Elective removal of cervical cerclage and onset of spontaneous labor

Objective

To determine the time interval between elective removal of cervical cerclage and onset of spontaneous labor.

Methods

A retrospective cohort study was conducted between January 2005 and December 2012 at a tertiary care hospital in Lisbon, Portugal. All singleton pregnancies with a McDonald or Shirodkar cerclage electively removed at 36–37 weeks were evaluated for the time interval between cerclage removal and spontaneous labor. Delivery within 72 hours after cerclage removal was compared between patients with elective cerclage and those with non-elective cerclage. In the non-elective group, a sub-analysis of the results for ultrasound- and physical examination-indicated cerclage was performed.

Results

Thirty-eight women were included. The time interval between cerclage removal and spontaneous labor did not differ significantly between the elective and the non-elective group (15.6 ± 7.6 vs 10.9 ± 7.4 days; P = 0.063). A higher incidence of delivery 72 hours after cerclage removal was seen in the non-elective group but this was not significant (P = 0.061). There were no differences regarding the time interval from elective removal of cervical cerclage to onset of spontaneous labor between ultrasound-indicated and physical examination-indicated cerclage.

Conclusion

Regardless of the indication for cervical cerclage, the probability of delivery soon after elective cerclage removal is low.     

Effect of maternal fasting for religious beliefs on fetal sonographic findings and neonatal outcomes

Objective

To investigate the effects of long-lasting maternal fasting on fetal biometry, amniotic fluid volume, fetal Doppler parameters, and neonatal outcomes.

Methods

The present study, conducted at Solhan State Hospital, Bingol, Turkey, between July and August 2013 recruited 82 healthy and otherwise normal pregnant women with a gestational age of 29 weeks or more who were fasting for at least 20 days. The control group comprised 87 healthy non-fasting women matched for maternal age, parity, gestational age. Fetal parameters were measured at the beginning and the end of the fasting month. Perinatal outcomes were compared between the groups.

Results

There were no significant differences between the groups in fetal biometry, fetal Doppler parameters, or neonatal outcomes. In the fasting group, however, there was a significantly greater decrease in amniotic fluid index during the fasting period (P < 0.001). The number of women who initially had a normal amniotic fluid measurement and subsequently developed oligohydramnios was also significantly higher in the religious fasting group (P < 0.05).

Conclusion

Fetal development, Doppler parameters, and neonatal outcomes were not significantly affected in healthy fasting women; however, there was a significant association between fasting and amniotic fluid index. These findings mandate more frequent follow-up visits for this group of women.     

Pentraxin 3 in amniotic fluid as a marker of intra-amniotic inflammation in women with preterm premature rupture of membranes

Objective

To determine whether amniotic fluid levels of pentraxin 3 (PTX3) are of value in the prenatal diagnosis of acute histological chorioamnionitis in preterm premature rupture of membranes (PPROM).

Methods

Forty pregnant women with PPROM between 24 and 36 weeks of pregnancy without (n = 21) and with (n = 19) histological chorioamnionitis (PPROM group) and 42 women between 16 and 20 weeks of pregnancy (midtrimester group) were included in the study. We compared amniotic fluid PTX3 levels in the PPROM group with versus without histological chorioamnionitis, and between the PPROM and the midtrimester groups using nonparametric tests (Mann-Whitney test), given the non-normal distribution of the analyte.

Results

Patients with histological chorioamnionitis had a significantly higher median amniotic fluid PTX3 concentration than patients without the histological signs of chorioamnionitis (3.69 ng/mL [0.51-106.8] versus 0.8 ng/mL [0.36-121.0]; P = 0.015). Patients in the PPROM group reached a significantly higher median amniotic fluid concentration of PTX3 compared with those in the midtrimester group (1.0 ng/mL [0.36-121.0] versus 0.67 ng/mL [0.4-2.8]; P = 0.007).

Conclusion

Histological chorioamnionitis is associated with a significant increase of amniotic fluid pentraxin 3 levels. Amniotic fluid pentraxin 3 appears to be a marker of intra-amniotic inflammation.     

Risk factors for preterm premature rupture of membranes in Chinese women from urban cities

Objective

To investigate the prevalence of preterm premature rupture of membranes (PPROM) in urban areas in China and examine the associated risk factors.

