withdrawal was direct while parity and gestational age indirectly related to the IAT. Studies are in progress to elucidate further the abortifacient action of PGF2alpha and through this knowledge promote predictable therapy.

Topics: Abortion, Induced; Adolescent; Adult; Amniotic Fluid; Body Height; Body Weight; Curettage; Female; Fetus; Gestational Age; Humans; Injections; Muscle Contraction; Nausea; Oxytocin; Parity; Pregnancy; Pressure; Progesterone; Prostaglandins; Time Factors; Uterus; Vomiting

Induction of 2nd-trimester abortion in 31 patients in England is described. An intraamniotic injection of 80g urea was administered after ensuring a free flow of amniotic fluid. The injection was followed by 5mg PGE2 (prostaglandin E2) injected into the amniotic cavity. The procedure was successful in 30 of the 31 patients, requiring a mean injection-to-abortion time of 10 hours and 30 minutes (ranging from 4 hours 10 minutes to 26 hours). 6 of the successful cases required general anesthesia for subsequent evacuation of retained conception products. Neither gestational age nor parity was associated with the injection-to-abortion interval. The described procedure is judged to be safe, rapid, and relatively inexpensive. It reduces the risk of maternal mortality connected with saline injection. It reduces the time required for urea injection alone. It reduces the cost of intraamniotic PG alone.

Topics: Abortion, Induced; Amniotic Fluid; Anesthesia, General; Curettage; Female; Gestational Age; Humans; Methods; Oxytocin; Pregnancy; Prostaglandins; Urea; Vomiting

132 physically health patients (aged 12-41 years; 12-21 weeks gestation) were given intraamniotic PGF2alpha (prostaglandin F2alpha) for induction of midtrimester abortion. Analgesic agents and antiemetics were administered intramuscularly as needed. The patients were grouped as follows: 1) Group A (n=48), those who were given an initial dose of 25 mg PGF2a, then as needed; 2) Group B (n=43), initial dose of 30 mg, 25 mg at hour 6-8, and 25 mg at hour 24; 3) Group C (n=17), initial dose of 40 mg, subsequent 40 mg if unaborted at hour 24; and 4) Group D (n=24), initial dose of 40 mg, 10-25 mg at hour 6-8, additional 20 mg if unaborted at hour 24. A 94.7% incidence of abortion was achieved. In Group A, 29 had complete abortion, 16 incomplete, and 3 failures. Group B had 32 complete abortions, 8 incomplete, and 3 failures. Group C had 9 complete, 7 incomplete, and 1 failure. Corresponding figures for Group D were 19, 5 and 0 respectively. Average time to abortion ranged from 13 hours 22 minutes to 25 hours 33 minutes. The primary side effects of PGF2a were gastrointestinal (vomiting, diarrhea). 70% of patients vomited and 13.6% became febrile. Serious complications included sepsis, systemic reaction to prostaglandin, and cervical laceration. Advantages of intraamniotic PGF2a include ease of administration; generally short injection-abortion time; and its ability to induce myometrial contractions regardless of gestational size. However, the safety, convenience, and acceptability of PGF2 are yet to be established. The following guidelines are suggested for minimizing complications: 1) a test dose of 2.5 mg should be administered slowly over at least 1 minute, 2) fever should not be attributed to drug reaction but considered as suggestive evidence of developing infection, 3) patients unaborted at hour 24 should be considered as high risk with respect to potential failure to abort, development of infection, or cervical laceration, and 4) cervical inspection should be performed, especially in the nulliparous patient with a later gestation and a long labor.

Topics: Abortion, Therapeutic; Adolescent; Adult; Amniocentesis; Amnion; Child; Diarrhea; Endometritis; Female; Fever; Humans; Infections; Injections, Intravenous; Oxytocin; Parity; Pregnancy; Prostaglandins; Time Factors; Vomiting

Topics: Administration, Oral; Adult; Diarrhea; Female; Fetus; Gestational Age; Heart Rate; Humans; Injections, Intravenous; Labor, Induced; Oxytocin; Pregnancy; Prostaglandins; Time Factors; Uterus; Vomiting

Topics: Anesthesia, Epidural; Blood Pressure; Bupivacaine; Cesarean Section; Epinephrine; Ergonovine; Female; Humans; Lidocaine; Methods; Nausea; Oxytocin; Pregnancy; Vomiting

