AIM: To evaluate the anti-fertility effect of methanolic (MeTD) and aqueous (AqTD) flower extracts of Tabernaemontana divaricata in rats. METHODS: The anti-fertility activity of the extracts was evaluated using two experimental animal models: 1) Estrogenic activity was carried out in immature female rats using ethinyl estradiol as standard. The evaluation parameters includes changes in uterine weight and histopathology of uterus. 2) Anti-implantation and early abortifacient activity was performed in female Wistar rats. The number of implants and resorbtions were compared to vehicle control. RESULTS: Phytochemical analysis of MeTD and AqTD revealed the presence of carbohydrates, amino acids, steroids, glycosides, flavonoids, alkaloids and tannins. In estrogenic activity, the MeTD and AqTD were offered significant estrogen-like activity at 500 mg·kg(-1), p.o. by increasing the uterine weight compared to vehicle control group. In Anti-implantation and early abortifacient activity study, MeTD (500 mg·kg(-1), p.o.) showed significant effect and it was evident by decrease in the number of implants and increase in the number of resorbtions compared to vehicle control group. CONCLUSION The MeTD at 500 mg·kg(-1), p.o. possess significant estrogenic, anti-implantation and early abortifacient activity, while the AqTD at 500 mg·kg(-1), p.o. was found to possess significant estrogenic activity and the results are in consistent with the literature reports related to anti-fertility effect of flower extracts of Tabernaemontana divaricata.
Abortifacient Agents ; pharmacology ; Animals ; Embryo Implantation ; drug effects ; Female ; Fertility ; Flowers ; chemistry ; Humans ; Models, Animal ; Organ Size ; drug effects ; Phytoestrogens ; pharmacology ; Plant Extracts ; chemistry ; pharmacology ; Rats ; Rats, Wistar ; Tabernaemontana ; chemistry ; Uterus ; drug effects

OBJECTIVETo evaluate the therapeutic effect and safety of pelvic methotrexate (MTX) injection via the posterior fornix for treatment of tubal pregnancy.

METHODSNinety-six patients with tubal pregnancy (mean age 21-40 years) were randomized into 3 groups for treatment with pelvic MTX injection via the posterior fornix+mifepristone+traditional Chinese medicine (experiment group), intramuscular MTX injection+mifepristone+traditional Chinese medicine (control group I), or mifepristone+traditional Chinese medicine (control group II). On days 4 and 7 of the treatment, blood β-HCG of the patients in different groups was detected, and in cases with continuous reduction of blood β-HCG or a reduction by over 15%, β-HCG was checked every week. One week after the treatment, the size of the mass was measured by B-mode ultrasound. The clearance time of β-HCG and the hospital stay of the patients were recorded.

RESULTSTwenty-nine patients in the experimental group were treated successfully, with a cure rate of 90.6%, which was significantly higher than those in the two control groups (P<0.05). The clearance time of β-HCG and hospital stay were also much shorter in the experimental group (P<0.05).

CONCLUSIONPelvic MTX injection via the posterior fornix is a convenient procedure associated with minimal complications and serves as a good alternative for treatment of tubal pregnancy.

Abortifacient Agents, Nonsteroidal ; administration & dosage ; Adult ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; administration & dosage ; Female ; Humans ; Injections ; Methotrexate ; administration & dosage ; Mifepristone ; administration & dosage ; Pelvis ; Phytotherapy ; Pregnancy ; Pregnancy, Tubal ; drug therapy ; Vagina ; Young Adult

OBJECTIVETo compare the effectiveness and safety of using the combination of dinoprostone suppository and ethacridine and ethacridine alone for the induction of mid-term pregnancy.

METHODSThe clinical data of 96 patients at 16-27+6 gestational weeks in Peking Union Medical College Hospital from March 2008 to December 2009 were retrospectively analyzed. Patients were divided into combination group (n=54) and ethacridine alone group (n=42) based on their induction methods. The efficacy and side effect were compared between these two groups after the induction.

RESULTSThe effectiveness rate was 70.4% (38/54) in the combination group,which was significantly higher than that in ethacridine alone group (4.8%) (2/42) (P=0.001). The durations of the first and second,and total stage of labor were found to be significantly shorter in combination group [(287∓39) and (513∓39) min)] when compared with ethacridine alone group [(546∓84) and (661∓82) min] (P=0.01). The bleeding volume in the combination group was (69∓4) ml, which was significantly less than that in control group (96∓7) ml (P=0.02). The two groups had no significant differences in terms of in-labor duration (P=0.45), postpartum placenta remnants (P=0.91), and fetal membrane remnants (P=1.31).