Methods

A population-based, prospective study was undertaken in 14 cities in China between January 1, 2011, and January 31, 2012. Women were recruited at their first prenatal-care visit, when maternal characteristics were recorded. Risk factors were analyzed by one-way analysis of variance.

Results

Of 112 439 women included in analyses, 3077 (2.7%) had PPROM. Univariate analysis showed an increased risk of PPROM before 28 weeks of pregnancy in migrant women (odds ratio [OR] 2.25; 95% confidence interval [CI] 1.53–3.30; P < 0.001), in those with a history of recurrent induced abortions (OR 2.75; 95% CI 1.66–4.56; P < 0.001), and in those with a history of preterm birth (OR 3.90; 95% CI 0.77–19.61; P < 0.001). The associations were maintained in multivariate analysis (P < 0.001).

Conclusion

Migration as a result of urbanization, high rates of induced abortion, and preterm birth are potential risk factors for PPROM in Chinese women.     

Inflammatory cytokine mRNA detection by real time PCR in chorioamniotic membranes from pregnant women with preterm premature rupture of membranes

Objective

To quantify the expression of interleukin (IL)-1β, IL-6, IL-8 and tumor necrosis factor alpha (TNF-α) in chorioamniotic membranes of PPROM pregnant women with chorioamnionits.

Study design

The study included 25 PPROM women in labor, 15 PPROM without labor, and 25 pregnant women in preterm labor (PTL). Chorioamniotic membranes were collected for histopathological analyses and cytokine mRNA expression quantification by real time PCR. Comparisons were performed using the Mann–Whitney, Kruskal–Wallis, Fisher's exact test or z test with significance set at p < 0.05. The software employed was the SigmaStat version 3.1.

Results

During the study PPROM incidence was 4.6% and chorioamnionits was present in 75% of the samples. IL-1β, IL-6, and IL-8 mRNA expression did not statistically differ among study groups. TNF-α mRNA expression was statistically higher in PTL. No difference in the mRNA concentration of the cytokines studied in the presence of chorioamnionitis was observed.

Conclusion

Chorioamniotic membranes are sources of IL-1β, IL-6, IL-8, and TNF-α and their mRNA concentrations in PPROM are not related to the presence of chorioamnionitis.     

Antibiotic susceptibility pattern of genital tract bacteria in pregnant women with preterm premature rupture of membranes in a resource-limited setting

Objective

To identify microbes prevalent in the genital tract of pregnant women with preterm premature rupture of membranes (PPROM) and to assess the susceptibility of the microbial isolates to a range of antibiotics to determine appropriate antibiotics for treating cases of PPROM in resource-limited settings.

Methods

A prospective cross-sectional study was undertaken involving women with (n = 105) and without (n = 105) a confirmed diagnosis of PPROM admitted to Nnamdi Azikiwe University Teaching Hospital, southeast Nigeria, between January 1, 2011, and April 30, 2013. Endocervical swabs were collected from all participants and examined microbiologically. Antibiotic sensitivity testing was performed using Kirby–Bauer disk diffusion.

Results

Streptococcus spp., Staphylococcus aureus, and Escherichia coli were significantly more prevalent among women with PPROM than among those without PPROM (P < 0.01). Among the antibiotics considered safe to use during pregnancy, the bacteria were most sensitive to ampicillin-sulbactam, cefixime, cefuroxime, and erythromycin.

Conclusion

For the first 48 hours, women with PPROM should receive an intravenous dose combining ampicillin-sulbactam, cefixime, cefuroxime, or erythromycin with metronidazole followed by oral administration of the chosen antibiotic combination to complete a 7-day course.     

Amniotic fluid S100B protein and erythropoietin in pregnancies at risk for fetal hypoxia

Objective

S100B protein is a biochemical marker for brain injury, and high serum S100B levels have been observed in newborns with birth asphyxia. We hypothesized that the concentration of amniotic fluid erythropoietin, which increases in chronic fetal hypoxia, correlates with amniotic fluid S100B concentration.

Study design

Amniotic fluid samples in 35 pregnancies at high risk for chronic fetal hypoxia were obtained at cesarean section or by amniocentesis done within a median of 2 days before delivery. S100B and erythropoietin concentrations were measured by chemiluminescent immunoassays.

