Prostaglandin E2 suppositories as a second-trimester abortifacient

Despite the large number of second-trimester abortions performed each year in the United States through labor induction, the optimal method of inducing labor has not been developed. This study was performed to evaluate the efficacy and safety of vaginal prostaglandin E2 suppositories as an abortifacient. We analyzed the abortions at 14-24 menstrual weeks' gestation performed at Women's Hospital, Los Angeles, in 1985 and 1986. The abortion rate at 24 hours was 90.4%, with a mean induction-to-abortion time of 13.8 hours. Although gastrointestinal side effects were frequent, hemorrhage, infection and live births were infrequent. Prostaglandin E2 suppositories are a simple, effective and safe means of effecting second-trimester abortion that requires little surgical skill.     

The efficacy and acceptability of intravenously administered prostaglandin F as an abortifacient

The efficacy and acceptability of PGF2alpha (prostaglandin F2alpha) as an abortifacient has been examined during intravenous infusion in 15 obstetrically normal midtrimester patients. Infusions of up to 200 mcg/minute of PGF2alpha induced complete abortions in 3 and incomplete abortions in an additional 3 patients. 4 patients failed to abort. All patients experienced undesirable side effects, i.e., nausea, vomiting, and diarrhea, in various degrees. This form of therapy cannot be recommended for routine therapeutic use; however, current clinical studies complemented by model experiments in animals suggest that the efficacy and acceptability of PGF2alpha can be increased by topical, intrauterine administration. Preliminary deductions pertinent to the mechanism of the abortifacient effect of PGF2alpha have been made based on measurements of intraamniotic pressure, circulating estradiol-17 beta, and progesterone levels.     

Embryocidal action of a bis(dichloroacetyl)-diamine: an oral abortifacient for rats

It is demonstrated that for rats N,N'-bis(dischloroacetyl)-1,8-octamethylenediamine (Win 18,446) is a highly efficient embryocidal N,N'-bis(dichloroacetyl)-1,8-octamethylenediamine It was previously used to supress spermatogenesis in man and other mammals. In the initial rat studies, a fixed dosage of Win 18,446 was administered daily from Day 3 to Day 21. With dosages equal to or greater than 100 mg per day all the implants are resorbed although the implantation sites are clearly visible. At a dose of 50 mg per day 90% of the embryos are resorbed; the remainder being alive but deformed. It was determined that although the drug is most effective when administered at Days 10 through 11, a longer schedule that includes these 2 days is not harmful to the mother. The optimal dosage is 200 mg. A mechanism is proposed involving mitochondrial function and replication to explain the action of this drug in the inhibition of embryonic development as well as the suppression of spermatogenesis.     

Vaginal gram stain as an immediate detector of group B streptococci in selected obstetric patients

During a 19-month period selective vaginal Gram stain and culturing were performed prospectively in all women admitted to the delivery room at risk for low birth weight delivery secondary to preterm premature rupture of the membranes or for prolonged membrane rupture secondary to term premature rupture of the membranes. Gram stain was performed and read immediately on admission. Cultures were also obtained simultaneously and sent for microbiologic evaluation. All women with Gram stains positive for gram-positive cocci were treated with intravenous ampicillin in the event of labor, unless vaginal culture results were already known and were negative for group B beta-hemolytic streptococcus. A total of 72 women had samples taken, and 30 (41.7%) were positive for gram-positive cocci. Nine (30%) of these were subsequently positive for group B beta-hemolytic streptococci by culture. There were no cultures positive for group B beta-hemolytic streptococci in the Gram stain-negative group. Gram stain sensitivity was 100% for predicting the presence of group B beta-hemolytic streptococci in the study population, and specificity was 66.7%. Selective vaginal Gram stain provides an effective and rapid screen for identifying the presence of group B beta-hemolytic streptococci and allows for immediate institution of appropriate antibiotic therapy in the event of onset of labor before the availability of culture results.     

The effects of longacting paracervical block anesthesia on the abortifacient efficacy of intra-amniotic PGF2alpha and hypertonic saline.

A comparative study was conducted to evaluate the effects of repeated, longacting paracervical blocks on the abortifacient efficacy of intraamniotic prostaglandin F2alpha (PGF2alpha)-40 mg initially and an additional 20 mg after 24 hours--and hypertonic saline augmented with intravenous oxytocin, for patients at 16 to 20 weeks' gestation. Patients were randomly assigned to the 2 abortion procedures, and one half (50) of the patients induced with each procedure received serial, longacting paracervical blocks. For those patients aborted with saline, the rates of complications, side effects, incomplete abortion, and cumulative abortion were similar for patients whether they did or did not receive paracervical blocks. Among the PGF2alpha-treated patients who were administered paracervical blocks, there was a significant reduction in the rates of gastrointestinal side effects and incomplete abortion and a significant differences in the cumulative abortion rates. Within 32 hours of the initial PGF2alpha, instillation, 98% of the patients who received paracervical blocks aborted compared to 70% of those who did not receive paracervical blocks. Although the cumulative abortion rates of PGF2alpha-treated patients with paracervical blocks and saline-treated patients were similar, the rate of incomplete abortion for the PGF2alpha-treated patients was significantly lower. Additional studies will be necessary to evaluate the safety and advantages of using paracervical block anesthesia as an adjunct to midtrimester abortion procedures.     

