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Biomedical subjects

M P Embrey

Publications and source records attributed to M P Embrey.

At least 19 recordsLinked to original sources
PubMed1987

Prostaglandin release from preparations used vaginally for the induction of labour.

The release and absorption profiles from the vagina of PGE2 in different vehicles used for cervical ripening and labour induction have been studied observing changes in concentrations of PGE metabolite (PGEM) and PGF metabolite (PGFM). In all groups a rise in PGEM concentration occurred over the 6 hour observation time but with wide variation. The profiles obtained differed markedly between the preparations under investigation correlating with the uterine contractions generated. PGFM generally showed little change. The model used could be explored further to enable modification of the vehicles used for PGE2 incorporation to achieve improved clinical results.

Abortion, Therapeutic↗
PubMed1984

Vaginal prostaglandins and labour induction for patients previously delivered by caesarean section.

Labour was induced at term with vaginal instillation of prostaglandin E2 in 143 patients who had been delivered by caesarean section in a previous pregnancy. The method was simple, safe and effective with 76% achieving a vaginal delivery, and even when the cervix was very unfavourable at the time of prostaglandin treatment, 68% achieved vaginal delivery. The procedure reduces the need for repeat caesarean section with its potential morbidity, without evidence of undue risk of lower segment scar rupture.

Cesarean Section↗
PubMed1981

A simpler approach to labor induction using lipid-based prostaglandin E2 vaginal suppository.

The outcome of labor induced by use of a glyceride-based vaginal suppository of prostaglandin E2 (PGE2) inserted 3 hours before amniotomy, when the cervix is favorable, has been assessed. Using 5 mg PGE2 for primigravidas and 2.5 mg for multigravidas, 63% of the former and 81% of the latter established labor and were delivered of their infants without oxytocin augmentation, allowing ambulation during early labor. No maternal complications were detected as a result of the PGE2 treatment. Compared with patients undergoing conventional induction by amniotomy and immediate oxytocin titration there was no difference in the duration of labor, with a few patients establishing labor and giving birth quickly with both induction methods. Fetal distress was less common following PGE2 treatment than following conventional induction, with three patients in each group requiring delivery by cesarean section. Cephalopelvis disproportion in the second stage of labor requiring cesarean section to deliver occurred more frequently in the prostaglandin-treated group, possibly as a result of reduced upper segment contractility in the first stage of labor with subsequent poor fetal head molding. Epidural analgesia and postpartum hemorrhge were both reduced following PGE2-induced labor.

Adult↗
PubMed1980

Induction of labour with a sustained-release prostaglandin E2 vaginal pessary.

A new polymer vaginal pessary providing sustained constant release of prostaglandin E2 was administered to 66 patients before planned induction of labour. Effective ripening of the unfavourable cervix was achieved in each of 18 primigravidas, in eight of whom labour was initiated without further treatment. When the cervix was moderately favourable the need for orthodox induction of labour was obviated in 16 out of 23 primigravidas and 21 out of 23 multigravidas. This method of sustained release of prostaglandin E2 is simple and convenient and readily acceptable to the patient; it is an important step in the development of non-invasive methods of inducing labour.

Delayed-Action Preparations↗
PubMed1980

In vitro studies of the characteristics of the release of prostaglandins from viscous solutions.

The diffusion rates of prostaglandin E2 in different viscous solutions used in clinical practice for inducing abortion and term labour have been studied in the laboratory. The results indicate that of those currently in use, solutions of Dextran might be more appropriate for the purposes. By increasing the viscosity of solutions in use at present, clinical results may be further improved by aiding retention in the vagina or uterus while producing a slow sustained linear release of prostaglandin.

Abortion, Induced↗
PubMed1979

Preinduction cervical priming with oral prostaglandin E2.

Seventy-three women, primigravidas and multigravidas, received 1.0 mg PGE2 tablets hourly for 5 doses the evening prior to scheduled induction of term labor to improve cervical ripeness. The over-all response to treatment depended upon the initial cervical score. Gastrointestinal side effects occurred infrequently and no complications to mother or fetus were observed. While the protocol used provoked an important in cervical favorability it is anticipated that a more prolonged PGE2 administration might achieve better results.

Administration, Oral↗
PubMed1979

A comparison of PGE2 and PGF2 alpha vaginal gel for ripening the cervix before induction of labour.

