Outpatient terminations were performed on 100 ultrasonographically confirmed pregnancies of less than or equal to 63 days with a single oral dose of RU 38,486 (600 mg) and a single vaginal pessary of 16,16-dimethyl-trans-delta 2-prostaglandin E1 (1 mg) 48 hours later. Abortion occurred in all patients; in 95 it was complete, in four it was incomplete, and one resulted in a missed abortion. In 88% the abortion occurred within 4 hours of prostaglandin treatment. A total of 25% of patients had nausea and 15% vomited after RU 38,486 treatment. After prostaglandin-treatment, 13% vomited, 10% had diarrhea, and 23% required administration of an opiate analgesic agent. No patient was transfused and there was no genital tract trauma; one case of suspected pelvic infection occurred. If the need for termination arose again, 88% would elect to use the method again, 9% would not. The combination of the antiprogestin RU 38,486 and a vaginal prostaglandin pessary appears to offer a safe, efficient, acceptable nonsurgical outpatient method of termination. Further studies on dosage and treatment protocols would be justified.
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http://dx.doi.org/10.1016/0002-9378(90)90398-q | DOI Listing |
Int Urogynecol J
January 2025
Division of Health Services Research & Implementation Science, Southern California Permanente Medical Group, San Diego, CA, USA.
Introduction And Hypothesis: This manuscript is part of the International Urogynecological Consultation (IUC) on Pelvic Organ Prolapse (POP), Chapter 3, Committee 1 focusing on pessary management of POP.
Methods: A narrative review was conducted by an international, multi-disciplinary group of clinicians working in the field of pelvic health following a search of the literature using the MeSH terms "pelvic organ prolapse" OR "urogenital prolapse" OR "vaginal prolapse" OR "uterovaginal prolapse" AND "pessary" OR "support device" OR "intravaginal device." Relevant studies, as determined after review using the Covidence manuscript review platform, were included.
Int Urogynecol J
January 2025
Department of Obstetrics & Gynaecology, Norfolk & Norwich University Hospitals NHS Foundation Trust, Norwich, UK.
Introduction And Hypothesis: Urogenital and rectovaginal fistulae are rare complications of pessary use for pelvic organ prolapse (POP). This systematic review investigates the prevalence of these complications in patients using pessary for POP, potential risk factors and approaches to their investigation and management.
Methods: All studies in English reporting urogenital or rectovaginal fistulae secondary to pessaries for POP were eligible for inclusion.
Eur J Obstet Gynecol Reprod Biol
December 2024
Department of Obstetrics and Gynaecology, Caen University Hospital, Caen, France; Inserm U1086 "ANTICIPE", Unité de Recherche Interdisciplinaire pour la Prévention et le Traitement des Cancers, Caen, France.
Introduction: Vaginal pessaries are offered as a first-line treatment for symptoms associated with pelvic organ prolapse (POP). The objective of our study was to identify risk factors for failure of pessary use within 1 year of insertion.
Materials And Methods: We prospectively included women who accepted a pessary fitting for symptomatic POP.
Urogynecology (Phila)
December 2024
From the Albany Medical Center Department of Obstetrics and Gynecology, Division of Urogynecology, Albany, NY.
Importance: A vaginal pessary is a highly effective treatment for patients with pelvic organ prolapse (POP). Patient views of pessaries and how their beliefs affect whether they choose pessary treatment is unknown.
Objective: Our objective of this study was to describe the knowledge, understanding, and patient concerns regarding pessary use for POP management.
Urogynecology (Phila)
October 2024
Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI.
In the United States, approximately 180,700 women are incarcerated across jails and prisons, comprising a demographic with an aging population and a higher growth rate compared to men. Despite this demographic trend, research into urogynecologic care for women who are incarcerated is notably lacking, with few studies addressing pelvic floor disorders such as incontinence, and even fewer focusing on access to treatment options like vaginal pessaries or surgical interventions. Women who are incarcerated may face unique challenges in obtaining urogynecologic care, including limited access to medical evaluations, invasive search procedures affecting intravaginal device use, and inadequate hygiene resources, all of which hinder effective management strategies.
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