Prostaglandin F2 Alpha Methyl Research Articles

Anesthetic Management in Parturients With Fontan Physiology

Anesthetic Management in Parturients With Fontan Physiology

Menstrual regulation by (15S)-15 methyl prostaglandin F2 alpha by intramuscular route.

(15S)-15 Methyl Prostaglandin F2 Alpha (Carboprost trometha-mine) was used as an abortificient drug in early pregnancy not exceeding 49 days. Its efficacy, side effects and complications were studied and discussed.

Management of missed abortion by intramuscular administration of 15(S) 15 methyl prostaglandin F2 alpha.

22 subjects with a diagnosis of missed abortion were induced with 15(S) 15 methyl prostaglandin F2alpha (PGF2alpha) by the intramuscular route. The induction succeeded in all cases. The mean induction-abortion interval was 16 hours with a range of 2 hours 30 minutes to 32 hours 10 minutes. The average dose of 15 methyl PGF2alpha required was 1675 mcg. 9 subjects (42%) had complete abortions. 7 (31.8%) had no gastrointestinal side effects. The mean number of episodes of vomiting and diarrhea was 1.3 and 0.8 respectively. 15(S) 15 methyl PGF2alpha has a high degree of efficacy in the management of missed abortion.

Rectal misoprostol vs 15-methyl prostaglandin F 2α for retained placenta after second-trimester delivery

The purpose of this study was to compare rectal misoprostol (RM) with 15-methyl prostaglandin F2alpha (PGF(2alpha)) for the management of retained placenta after second-trimester deliveries. A retrospective study of all second-trimester deliveries between the years 2000 and 2005 was performed. Women were divided into 2 groups, depending on whether they received RM or PGF(2alpha) after the delivery. Three hundred three second-trimester deliveries were analyzed. The time from the administration of medications to the placental delivery was significantly shorter in women who received PGF(2alpha), compared with the RM group (49.5 vs 89 minutes; P < .01). Women who received PGF(2alpha) had lower rates of retained placenta (4.9% vs 12.4%; P = .02). The use of PGF(2alpha) after second-trimester deliveries results in shorter third stage of labor and lower rates of retained placenta compared with RM.

Effect of intramuscular 15-methyl prostaglandin F 2 α after second-trimester delivery

To determine whether 15-methyl prostaglandin (PG) F2 alpha shortens the third stage of labor in second-trimester pregnancy loss. This was a randomized, double-blind, placebocontrolled study of women between 13 and 28 weeks' gestation admitted for spontaneous or induced pregnancy termination. Subjects were randomized on admission to receive either PG (250 micrograms) or placebo (normal saline), 1 mL intramuscularly every 20 minutes, for a maximum of three doses if the placenta had not delivered spontaneously within 10 minutes of the fetus. A dilute oxytocin infusion was given to women in both groups. The patients were managed expectantly with hourly vaginal examinations until intervention was required or up to 6 hours, when curettage was scheduled. Thirty-eight women received PG and 29 received placebo. There was no difference between the groups with regard to method of pregnancy termination or gestational age. There was a statistically significant decrease in the time from first injection to placental delivery (40.0 versus 92.5 minutes; P = .02) between the PG and control groups, respectively. The therapeutic use of PG in the third stage of labor in second-trimester pregnancy loss reduces the time to complete spontaneous placental delivery.

Nerve fibres in urothelium and submucosa of neuropathic urinary bladder: an immunohistochemical study with S-100 and neurofilament.