The efficacy of a vaginal gel containing either 5 mg prostaglandin E2 (PGE2) or 25 mg prostaglandin F2 alpha (PGF2 alpha) to ripen the unfavourable cervix for labour induction was assessed in a double blind trial. PGF2 alpha, compared with PGE2, had little effect upon the clinical state of the cervix, but the resultant duration of labour in each of the two groups was shorter than in a control group. While the numbers of patients requiring oxytocin stimulation of labour and regional analgesia were reduced in both groups compared with the controls, PGF2 alpha was much less effective than PGE2. Uterine hypertonus was observed using both prostaglandins during an experimental study and the implications are discussed.

Cervix Uteri↗
PubMed1978

Very early abortion by prostaglandins.

309 women whose menstruation was delayed by 3-35 days were treated with intrauterine or vaginal prostaglandins. Of 275 confirmed pregnancies, 229 were successfully terminated without further abortifacient therapy. A successful outcome was often associated with episodes of vomiting, diarrhoea, and uterine cramps in the 24 hours after prostaglandin administration, but the incidence was related to prostaglandin dosage and gastrointestinal side-effects were more common after vaginal administration. The best results were achieved by the analogue 16:16 dimethyl P.G.E2 as a vaginal pessary. 14 patients (6.1%) required uterine curettage for escessive or prolonged bleeding, while 2 patients required blood transfusion. One patient, who had an intrauterine contraceptive device left in situ during treatment, developed acute pelvic sepsis. No deleterious side-effects occurred in 34 patients who were subsequently proven not to be pregnant at the time of treatment. Treatment by intrauterine or vaginal prostaglandins offers promise as a method of pregnancy termination which avoids much of the physical and emotional trauma associated with surgical termination, and has the advantage of not requiring hospital admission in the majority of cases. The present study shows the safety of the method, and its potential as a self-administration technique.

Abortifacient Agents, Nonsteroidal↗
PubMed1978

The influence of pre-induction vaginal prostaglandin E2 gel upon subsequent labour.

Eight hundred and three patients with singleton viable pregnancies and fetal cephalic presentation were given prostaglandin E2 in viscous gel by intravaginal instillation the evening before planned surgical induction. When the cervix was 'ripe', surgical induction was avoided in 65.9 per cent of primigravidae and 87.5 per cent of multigravidae; the administration of epidural analgesia was less frequent, the rate of spontaneous vaginal delivery greater, the Caesarean section rate lower, and the state of the newborn at delivery better than in those patients who required surgical induction. Side effects attributable to the prostaglandin gel were rare as were complications.

Administration, Topical↗
PubMed1977

Cervical ripening with intravaginal prostaglandin E2 gel.

We describe a technique of administering prostaglandin E2 (PGE2) in a viscous cellulose gel into the vagina to ripen the unfavourable cervix in patients requiring induction of labour. A total of 168 primigravidae were studied, of whom 102 received 2 mg PGE2 in 2% gel and 66 received 5 mg PGE2 in 4% gel. In the latter group, the state of the cervix was significantly improved in 58 patients (87.9%), while 32 (48.5%) had started labour before planned induction. There were no maternal or fetal side effects or complications.

Cervix Uteri↗
PubMed1977

The kinetics of extraamniotically injected prostaglandins to induce midtrimester abortion.

In an attempt to improve the extraamniotic administration of prostaglandins in effecting abortion, the movement of injected prostaglandins in a high or low viscosity medium has been observed by radiological studies and radioimmunoassy of PGE and PGFalpha in amniotic fluid and maternal plasma in association with intrauterine tocographic responses. Results obtained suggest that the immediate response by the uterus is a reflection of the speed of absorption of prostaglandins from the chorio-decidual space and that this influences the outcome in inducing abortion within 24 hours. By giving the prostaglandins in a viscous medium a slower release of prostaglandins was produced in most cases, which probably accounts for the greater efficacy obtained using single injections of prostaglandins in this vehicle compared with normal saline.

Abortion, Induced↗
PubMed1977

Ripening of the cervix with extra-amniotic prostaglandin E2 in viscous gel before induction of labour.

A metohod of extra-amniotic prostaglandin administration to achieve ripening of the cervix as a preliminary to induction of labour is described. Compared with a control group the method achieved a 25 per cent reduction in the length of the induced labour, a fall in the incidence of maternal pyrexia and fetal distress, an improvement in neonatal condition of the infants and a reduction in the need to resort to Caesarean section.

Adolescent↗