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Termination of second trimester pregnancy with intra-amniotic 15 (S) 15 methyl prostaglandin F-2alpha - a two dose schedule study.

Termination of second trimester pregnancy with intra-amniotic administration of 15 (S) 15 methyl prostaglandin F-alpha (15 me F-alpha) was attempted in fifty patients. One group (26 patients) was given 1 mg of the analogue and the other group received 2.5 mg. The abortifacient efficacy of 15 me F-2alpha was similar in both groups; over 90% of the patients aborted with a single dose. There was a higher incidence of vomiting, diarrhoea and incomplete abortions in the group treated with 2.5 mg 15 me F-2alpha. Although the mean injection-abortion interval in the 2.5 mg group was shorter, it is concluded that intra-amniotic administration of 1 mg 15 me F-2alpha provides a better regime, giving high efficacy with a single dose, a low incidence of side effects and greater safety in case of inadvertent entry of the intra-amniotic dose into systemic circulation.

Abortion, Induced

[Intra-amniotic administration of prostaglandin F 2 alpha, 12-methyl-prostaglandin F 2 alpha and hypertonic sodium chloride solution for induction of abortion in second-trimester pregnancy].

The authors had performed comperative studies of the effect of the induction of abortion in late pregnancy according to the medical indications by intra-amniotic injection of 20% hypertonic NaCl saline in 26 pregnant patients, of 25 mg prostaglandin F2alpha with 6 hours' intervals in 25 patients, a single dose injection of 40 mg PGF2alpha in 27 cases and single dose injection of 2,5 mg 15-me-PGF2alpha given to 25 patients. The highest success rate was obtained with the single dose injection of 2,5 mg 15-me-PGF2alpha and the lowest success rate was obtained with 25 mg prostaglandin F2alpha with 6 hours' intervals. Despite of rather high procentage of success rate in using the hypertonic NaCl saline, this method is more dangerous in the moment of the injection of saline and complications during the abortion (water intoxication, necrosis of tissue, coagulation defects and other). The most frequently incountered side-effects in using PGs were vomiting and diarhea. Histologic examinations of the placenta revealed massive bleedings, at frequency rate being the same for prostaglandins and the hypertonic saline. The degree of isoimmunisation was lower with prostaglandins than with hypertonic NaCl saline, despite of the late dates of pregnancy termination. The intro-amniotic injection of the small volume solution of 15-me-PGF2alpha or PGF2alpha is more simpler and easier from the technical point of view than any methodic recommended for using saline and at the same time it is more effective.

Abortion, Induced

Termination of second trimester pregnancy with intraamniotic administration of 16-phenoxy-omega-tetranor-PgE2-methylsulfonamide (SHB 286) alone and combined with oxytocin and calcium gluconate.

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.

Abortion, Induced

Prostaglandins and abortion. III. Comparison of single intra-amniotic injections of 15-methyl prostaglandin F2alpha and prostaglandin F2alpha for termination of second-trimester pregnancy: an international multicenter study. World Health Organization Tast Force on the Use of Prostaglandins forthe Regulation of Fertility.

A multicenter, multinational study involving 1,521 patients has compared prostaglandin F2alpha (PGF2alpha) (40 or 50 mg.) and 15-methyl PGF2alpha (2.5 mg.) given intra-amniotically for induction of second-trimester abortion. The highest success rates for PGF2alpha at 24 and 48 hours were 67.8 and 86.6 per cent, respectively. The percentages for 15-methyl PGF2alpha for the equivalent times were 74.1 and 95.6 per cent, respectively. There were 75 cases classified as failures in 602 patients treated with PGF2alpha and only 34 cases were classified as failures among 919 patients treated with 15-methyl PGF2alpha. A further 35 patients required additional treatment to complete the abortion. The over-all incidence of diarrhea and vomiting was low, less than 3.4 episodes per patient. There were 20 cases of cervical laceration (2.9 per cent); only one extended into the lower segment of the uterus. It is concluded that intra-amniotic administration of either 50 mg. of PGF2alpha or 2.5 mg. 15-methyl PGF2alpha provides an effective and safe method for termination of second-trimester pregnancies.

Abortion, Induced

Termination of second trimester pregnancy with intra-muscular administration of 16 phenoxy-omega-17,18,19,20 tetranor PGE2 methylsulfonylamide.

A new prostaglandin analogue, 16 phenoxy-omega-17,18,19,20 tetranor PGE2 methylsulfonylamide was used for the termination of second trimester pregnancy in 60 patients. The drug was injected intramuscularly in doses of 0.5 mg 4 hourly, 1 mg 8 hourly or 1 mg 6 hourly for a maximum of 36 hours. Fifty five patients aborted. The incidence of gastrointestinal side effects was low and there were no complications.