Results

A positive correlation existed between the concentrations of S100B and erythropoietin in the amniotic fluid (r = 0.57, p < 0.0001). Amniotic fluid S100B concentration was higher (70 ng/l; 33–469, n = 17) (median; range) in pregnancies with elevated amniotic fluid erythropoietin (≥50 IU/l) than in pregnancies with normal erythropoietin (34 ng/l; 20–340, n = 18) (p < 0.0001, Mann–Whitney U-test). S100B predicted an elevated amniotic fluid erythropoietin concentration in the study population with the sensitivity of 94% and specificity of 83%.

Conclusion

A strong positive correlation exists between amniotic fluid S100B and erythropoietin concentrations in pregnancies at high risk for chronic fetal hypoxia. This suggests that chronic fetal hypoxia increases the intrauterine release of S100B.     

Amniotic fluid insulin-like growth factor binding protein 3 concentration as early indicator of fetal growth restriction

Objective

Insulin-like growth factor-I (IGF-I) is an important regulator of fetal growth and its bioavailability depends on insulin-like growth factor binding proteins (IGFBPs). Genes coding for IGF-I and IGFBP3 are polymorphic. We hypothesized that either amniotic fluid protein concentration at the beginning of the second trimester or genotype of one of these two genes could be predictive of abnormal fetal growth.

Study design

Amniotic fluid samples (14–18 weeks of pregnancy) from 123 patients with appropriate for gestational age (AGA) fetuses, 39 patients with small for gestational age (SGA) fetuses and 34 patients with large for gestational age (LGA) were analyzed. Protein concentrations were evaluated by ELISA and gene polymorphisms by PCR.

Results

Amniotic fluid IGFBP3 concentrations were significantly higher in SGA compared to AGA group (P = 0.030), and this was even more significant when adjusted to gestational age at the time of amniocentesis and other covariates (ANCOVA analysis: P = 0.009). Genotypic distribution of IGF-I variable number of tandem repeats (VNTR) polymorphism was significantly different in SGA compared to AGA group (P = 0.029). 19CA/20CA genotype frequency was threefold decreased in SGA compared to AGA group and the risk of SGA occurrence of this genotype was decreased accordingly: OR = 0.289, 95%CI = 0.1–0.9, P = 0.032. Genotype distribution of IGFBP3(A-202C) polymorphism was similar in all three groups.

Conclusions

High IGFBP3 concentrations in amniotic fluid at the beginning of the second trimester are associated with increased risks of SGA while 19CA/20CA genotype at IGF-I VNTR polymorphism is associated with reduced risks of SGA. Neither IGFBP3 concentrations, nor IGF-I/IGFBP3 polymorphisms are associated with modified risks of LGA.     

Trends in preterm birth in singleton deliveries in a Hong Kong population

Objective

To examine trends in preterm birth and its relationship with perinatal mortality in Hong Kong.

Methods

In a retrospective cohort study, data were reviewed from singletons delivered between 1995 and 2011 at a university teaching hospital. Trends in preterm birth (between 24 and 36 weeks of pregnancy), perinatal mortality, and subtypes of preterm birth (spontaneous, iatrogenic, and following preterm premature rupture of membranes [PPROM]) were examined via linear regression.

Results

There were 103 364 singleton deliveries, of which 6722 (6.5%) occurred preterm, including 1835 (1.8%) early preterm births (24–33 weeks) and 4887 (4.7%) late preterm births (34–36 weeks). Frequency of preterm birth remained fairly consistent over the study period, but that of spontaneous preterm birth decreased by 25% (β = –0.83; P < 0.001), from 4.5% to 3.8%. Frequency of preterm birth following PPROM increased by 135% (β = 0.82; P < 0.001), from 0.7% to 1.7%. The perinatal mortality rate decreased from 56.7 to 37.0 deaths per 1000 deliveries before 37 weeks (β = –0.16; P = 0.54). Early preterm birth contributed to 16.0% of all deaths.

Conclusion

Although the overall rate of preterm birth in Hong Kong has remained constant, the frequencies of its subtypes have changed. Overall perinatal mortality is gradually decreasing, but early preterm birth remains a major contributor.     

Concentraciones de quimiocina RANTES en preeclámpticas y embarazadas normotensas sanas

Objective

To compare concentrations of chemokine RANTES in pre-eclampsia patients and healthy normotensive pregnant women.