Intravesical administration of drugs has been used commonly in spinal cord injury patients to suppress detrusor hyperreflexia (eg oxybutynin, verapamil, terodiline) or, to initiate a micturition reflex (eg 15S 15-methyl prostaglandin F2 alpha, protaglandin E2); however, the response has been variable and sometimes, unpredictable. This prompted us to study the presence of nerve fibres in the vesical urothelium and submucosa in mucosal biopsies taken from the dome and trigone (obtained prior to performing a therapeutic procedure eg, vesical lithotripsy, or a diagnostic cystoscopy) in 47 consecutive, unselected paraplegic/tetraplegic patients with a neuropathic urinary bladder. Nerve fibres were demonstrated by routine immunohistochemical technique using commercially available monoclonal and polyvalent antibodies against S-100 (DAKO A/S, Glostrup, Denmark) and Neurofilament (MILAB, Malmo, Sweden). Biopsy specimens were graded for the presence of nerve fibres on a 0-3 scale for urothelium, and superficial/deep submucosa separately in a blind and randomised manner. Virtually no fibre presence was found in one paraplegic patient and no superficial or single fibres were noted in a tetraplegic patient. Absence of C-fibre hyperplasia (Grade 0) was found in nine cases (paraplegic: 4; tetraplegic: 5); Grade 1 hyperplasia was observed in 17 cases (paraplegic: 4; tetraplegic: 13); Grade 2 hyperplasia was seen in 11 cases (paraplegic: 7; tetraplegic 4); and Grade 3 hyperplasia was noticed in eight cases (paraplegic 3: tetraplegic: 5). The magnitude of C-fibre hyperplasia was not significantly different between paraplegic and tetraplegic patients (chi(2) = 4.64; P = 0.3262). The relationship, if any, between the degree of C-fibre hyperplasia and duration of paralysis was studied by categorising patients as < 5 years, and > 5 years of paralysis. No evidence of single fibre or fibre bundle hyperplasia (Grade 0) was seen in five and six cases, grade 1 hyperplasia in six and 11 cases, grade 2 hyperplasia in two and nine cases, and grade 3 hyperplasia in three and five cases respectively in these two categories of patients. (chi(2) = 1.92; P = 0.58). The possible relationship between C-fibre hyperplasia in the vesical mucosa/submucosa and (i) the vesical response to intravesical drug administration; (ii) the vesical urothelial proliferation arrest; (iii) the electrical stimulation of urinary bladder by implanted electrodes (sacral anterior root stimulator); and (iv) long-term indwelling urethral Foley catheter drainage, are discussed with illustrative case reports. In conclusion, mucosal biopsy and study of nerve fibres in urothelium and submucosa of neuropathic bladder has helped to generate hypotheses on the association between C-fibre hyperplasia and response to intravesical pharmacotherapy and the predictive value of such a study in identifying those patients who are likely to respond to intravesical pharmacotherapy.

A prospective, double-blind, randomized comparison of prophylactic intramyometrial 15-methyl prostaglandin F2α, 125 micrograms, and intravenous oxytocin, 20 units, for the control of blood loss at elective cesarean section

Our purpose was to compare intramyometrial 15-methyl prostaglandin F2 alpha with intravenous oxytocin for controlling blood loss at elective cesarean section. A double-blind, randomized trial was performed with intramyometrial 15-methyl prostaglandin F2 alpha, 125 micrograms, or intravenous oxytocin, 20 U, in 60 women undergoing elective lower segment cesarean section at 36 to 41 weeks' gestation. Subjective assessment of the operative blood loss and early lochial discharge and objective change in hemoglobin and hematocrit before and 24 hours after delivery and the incidence of side effects were compared by nonparametric statistical tests. The mean estimated blood loss was similar in both groups, with 645 ml (SD 278, range 400 to 1500) in the 15-methyl prostaglandin F2 alpha group compared with 605 ml (SD 303, range 200 to 1750) in the oxytocin group. The mean fall in hemoglobin and hematocrit was greater in the 15-methyl prostaglandin F2 alpha group than in the oxytocin group, 0.98 gm/dl (SD 0.95) versus 0.65 gm/dl (SD 0.79) for hemoglobin and 2.58% (SD 2.96) versus 2% (SD 2.96) for hematocrit. None of these differences reached statistical significance. There were no differences in side effects and lochial discharge between the treatment groups. In both groups there was a decrease of approximately 1% in maternal arterial oxygen saturation. Routine intramyometrial 15-methyl prostaglandin F2 alpha, 125 micrograms, does not offer any obvious advantage over intravenous oxytocin, 20 U, in reducing operative blood loss at elective lower-segment cesarean section.

Gemeprost vaginal pessaries for inducing third-trimester intrauterine deaths.

In 3rd trimester fetal death, when the cervix requires softening, labor may be induced by the administration of intravenous, intra-or extraamniotic, or vaginal prostaglandin E2 or intramuscular injections of synthetic prostaglandins, such as 15(S)-methyl prostaglandin F2 alpha. These methods all have various disadvantages. In 10 women with 3rd trimester intrauterine death, labor was induced by vaginal insertion of a 1 mg gemeprost (16,16-dimethyl-trans delta 2 prostaglandin E1 methyl ester) pessary. The mean number of pessaries s required was 1.9, and the mean duration of labor was 11.7 hours. The women remained mobile during most of the procedure. No patient required additional oxytocin, and the only side effects were mild fever and diarrhea.