CONCLUSIONThe combination of dinoprostone suppositories and ethacridine is more effective and safer than ethacridine alone for induction of mid-term pregnancy.

Abortifacient Agents ; therapeutic use ; Abortion, Induced ; methods ; Adult ; Dinoprostone ; therapeutic use ; Ethacridine ; therapeutic use ; Female ; Humans ; Pregnancy ; Pregnancy Trimester, Second ; Retrospective Studies ; Young Adult

OBJECTIVETo observe the metabolism-based interaction of diphenytriazol and flavone compounds.

METHODSFlavone compounds kaempferol, isoharmnten and Elsholtzia blanda benth extract were chosen as the substrate of glucuronidation in the phase II metabolism. The metabolism was investigated in different rat liver microsome incubates pretreated with beta-naphthoflavone (BNF), diphenytriazol and tea oil (control). The concentrations of residual substrate were determined by HPLC. Quercetin and kaempferol were coincubated with diphenytriazol in control microsome to evaluate the inhibition for phase I metabolism. The concentration of diphenytriazol was determined by HPLC.

RESULTThe phase II metabolic activity of kaempferol, isoharmnten and Elsholtzia blanda benth extract in diphenytriazol-treated microsome was more potent than that in BNF-treated microsome (P<0.01). The phase I metabolism of diphenytriazol was markedly inhibited by quercetin and kaempferol, with the inhibition constants (Ki) (12.41 +/-0.26)microg . ml(-1) and (7.97 +/-0.08)microg . ml(-1), respectively.

CONCLUSIONDiphenytriazol demonstrates metabolism-based interaction with flavone compounds in vitro.

Abortifacient Agents ; metabolism ; pharmacology ; Animals ; Drug Interactions ; Female ; Flavones ; metabolism ; pharmacology ; Kaempferols ; metabolism ; pharmacology ; Plant Extracts ; pharmacology ; Quercetin ; metabolism ; pharmacology ; Rats ; Rats, Sprague-Dawley ; Triazoles ; metabolism ; pharmacology

OBJECTIVEObserving the effect of phenolic acids from Arnebia euchroma assist mifepristone in anti-early pregnancy of SD rattus norvegicus.

METHODFeed the SD rattus norvegicus with phenolic acids from A. euchroma during the 7 th to 9 th day, and then we observe the restaining rate of pregnancy. At the same time, we determine the progesterone level in blood serum in the ways of radioimmunoassay.

RESULT720 g x kg(-1) enolic aids from A. euchroma can markedly increase the restaining rate of pregnancy (P < 0.05) than that only mifepristone dose (8.0 g x kg(-1)). In addition, the number of everage still bith increase, however, to the pogesterone level in blood serum. It has little effect.

CONCLUSIONThe effect of phenolic acids from A. euchroma assist mifepristone in anti-early pregnancy of SD rattus norvegicus is clear, and it dosen't work in the ways of decreasing the pogesterone level.

Abortifacient Agents ; chemistry ; pharmacology ; Animals ; Boraginaceae ; chemistry ; Female ; Hydroxybenzoates ; chemistry ; pharmacology ; Male ; Mifepristone ; pharmacology ; Pregnancy ; drug effects ; Progesterone ; blood ; Radioimmunoassay ; Rats ; Rats, Sprague-Dawley

OBJECTIVETo evaluate the effect and risk of misoprostol for stimulating cervical maturity in women with post-term pregnancy negative for insulin-like growth factor binding protein-1 (IGFBP-1) in cervical secretion with modified Bishop score less than 3.

METHODSSeventy-one women with post-term pregnancy randomized into misoprostol group (n=37) and control group (n=34) received misoprostol placement at the posterior vaginal fornix and routine intravenous oxytocin infusion, respectively, to stimulate cervical maturity. Failure to respond to the treatment within the initial 24 h necessitated a repeated administration for no more than 3 times in all. Modified Bishop score was recorded and fetal heart monitored once every 24 h, and IGFBP-1 in the cervical secretion was detected at 24 and 48 h after drug administration.