Method

A total of 100 patients were selected. We included 50 pre-eclamptic patients as cases (group A) and a control group of 50 healthy normotensive women with the same age and body mass index as the study group (group B). Blood samples were collected in all patients before labor and immediately after diagnosis in group B to determine RANTES concentrations.

Results

There were no significant differences in maternal age, gestational age, or body mass index when the samples were taken (P = ns). RANTES concentrations showed statistically significant differences between cases (group A; 2484.6 ± 113.7 pg/mL) and controls (group B; 2002.8 ± 62.6 pg/mL; P < .05). There was a moderate, positive and significant correlation with systolic blood pressure values (r = .283; P < .05) and with diastolic blood pressure values (r = .322; P < .05).

Conclusions

Chemokine RANTES concentrations were significantly higher in pre-eclampsic patients than in healthy normotensive pregnant women.     

Selectinas solubles en preeclámpsicas y embarazadas normotensas sanas

Objective

To compare concentrations of soluble selectins in preeclamptic patients and healthy normotensive pregnant women.

Method

A total of 100 patients were selected. Fifty preeclamptic patients were selected as cases (group A) and 50 healthy normotensive pregnant women with the same age and body mass index as the study group were selected as controls (group B). Blood samples were extracted from all patients before labor and immediately after diagnosis in group A to determine concentrations of P-, E- and L-selectin.

Results

No significant differences were found in maternal age, gestational age or body mass index at sample extraction (P = ns). Significantly higher concentrations of P- and E-selectin were found in group A than in group B (P < 0.05). However, L-selectin concentrations were significantly lower in preeclamptic patients than in normotensive pregnant controls (P < 0.05). A strong, positive and significant correlation was found between P- and E-selectin and values of systolic and diastolic blood pressure (P < 0.05) and a strong, negative and significant correlation was observed between L-selectin concentrations and values of systolic and diastolic blood pressure (P < 0.05).

Conclusions

Preeclamptic patients had significantly higher concentrations of P- and E-selectin and lower concentrations of L-selectin than healthy normotensive pregnant women.     

Mifepristona 5 mg frente a 10 mg diarios en el tratamiento del leiomioma. Ensayo clínico aleatorizado

Objective

To estimate the efficacy and safety of 5 mg or 10 mg mifepristone daily in the treatment of leiomyoma.

Material and methods

Ninety women with symptomatic uterine myomas were randomised to receive 5 mg or 10 mg of mifepristone (45 per group). Leiomyomata and uterine volumes were evaluated by ultrasonography. Efficacy was estimated by the reduction of the leiomyomata and uterine volumes and the prevalence of symptoms.

Results

After treatment, in the 5 mg group there was a 60.8%, (P < .001), reduction in the fibroid volume and it was 59.4%, (P < .001), in the 10 mg group. The prevalence of symptoms decreased significantly. After treatment, 93.8% subjects from the 10 mg mifepristone group and 86.4% subjects from the 5 mg group were amenorrheic, respectively.

Conclusions

Both treatments were effective for treating uterine fibroids.     

Time interval from elective removal of cervical cerclage to onset of spontaneous labour

Objective

To determine the time interval between elective removal of a cervical cerclage to the onset of spontaneous labour in women who had either a history- or ultrasound-indicated cervical cerclage.

Study design

A retrospective cohort study of women with a singleton pregnancy that had either a modified Shirodkar or McDonald cervical cerclage inserted were evaluated for the time interval between elective cerclage removal and onset of spontaneous labour and also spontaneous labour with 72 h of cervical cerclage removal.

Results

Two hundred and sixty-nine singleton pregnancies with either a modified Shirodkar or McDonald cervical cerclage were analysed. The mean gestational age at cerclage removal was 36.7 ± 1.10 weeks and gestational age at spontaneous labour was 39.0 ± 1.94 weeks (mean ± SD). The median interval between cerclage removal and spontaneous labour was 14 days. Only 18% of women laboured spontaneously within 72 h. Women with ultrasound-indicated cerclage were more likely to deliver within 72 h, compared with women with a history-indicated cervical cerclage (odds ratio, 3.68; 95% confidence interval, 1.31–10.85, p = 0.01).

Conclusion

Independent of the indication or technique used for cervical cerclage, the rate of early spontaneous labour following elective removal of cervical cerclage is sufficiently low to justify outpatient management.     