Maternal Arterial Desaturation With 15-Methyl Prostaglandin F2 Alpha for Uterine Atony

Abstract Over a six-month period, five women with severe uterine atony and postpartum hemorrhage developed marked maternal arterial oxygen desaturation within five to ten minutes of the administration of 15-methyl prostaglandin F2 alpha. The average fall from baseline was 10.4 +/- 5.4%, to a mean arterial oxygen saturation of 88.8 +/- 5.45%. The desaturation was accompanied by acute increases, averaging 20.7 +/- 5.9%, in the intrapulmonary shunt.

Intravenous infusion of 15 methyl-prostaglandin F2 alpha (Prostinfenem) in women with heavy post-partum hemorrhage.

Post-partum hemorrhage is a serious complication in obstetric practice. The aim of this study was to investigate, in vivo, the effects of 15 methyl-prostaglandin F2 alpha (Prostinfenem, Upjohn, Sweden) on uterine activity and hemorrhage. Twenty-seven women were included in the study and, in accordance with our clinical routine, all were given oxytocin (10 IE Syntocinon) intramuscularly immediately after delivery. In cases of heavy bleeding and signs of uterine atony, ethylergometrine (0.2 mg Methergin) and oxytocin (40 i.e. Syntocinon in 500 ml, 5.5% glucose) were administered intravenously. If this therapy failed, the woman was given an intravenous infusion of 15-methyl-prostaglandin F2 alpha (0.25 mg Prostinfenom, in 500 ml, 5.5% glucose). Myometrial activity was quantitated in 5 women by a micro-transducer introduced into the uterine cavity. The treatment resulted in a contracted uterus and cessation of bleeding within 12.5 min (mean). The intra-uterine pressure registered a prompt effect regarding both amplitude and frequency of uterine contractions.

Menses induction in rhesus monkeys using a controlled-release vaginal delivery system containing (15S)15-methyl prostaglandin F2α methyl ester

Polymeric controlled-release vaginal delivery systems were designed for (15S)15-methyl prostaglandin (PG)F2 alpha methyl ester (carboprost methyl). The drug was incorporated into a highly permeable reservoir membrane that was bound to a relatively nonpermeable support membrane. The rate of drug release was controlled by coating the reservoir membrane with a less permeable rate-controlling membrane. Vaginal devices were prepared with in vitro steady-state release rates from 5 to 180 microgram/hour. The release curves were characterized by an initial, transient rapid release of the drug, followed by a linear zero-order release phase. Pregnancy was terminated in rhesus monkeys following a 24-hour treatment with vaginal devices having release rates of carboprost methyl of 45 microgram/hour or greater. Successful menses induction was associated with peripheral plasma concentrations of (15S)15-methyl PGF2 alpha between 2000 and 3000 pg/ml. Peripheral plasma concentrations of progesterone declined very rapidly to less than 1.0 ng/ml in monkeys in which pregnancy was terminated. These studies demonstrate the feasibility of manufacturing controlled-release vaginal delivery systems containing carboprost methyl for use in early pregnancy termination.

Internal and external cervical os dilatation with vaginal 15-methyl prostaglandin F2α

Changes in the external and internal cervical os after vaginal administration of a suppository containing 1 mg of 15-methyl prostaglandin F2alpha (PGF2alpha) were differentiated in this study of 19 pregnant women prior to a 1st trimester pregnancy termination. Mean age of the women was 20.6 +or- .99, mean parity was .68 +or- .2, and mean gravidity was 2.32 +or- .54. Pregnancies averaged 10 weeks duration. Cervical dilatation before administration averaged 6.89 +or- .45 mm in the external os and 3.37 +or- .43 in the internal os; compared to 10 +or- .44 mm in the external os and 8.05 +or- .57 mm in the internal os 3 hours after administration of suppositories. Mean additional dilatation prior to the procedure was 1.84 +or- .43 mm. 74% of the women experienced diarrhea, 37% had vomiting, 27% cramps, 21% nausea, 26% vaginal pain, and 26% bleeding prior to the procedure. The greater dilatation of the internal os found in the study is comparable to the behavior of the cervix in the uterus near term when lower segment changes often precede the dilatation of the external os.