This study determines the efficacy of extraamniotic administration of prostaglandins E2 and F2alpha (PGE2 and PGF2alpha) in abortion induction. The method consists of introducing a Foley catheter (14 gauge) through the cervix with the aid of a speculum so that the inflated balloon lies just within the internal os. The balloon volume varies from 30 ml at 12 weeks to 40 ml at 16 weeks gestation and over. Following an initial test dose, a fully effective dose of 200 mcg PGE2 or 750 mcg PGF2alpha is instilled for diffusion into the extraovular space; this dose is repeated at 2 hourly intervals. An automatic pump may also be used to administer the PG. The pattern of uterine contractility with this method is similar to that seen with intravenous therapy. Of 163 consecutive cases analyzed, 144 (88%) achieved abortions within 36 hours, 72% aborted within 24 hours and 94% within 48 hours. Mean abortion time was 22.2 hours. No significant difference was seen in the success rate or abortion time between 21 patients in their 1st trimester of pregnancy and 142 patients in the 2nd trimester. In primigravidas, abortion (within 36 hours) was successful in 87% of the cases; mean abortion time was 24.0 hours. Multigravidas had higher success rate (90%) and shorter mean abortion time (20.4 hours). Comparison of results obtained separately with PGF2alpha and PGE2 shows the superiority of PGE2. Of 93 patients receiving PGF2alpha, 85% aborted within 36 hours (mean abortion time, 24.9 hours). Of 70 PGE2-treated patients, 93% aborted within 36 hours (p=.01) (mean abortion time, 19.4 hours). When parity was considered, PGE2 came out superior again over PGF2alpha. In primigravidas, only 84% of PGF2alpha-treated patients had abortion within 36 hours compared to 90% for PGE2-treated patients. In multigravidas, the success rates at 36 hours were 86% for PGF2alpha and 95% for PGE2. Side effects were minimal. In another trial, intravenous oxytocin was used in addition to extraamniotic PG, resulting in a very substantial decrease in mean abortion time. This method is a simple, effective abortion technique which can be carried out in most cases on a 24-hour basis.

Topics: Abortion, Induced; Administration, Topical; Diarrhea; Dose-Response Relationship, Drug; Drug Synergism; Female; Fever; Humans; Oxytocin; Pregnancy; Prostaglandins; Prostaglandins E; Prostaglandins F; Time Factors; Uterus; Vomiting

Topics: Abortion, Induced; Adolescent; Adult; Amnion; Amniotic Fluid; Diarrhea; Dose-Response Relationship, Drug; Drug Evaluation; Female; Humans; Injections; Oxytocin; Pregnancy; Prostaglandins F; Time Factors; Vomiting

Topics: Abortion, Induced; Administration, Topical; Female; Fever; Humans; Oxytocin; Pregnancy; Prostaglandins F; Time Factors; Uterus; Vomiting

Topics: Abortion, Induced; Amnion; Catheterization; Female; Gestational Age; Humans; Injections, Intravenous; Nausea; Oxytocin; Pregnancy; Prostaglandins; Vomiting

Topics: Abortion, Induced; Abortion, Therapeutic; Adolescent; Adult; Amnion; Child; Evaluation Studies as Topic; Female; Fever; Follow-Up Studies; Humans; Injections; Oxytocics; Oxytocin; Pain; Pregnancy; Prostaglandins; Time Factors; Vomiting

Topics: Adolescent; Adult; Evaluation Studies as Topic; Female; Fetus; Heart Rate; Humans; Hypertension; Labor, Induced; Oxytocin; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Pregnancy Complications, Cardiovascular; Pregnancy in Diabetics; Prostaglandins; Uterus; Vomiting

Topics: Abortion, Therapeutic; Adolescent; Adult; Amniotic Fluid; Curettage; Diarrhea; Evaluation Studies as Topic; Female; Gestational Age; Humans; Oxytocin; Pregnancy; Prostaglandins; Vomiting

Topics: Female; Gestational Age; Humans; Labor, Induced; Muscle Contraction; Muscle, Smooth; Oxytocin; Phlebitis; Pregnancy; Prostaglandins; Time Factors; Uterus; Vomiting

Topics: Abortion, Spontaneous; Adolescent; Adult; Atropine; Cervix Uteri; Curettage; Cyclopropanes; Dilatation; Ergonovine; Female; Humans; Meperidine; Middle Aged; Morphine; Nausea; Nitrous Oxide; Oxygen; Oxytocin; Postoperative Complications; Preanesthetic Medication; Pregnancy; Thiopental; Uterine Hemorrhage; Uterus; Vomiting

Topics: Emetics; Ergot Alkaloids; Female; Humans; Hypertension; Labor, Obstetric; Obstetric Labor Complications; Oxytocics; Oxytocin; Pregnancy; Toxicology; Vomiting