Abortion, Induced

A monthly cycle in the plasma concentration of GnRH and the glomerular filtered load of GnRH during second trimester pregnancy.

Six healthy women were examined three times a week during the second trimester. The aim of the study was to test the existence of a monthly cycle in plasma GnRH. Because the kidney plays a dominant part in the elimination of small peptides from the circulation by filtration, the filtered load (P-GnRH x GFR) of GnRH was estimated and tested for a cycle. A mathematical model (parabolas overlaid with a cosine curve and containing parameters for cycle length, cycle amplitude and phase) was used in a multivariate analysis of changes in plasma GnRH, creatinine clearance and GnRH filtered load. We found significant monthly cycles in plasma GnRH (p = 0.003) and in GnRH filtered load (p = 0.004), but no significance for a cycle in creatinine clearance. As an intermediate result we demonstrated that the tubular reabsorption of GnRH was unsaturated for all values of plasma GnRH and GnRH filtered load in question. The increased pregnancy level of plasma GnRH originates in part in the placenta, but we assume that the cycle generator is contained in the maternal neuroendocrine system.

Absorption

A study of gemeprost alone, dilapan or mifepristone in combination with gemeprost for the termination of second trimester pregnancy.

It is well established that abortion can be induced successfully in midtrimester of pregnancy by gemeprost vaginal pessaries. A randomised study was carried out to determine the efficacy of mifepristone and dilapan in combination with gemeprost for second trimester termination between 12-18 weeks' gestation. A contemporary group of women treated with gemeprost alone was used as a control group. A single course of 4 x 1 mg gemeprost pessaries was administered every six hours. If abortion had not occurred after 24 hours, a further course of 5 x 1 mg pessaries was administered every three hours over the next 24 hours. In the first twenty hours after administration of gemeprost, 95%, 85% and 72% of women aborted in the mifepristone, dilapan and the control group, respectively. The median induction-abortion interval in the mifepristone group (6.6h) was significantly shorter than the other two groups and fewer pessaries were required to induce abortion. The incidence of diarrhoea and vomiting was lower in the mifepristone than the other two study groups. This study demonstrated the efficacy of mifepristone in combination with gemeprost and this regimen is associated with fewer gastrointestinal side effects.

Abortifacient Agents, Nonsteroidal

Maternal and fetal renin activity and renin and big renin concentrations in second-trimester pregnancy.

Plasma renin activity (PRA) and the concentrations of renin (PRC) and big renin (PBRC) have been determined in maternal and fetal blood, and renin and big renin have been measured in amniotic fluid, at 16 to 20 weeks of gestation. Gradients between peripheral arterial and venous and uterine venous maternal circulation were not apparent for PRA, PRC, or PBRC. PRC and PBRC but not PRA were consistently higher in fetal cord blood than in the maternal compartment. The concentrations of big renin and of renin were tenfold higher in amniotic fluid than in maternal plasma and were significantly correlated in amniotic fluid but not maternal or fetal plasma.

Amniotic Fluid

Active and inactive renin in pregnancy and in women on estrogen-containing oral contraceptives.

Total and active renin concentrations (TRC and ARC) were determined in pregnant women and in women on estrogen-containing oral contraceptives to study the variation of plasma renin forms in pregnancy. TRC was already elevated in the first trimester. After that TRC increased consistently reaching the maximum in the third trimester. The ratio of inactive renin concentrations (IRC) to TRC was between 20 and 30% throughout gestation. Therefore, it was supposed that the development of the placenta or the enlargement of the uterus do not affect the ratio of IRC to TRC too much. In women on oral contraceptives in whom plasma renin activity was increased due to elevation of renin substrate, the ratio of IRC to TRC was almost the same as that in normal controls. From these results, it was suggested that the development of the placenta and the enlargement of the uterus do not play an important role in the variation of plasma renin forms, although remarkable changes are observed in the renin substrate and total amounts of renin in pregnancy.

Adult

Cultivated cells from diagnostic amniocentesis in second trimester pregnancies. II. Cytogenetic parameters as functions of clonal type and preparative technique.

From a total of 418 primary amniotic fluid colonies, 5.5% were fibroblast-like (F), 33.7% epithelioid (E) and 60.8% had characteristics of what was previously shown to be the principal class of clonable amniotic fluid cells (AF). Polyploidy occurred in all three categories, although both pure tetraploidy and mixoploidy were more frequent in E colonies. The incidence of non-constitutional chromosomal changes was identical in AF and E type colonies if primary spreads were analyzed in situ without prior trypsinization. Spreads from pooled cell suspensions showed higher base-line levels of both aneuploidy and structural changes. Analysis of individual colonies employing an in situ preparative technique is clearly the method of choice for a reliable cytogenetic prenatal diagnosis within the shortest possible period of time.

Amniocentesis