Low-dose vaginal 15 methyl prostaglandin F2α for cervical dilatation prior to vacuum curettage abortion

35 healthy women of 7-16 weeks gentation were treated with low-dose vaginal 15 methyl prostaglandin F2 alpha (PGF2alpha) for cervical dilatation. 15 patients (mean age, 24.6 +or- 5.5 years) were treated with a vaginal suppository containing 0.5 mg of the drug while 20 patients (mean age, 20.5 +or- 5.3 years) were treated with a 1.0 mg suppository. 2 time intervals, 3 and 6 hours, were studied. The internal diameter of the cervical canal at the internal os level was measured prior to PG treatment, after treatment, and again at the 2-week postabortion visit. Vacuum curettage abortions were performed with paracervical block anesthesia; intravenous sedation with low doses of diazepam and fentanyl was used as needed. The higher dose group appeared to have greater dilatation but the difference is of borderline statistical significance due to the small sample size. Treatment for 6 hours did not result in greater dilatation than treatment for 3 hours. The more advanced gestations exhibited a somewhat greater dilatation. In most cases, additional forcible dilatation was needed although it was usually easy to perform. 7% of the 0.5 mg group and 40% of the 1.0 mg group experienced vomiting. Diarrhea occurred in 40% of the 0.5 mg group and in 65% of the 1.0 mg group. There was a tendency for patients with the most vomiting and diarrhea to experience more cervical dilation with treatment. Complications included 2 cases of superficial tenaculum tears of the cervical mucosa and 1 case of transient generalized pruritus. Generally, the cervical dilatations were modest and not of sufficient benefit to offset the side effects in the patients. Perhaps a greater dose of the drug used for a 3-hour interval with antiemetic and antidiarrheal medication would produce adequate dilatation with no increase in side effects.

Study of Intravesical Instillation of 15(S)-15 Methyl Prostaglandin F2-Alpha in Patients with Neurogenic Bladder Dysfunction

Intravesical 15(3)-15 methyl prostaglandin F2-alpha was instilled in 21 patients with urinary retention or large volumes of residual urine because of neurogenic vesicourethral dysfunction. Administration of this prostaglandin analogue may prove useful in promoting bladder emptying in selected patients with incomplete suprasacral spinal lesions who do not exhibit detrusor-sphincter dyssynergia.

Ovum transport in the rhesus monkey following postovulatory intravaginal 15(S)-15-methyl prostaglandin F2α-methyl ester administration

The effects of postovulatory intravaginal 15(S)-15-methyl prostaglandin F2 alpha-methyl ester (Me PGF2 alpha) on ovum transport was assessed in the spontaneously ovulatory rhesus monkey. A single suppository containing 3.0 mg of Me PGF2 alpha in lipid base was inserted intravaginally in adult female monkeys 14 to 36 hours following laparoscopically timed ovulation. The reproductive tract was flushed 2, 4, or 24 hours later to recover ova. Four of five ova were recovered at 2 hours, one of five at 4 hours, and none of five at 24 hours after insertion. All ova recovered were in the oviduct. Since ova are normally found in the oviduct until 72 hours after ovulation, these results are interpreted to indicate acceleration and expulsion of ova from the tract following exposure to intravaginal Me PGF2 alpha in excess of 4 hours.

(15S)-15 Methyl Prostaglandin F2α Levels in Amniotic Fluid, and Blood in Second Trimester Abortions

A single intra-amniotic injection of (15S)-15 methyl prostaglandin F2 alpha (THAM) was used to induce second trimester abortion in five patients. Serial levels of (15S)-15 methyl prostaglandin F2 alpha were subsequently measured in amniotic fluid and plasma by radioimmunoassay. The slow removal of this drug from the amniotic fluid was documented. Plasma levels of (15S)-15 methyl prostaglandin F2 alpha increased fourfold to sevenfold after clinical rupture of the membranes in three patients, supporting the fact that prostaglandins are well absorbed from the vagina. Because this analogue of prostaglandin can cause marked peripheral bronchoconstriction when administered systemically, it is best to avoid its use in patients with a history of asthma.

Preoperative cervical dilatation with 15(S)15-methyl PGF2alpha methyl ester pessaries.