Amniotic fluid interleukin-6 and tumor necrosis factor-α at mid-trimester genetic amniocentesis: Relationship to intra-amniotic microbial invasion and preterm delivery

Objective

To determine the value of amniotic fluid interleukin-6 (AF IL-6) and tumor necrosis factor-α (AF TNF-α) in the diagnosis of microbial invasion of the amniotic cavity and in the prediction of preterm delivery (PTD).

Study design

Following amniocentesis, a sample of amniotic fluid was sent for aerobic and anaerobic bacterial cultures along with Ureaplasma urealyticum culture and it was also assessed for IL-6 and TNF-α.

Results

Forty-eight women who delivered preterm (<37 weeks) were matched with 96 controls. The AF IL-6 and TNF-α concentrations of women with spontaneous PTD were significantly higher than those who delivered at term (IL-6: 176.3 pg/ml [130.6–208.6] vs. 52.3 pg/ml [37.2–92.3]; TNF-α: 8.8 pg/ml [7.2–10.7] vs. 5.5 pg/ml [5.0–6.3]). AF IL-6 and TNF-α concentrations of >99.3 pg/ml and of >6.6 pg/ml respectively, had a sensitivity of 89.6% and 81.3% and a specificity of 80.3% and 79.2% for the prediction of spontaneous PTD. Moreover, AF IL-6 and TNF-α concentrations of >99.3 pg/ml and of 6.3 pg/ml respectively, had a sensitivity of 91.9% and 78.4% and a specificity of 73.8% and 70.1% for the prediction of a positive AF culture.

Conclusions

Elevated mid-trimester concentrations of AF IL-6, or/and of TNF-α can identify women at risk for intra-amniotic infection and for spontaneous PTD.     

Effect of latency period after premature rupture of membranes on 2 years infant mortality (DOMINOS study)

Objective

To assess the impact of a short latency period after preterm premature rupture of the membranes (PPROM) on infant mortality.

Study design

A prospective cohort study of women with PPROM between 24^0/7 and 33^6/7 weeks’ in singleton gestation was performed in all maternity wards of the Rhône-Alpes Region. Neonatal and infant outcomes were compared according to the latency period (<48 h and ≥48 h). The primary outcome was the mortality rate and the secondary outcome was a composite variable of significant neurological disorders at 2 years of age. Outcomes was stratified according to gestational age at rupture. Univariate and multiple logistic regression analyses were used with SAS statistical software.

Results

Out of 471 women recruited in the study at a mean gestational age of 30.5 ± 0.2 weeks, 170 (37%) presented with a <48-h latency period, and 301 (63%), a ≥48-h latency period. While prior to 30 weeks’ gestation, the mortality rate was higher in neonates with a short latency period (16.3% versus 7.3%, p < 0.01) with pulmonary disease being the major cause of death, a short latency period was associated with a lower mortality rate after 30 weeks’ gestation (0% versus 3.7%, p = 0.02). After adjusting for confounding factors, a <48-h latency period remained an independent factor associated with infant mortality prior to 30 week's gestation (odds ratio 3.8, 95% confidence interval 1.3–11.7). Significant neurological disorders were not modified by the length of the latency period.

Conclusion

For PPROM that occur before 30 weeks’ gestation, a short latency period was associated with a higher infant mortality rate. Inversely, it was associated with a lower mortality rate after 30 weeks’. There is an urgent need for a thorough evaluation of expectant management of PPROM after 30 weeks’ gestation.     

Hydrogel protection: a novel approach to reduce bowel inflammation in experimental gastroschisis

Objective

In gastroschisis there is herniation of the fetal bowel into the amniotic cavity that results in severe intestinal dysfunction. In order to reduce bowel exposure to amniotic fluid we used a hydrogel of N-isopropylacrylamide copolymerized with acrylic acid (P(NIPAAm-co-AAc)) to coat the herniated bowel through the use of a fibrin adhesive (Beriplast^®).