RESULTSThe misoprostol group showed better effect of cervical maturity stimulation than the control group (P<0.001), and the positivity rates of IGFBP-1 24 and 48 h after drug administration were significantly higher than that of the control group (P<0.01 and 0.001). The number of cases with indication for cesarean section was significant higher in the control group (P<0.001). There were no significant differences in postpartum hemorrhage, excessive uterine contraction, incidence of fecal contamination of the amniotic fluid or Apgar score of the newborn between the two groups (P>0.05).

CONCLUSIONSMisoprostol is safe and effective for stimulating cervical maturity in women with post-term pregnancy who have modified Bishop score lower than 3 and are negative for IGPBF-1 in cervical secretion. Oxytocin is not advised for use in such gravida for stimulating cervical maturity. IGFBP-1 in cervical secretion may serve as an important index for evaluating the cervical maturity.

Abortifacient Agents, Nonsteroidal ; administration & dosage ; adverse effects ; therapeutic use ; Administration, Intravaginal ; Adult ; Cervical Ripening ; drug effects ; Cervix Uteri ; drug effects ; metabolism ; Female ; Heart Rate, Fetal ; drug effects ; Humans ; Insulin-Like Growth Factor Binding Protein 1 ; metabolism ; Misoprostol ; administration & dosage ; adverse effects ; therapeutic use ; Pregnancy ; Pregnancy, Prolonged ; drug therapy ; Treatment Outcome

AIMTo observe the metabolic interaction between diphenytriazol and steroid hormone drugs, and provide some useful information for clinical medication.

METHODSThe steroid hormone drugs which may be co-administrated with diphenytriazol were selected, such as mifepriston, estradiol, medroxyprogesterone acetate, progesterone, norethisterone and so on. Diphenytriazol was incubated with each drug in rat liver microsome. The residual concentration of diphenytriazol or steroid hormone drugs in the microsomal incubates was determined by reversed-phase high-performance liquid chromatography, separately. The inhibition constants (K(i)) for each of them were calculated.

RESULTSThe inhibition constant K(is) of diphenytriazol for the metabolism of mifepristone, estradiol, medroxyprogesterone acetate, progesterone and norethisterone were (201.3 +/- 1.0), (94 +/- 4), (128.7 +/- 2.2), (64 +/- 5) and (80 +/- 4) micromol x L(-1), respectively. The inhibition constants K(i) of steroid hormone drugs for the metabolism of diphenytriazol was (66.9 +/- 2.2) micromol x L(-1) for estradiol, (60.0 +/- 2.3) micromol x L(-1) for medroxyprogesterone acetate, (163 +/- 10) micromol x L(-1) for progesterone and (88 +/- 5) micromol x L(-1) for norethisterone, respectively.

CONCLUSIONDiphenytriazol shows metabolism interaction with steroid hormone drugs such as estradiol, medroxyprogesterone acetate, progesterone and norethisterone.

Abortifacient Agents, Nonsteroidal ; metabolism ; pharmacology ; Abortifacient Agents, Steroidal ; metabolism ; Animals ; Contraceptives, Oral, Synthetic ; metabolism ; Drug Interactions ; Estradiol ; metabolism ; Female ; In Vitro Techniques ; Medroxyprogesterone ; metabolism ; Microsomes, Liver ; metabolism ; Mifepristone ; metabolism ; Rats ; Rats, Sprague-Dawley ; Triazoles ; metabolism ; pharmacology

The purpose of this study is to evaluate predictors of success of repeated injections of methotrexate in the single-dose regimen for the treatment of tubal ectopic pregnancy. All patients who had ectopic tubal pregnancy and were treated with a single dose regimen were retrospectively identified. 126 patients were treated with methotrexate. Among them, 39 patients were adequate for this study. 33 were treated with the 2nd dose and 27 were successfully cured. Additionally, 6 who were injected with the 3rd dose were all cured as well. Therefore, in our study, the success rate for the repeated injections of methotrexate was found to be 84.6% (33/39). The mean initial beta-hCG level was significantly lower in patients who were successfully treated than in patients who failed (3915.3+/-3281.3 vs. 8379.7+/-2604.4 IU/mL, p<0.05). The success rate is 96% when the beta-hCG level is less than 6,000 IU/mL and is 58% when beta-hCG is greater than 6,000 IU/mL (OR=18.57, 95% CI 1.86-185.89). The initial beta-hCG level is the only factor that has significant meaning as predictor of success of repeated injections of methotrexate in the single-dose regimen. Repeated injections of methotrexate may be particularly effective when the initial beta-hCG level is below 6,000 IU/mL.
Abortifacient Agents, Nonsteroidal/administration & dosage/therapeutic use ; Chorionic Gonadotropin, beta Subunit, Human/blood ; Female ; Humans ; Injections ; Methotrexate/administration & dosage/*therapeutic use ; Predictive Value of Tests ; Pregnancy ; Pregnancy, Tubal/blood/*drug therapy ; Retrospective Studies ; Time Factors ; Treatment Outcome