A clinical trial comparing two vaginal dose schedules of 15(S)15-methyl prostaglandin F2alpha (PGF2alpha) methyl ester (4 or 6 mg) for preoperative dilatation of the cervix is described. The trial included 28 patients at 8-12 weeks' gestation. Vaginal pessaries containing either 1.0 mg (15 patients) or 1.5 mg (13 patients) of the prostaglandin analogue were administered every 3 hours (maximum, 4 doses). The success rates for the two groups were 93% and 100%, respectively. Sixty percent of the patients aborted before the planned vacuum aspiration. Minor side effects, primarily vomiting and diarrhea, occurred in approximately 80% of the cases and were more prominent with the higher dose pessary. It is concluded that the vaginal administration of 15(S)15-methyl PGF2alpha methyl ester is highly effective for preoperative dilatation of the cervix before suction curettage abortion.

Fertility of Male Rats Treated with 15(S)-15-Methyl Prostaglandin F2α Methyl Ester-Containing Silastic Implants

Male Spraque-Dawley rats receiving implants of silicone rubber discs containing 1% or 2% 15(S)-15-methyl prostaglandin F2 alpha methyl ester (15-Me-PGF 2 alpha) or no prostaglandin were tested in successive breeding trials for potency and fertility. One week after implantation, discs containing 1% 15-Me-PGF2 alpha reduced potency and fertility, which returned 2 weeks after implantation. Animals receiving implants of the 2% discs were apparently impotent the 1st week following implantation; potency returned before full fertility returned 11 weeks after implantation.

Early First-Trimester Abortion Induction by Silastic Vaginal Devices for Continuous Release of 15(S)-15-Methyl Prostaglandin F2α Methyl Ester

The abortifacient efficacy of four Silastic devices containing 15(S)-15-methyl prostaglandin F2alpha methyl ester (15-Me-PGF2alpha methyl ester) was evaluated by single vaginal insertion and retention for 24 hours in four groups of ten patients each at 31 to 49 days beyond the 1st day of the last menstrual period. There were eight complete and two incomplete abortions in the group receiving a device with a drug concentration of 0.5% and a surface area of 20 sq cm. Four complete abortions, four incomplete abortions, and two failures occurred with a 0.2%, 10 sq cm device. Seven complete and two incomplete abortions were obtained with a 0.5%, 10 dq cm device; one patient in this group was found to have aborted prior to treatment. A 0.5%, 2o sq cm device with one-half the thickness of the other 0.5% devices yielded five complete abortions, one incomplete abortion, and four failures. Side effects were minor and well tolerated in each group. Serial determinations of plasma progesterone, human chorionic gonadotropin, and 15-Me-PGF2alpha were obtained and related to the outcome of therapy. Because of failure to achieve sustained blood levels of drug or satisfactory rates of complete abortions, this technique, with the devices used in this study, is not believed to be acceptable for routine early first-trimester pregnancy termination.

Undiagnosed abdominal pregnancy with inadvertent prostaglandin administration

2 cases of undiagnosed abdominal pregnancy observed in a 1-year period are reported. Both were complications of 2nd-trimester induced abortion. In case 1, a 25-year old black woman (gravida 5, para 2), multiple attempts at amniocentesis resulted only in bloody fluid. Intramuscular methyl-prostaglandin F2alpha (PGF2alpha) was administered and hypertonic saline was infused, but neither uterine cramping nor rupture of the membranes followed. PGE2 vaginal suppositories produced no change. Laparotomy revealed a large abdominal mass superimposed on the fundus, extending posterior to the uterus in the cul-de-sac. The amniotic sac contained a 15 ounce stillborn fetus. In case 2, a 33-year old black woman (gravida 2, para 1), bloody fluid was again obtained on amniocentesis. Intravaginal PGE2 suppositories and oxytocin were given, but dilation did not proceed despite uterine cramping. Examination revealed a cystic mass to the right of the uterus and fixed to the cul-de-sac. Laparotomy resulted in removal of a 45 gm macerated fetus. There appeared to be a rent in the right tube from which the gestation had been extruded with secondary implantation upon the abdominal viscera. A 3rd abdominal pregnancy observed in that time period resulted in a live birth at 41.5 weeks of gestation. Clinically, the diagnosis of abdominal pregnancy can be made by sounding the uterus. Laparoscopy will differentiate between abdominal and cornual pregnancy. Sonography is an additional diagnostic aid. When 2nd trimester abortion patients are given PGE2 as a vaginal suppository, 97% abort within 36 hours. Side effects such as vomiting, diarrhea, temperature elevation, and facial flush indicate adequate absorption. When these signs are present but expulsion of fetal tissue or membrane rupture do not occur, extrauterine gestation should be considered.