Study design

Gastroschisis was created in fetuses of 31 pregnant Sprague–Dawley rats by evisceration of the bowel through a right paramedian incision in the abdominal wall on day 18.5 of pregnancy. The fetuses were separated in four groups of 12 fetuses: control (C), gastroschisis (G), gastroschisis + fibrin adhesive (GA) and gastroschisis + fibrin adhesive + dry hydrogel (GAH). Animals were harvested at day 21.5 of pregnancy and the hydrogel was removed. Fetuses and bowels were weighed and morphometric analysis was performed. Isoelectric focusing of the amniotic fluid determined its electrical charge. We evaluated the hydrogel swelling ratio (Q) in the amniotic fluid. Histological analysis and scanning electronic microscopy (SEM) of the bowel and hydrogel were performed. Our primary outcome was bowel intactness after hydrogel removal and our secondary outcome was the effectiveness of the hydrogel in protecting the bowel against amniotic fluid and its components. Differences among the groups were tested by the ANOVA and Tukey–Kramer post-test method and the statistical significance accepted was for p values <0.05.

Results

The mass of swollen hydrogel was 34 times the mass of dry hydrogel. Isoelectric focusing of the amniotic fluid showed that most of its proteins are negatively charged as the hydrogel. SEM showed that removal of the hydrogel did not damage bowel serosa. Bowel weight, diameter and wall thickness were similar between groups C and GAH but bowel diameter and wall thickness was significantly reduced in C and GAH compared to G and GA (p < 0.001).

Conclusion

The P(NIPAAm-co-AAc) hydrogel does not harm the bowel and provides a safe effective protection with reduction of bowel damage in gastroschisis.     

Micropartículas plaquetarias en preeclampsia y eclampsia

Objective

To compare platelet microparticle values in eclamptic, preeclamptic and normotensive pregnant women.

Material and methods

Patients attending the Dr. Urquinaona Central Hospital in Maracaibo, Venezuela, were selected. Thirty patients with mild preeclampsia (group A), 30 with severe preeclampsia (group B) and 30 with eclampsia (group C) were included. Thirty-five healthy women with a similar age and body mass index to those in the study groups were selected as controls (group D). Only nuliparous patients were included. Blood samples were collected before delivery from all patients and immediately after diagnosis for platelet microparticle determination in the study groups.

Results

Statistically significant differences were found in gestational age between groups B and C compared with the control group (P < .05). Higher platelet microparticle values were found in eclamptic patients and severe preeclamptic patients. Lower values were found in mild preeclamptic patients. Significantly higher platelet microparticle values were found in the study groups than in controls (P < .05). When linear regression was performed, the factors significantly affecting platelet microparticle values were 24-hour proteinuria, transaminase and uric acid levels and platelet count (P < .05).

Conclusions

Our findings indicate that platelet microparticle values are higher in eclamptic and preeclamptic women than in normotensive pregnant women.     

Proteína C reactiva y homocisteína en menopáusicas tratadas con tibolona

Objective

To determine modifications in C-reactive protein and homocysteine in postmenopausal women who used tibolone.

Materials and methods

We selected a sample of 45 postmenopausal women treated with a 2.5-mg dose of tibolone daily for 6 months. Serum concentrations of C-reactive protein and homocysteine were measured.

Results

C-reactive protein concentrations were significantly increased after 6 months of treatment (0.51 ± 0.29 mg/dl at baseline compared with 0.95 ± 0.34 mg/dl after treatment; P<.05). Homocysteine concentrations were significantly reduced after 6 months of treatment (10.16 ± 1.45 picomol/L) compared with initial values (10.95 ± 1.87 picomol/L; P<.05).

Conclusions

After 6 months of use, tibolone significantly increased C-reactive protein concentrations and reduced homocysteine concentrations.     

Tratamiento de la endometriosis con 5 mg o 25 mg diarios de mifepristona durante 6 meses. Ensayo clínico aleatorizado,doble ciego

Objectives

To evaluate the safety and efficacy of 5 mg and 25 mg doses of mifepristone for the treatment of endometriosis.

Design

Randomized double-blind study.

Setting

Eusebio Hernández Hospital, Havana, Cuba.

Subjects

Twenty-six women laparoscopically diagnosed with endometriosis were included.

Treatment

Group I received one tablet of 25 mg mifepristone daily and group II received one tablet of 5 mg mifepristone daily for 6 months. Laparoscopy and endometrial biopsy were performed before and after treatment.

Variable to evaluate efficacy

Reduction in the intensity of dysmenorrhea measured by a visual analogue scale.

Results

In both groups reductions in the intensity of dysmenorrhea and dyspareunia were highly significant compared with initial values (P <.001). All the women were amenorrheic after 45 days of treatment.

Conclusions

At doses of 5 mg or 25 mg, mifepristone could be an alternative for the treatment of endometriosis.