OBJECTIVETo analyze and evaluate the acceptability of mifepristone compatible with misoprostone versus conventional surgical abortion among women under unwanted early pregnancy, so as to help the unexpected pregnant women to choose the satisfactory abortion, and to provide the evidence for clinicians to make a proper clinical decision.

METHODSSix medical databases were searched, including MEDLINE, EMBASE, Cochrane library, CBMdisc, CNKI and VIP, together with twelve journals hand-searched, and references of included studies additionally searched. Two qualified reviewers reviewed the original articles, evaluating qualities of articles, and extracting data independently. After heterogeneity test, the data was pooled using Revman software if capable, or descriptive analysis was applied.

RESULTSIn total, nine original clinical controlled trials were included, containing 3565 cases. Before abortion, more unwanted pregnant women chose the medical abortion because they believed medical abortion was less painful than surgical abortion (OR = 466.51, 95% CI: 91.37 - 2381.88), but medical abortion was less time-consuming than surgical abortion (OR = 0.02, 95% CI: 0.01 - 0.06). After abortion, satisfaction with medical abortion was similar to that with surgical abortion, with insignificant difference (P = 0.89). However, second choice and recommendation rates of medical abortion were much higher than those of surgical abortion with OR and 95% CI as 2.72, 2.13 - 3.47 and 4.19, 2.16 - 11.16, respectively.

CONCLUSIONSMedical abortion was less painful than surgical abortion and the rate of second choice and recommendation to others were all also higher than those of surgical abortion. However, the process of medical abortion was not as quick as surgical abortion but the satifacation of both methods seemed similar. Therefore, the two artificial abortion methods were not recommended to replace each other at the present time.

Abortifacient Agents ; adverse effects ; Abortion, Induced ; adverse effects ; methods ; Choice Behavior ; Controlled Clinical Trials as Topic ; Female ; Humans ; Mifepristone ; Misoprostol ; Pain ; etiology ; Patient Satisfaction ; statistics & numerical data ; Pregnancy ; Pregnancy, Unwanted

OBJECTIVETo evaluate the clinical effect and safety of combined use of methotrexate and mifepristone for treatment of ectopic pregnancy.

METHODSBy searching in the major databases of CNKI, CBMdisk and Pubmed according to the criteria of evidence-based medicine, we collected data of randomized controlled trials pertaining to combined use of methotrexate and mifepristone in the treatment of ectopic pregnancy.

RESULTSTwenty-three randomized controlled trials involving totally 1 706 patients were collected according to the inclusion criteria, and meta-analysis of the data indicated that combined use of methotrexate and mifepristone can be of great value in the management of ectopic pregnancy in comparison with exclusive use of methotrexate [ combined odds ratio (OR) was 2.84 with 95%confidence interval [CI] (2.18, 3.69), Z=7.79, P<0.000 01].

CONCLUSIONThe clinical evidence derived from the analysis suggests that the combination of methotrexate and mifepristone for ectopic pregnancy management can be effective with good safety security and minimal side effects, but still, this conclusion needs further verification by randomized, double-blind, and controlled trials with larger sample size and more rigorous trial design.

Abortifacient Agents, Nonsteroidal ; administration & dosage ; Abortifacient Agents, Steroidal ; administration & dosage ; Adult ; Drug Therapy, Combination ; Female ; Humans ; Methotrexate ; administration & dosage ; Mifepristone ; administration & dosage ; Pregnancy ; Pregnancy, Ectopic ; drug therapy ; Randomized Controlled Trials as Topic ; Treatment Outcome