Progesterone antagonist lilopristone: a potent abortifacient in the common marmoset

The effects of a progesterone antagonist ZK 98.734 (lilopristone) on implantation, early pregnancy, and midpregnancy were studied in the common marmoset, Callithrix jacchus jacchus. Treatment (5 mg/da intramuscularly for 3 consecutive days) on day (n = 8) after the midcycle peak in estradiol levels in mated animals induced a premature drop in plasma progesterone levels and shortened the ovarian cycle length. Treatment on day 20 (n = 5) or day 40 (n = 5) induced a drop in progesterone levels and decidual collapse. In three animals treated on day 40, vaginal bleeding was observed within 46 hours of the initiation of treatment. Treatment on day 80 resulted in expulsion of the fetuses with a mean induction abortion interval of 39 hours (range, 20 to 48 hours). The progesterone antagonistic effects of ZK 98.734 could be a result of the decrease in progesterone synthesis by the corpus luteum and/or placenta in addition to the interference with the progesterone binding to its cellular receptors in the target organ. Our study suggests that ZK 98.734 has potential for fertility regulation. Clinical trials for postcoital contraception, induction of menstruation, and early abortifacient effects are warranted.     

The value of saline salpingosonography as a surrogate test of tubal patency in low-resource settings

BACKGROUND: Tubal factor, which accounts for 15-30% of infertility in all women, is common in developing countries with high rates of pelvic inflammatory disease but limited resources. It is possible to outline the fallopian tubes by injecting isotonic saline transcervically during transvaginal ultrasound scanning of the pelvis, and both color flow Doppler and 3-dimensional scanning modes have been employed to improve visualization of the tubes, with varying success. METHOD: We investigated the value of saline salpingosonography (SSG), using 2-dimensional transvaginal ultrasound scanning, as a screening test of tubal patency in 113 women by comparing SSG findings to those at HSG or laparoscopy. RESULTS: The findings at SSG correlated well with the results of HSG or laparoscopy, with an overall concordance of 82.5%. SSG was more accurate at diagnosing patent tubes than blocked tubes and was well tolerated. The results are, however, unreliable when it is difficult to inject the saline and when the patient experiences severe pain during the procedure. CONCLUSION: SSG is a useful screening tool for investigating infertility, particularly in low-resource settings.     

Obesity as an independent risk factor for group B streptococcal colonization

Objective: Approximately 25% of women are colonized with group B streptococcus (GBS). We assessed whether body mass index (BMI) is an independent risk factor for GBS colonization.

Study design: We performed a retrospective cohort study using a previously collected database of women who delivered singleton gestations at term. Individual patient medical record review was undertaken to add GBS-related information to the database. Univariable logistic regression was used to assess the relationship between GBS colonization and BMI. Multivariable logistic regression was used to adjust for confounders.

Results: A total of 2045 patients met enrollment criteria. The prevalence of GBS colonization was 29%. In the unadjusted analysis, there was a statistically significant increase in GBS colonization per unit increase in BMI (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.01–1.04). This relationship remained significant after adjusting for confounders (race, marital status, payer, chronic hypertension, concomitant genital infections) (OR 1.01, 95% CI 1.00–1.03; p?=?0.04). By BMI category, there were no differences in antibiotic susceptibilities or mode of ascertainment of GBS colonization.

Conclusion: Obesity is an independent risk factor for GBS colonization; however, this association is weak.     

Carbon dioxide versus normal saline as a uterine distension medium for diagnostic vaginoscopic hysteroscopy in infertile patients: a prospective,randomized, multicenter study

OBJECTIVE: To evaluate the satisfaction rate, efficacy, and complication rate of carbon dioxide (CO(2)) versus normal saline as a uterine distension medium for outpatient diagnostic vaginoscopic hysteroscopy in infertile patients. DESIGN: Prospective, randomized multicenter study. SETTING: Hysteroscopy units in two university hospitals and in a private center. PATIENT(S): One hundred eighty-nine infertile women undergoing outpatient hysteroscopy. INTERVENTION(S): Outpatient hysteroscopy was performed with CO(2) (group A) or normal saline (group B) and with endometrial biopsy when indicated. MAIN OUTCOME MEASURE(S): Quality of the visualization of the uterine cavity, procedure time, complications, patient discomfort, and satisfaction rate. RESULT(S): Significantly lower abdominal and shoulder tip pain and a lower incidence of vasovagal reactions were observed in group B in comparison with group A. A higher satisfaction rate and a lower operative time were obtained in the normal saline group in comparison with the CO(2) group. Moreover, group A required significantly more analgesics after the procedure than group B. CONCLUSION(S): Uterine distension with normal saline seems to have less adverse effects and is better tolerated by patients. Moreover, it allows operative procedures to be performed with the new bipolar instruments.     

Use of recombinant LH in a group of unselected IVF patients

The aim of this study was to evaluate the use of recombinant luteinizing hormone (rLH) supplementation in an unselected group of IVF patients undergoing follicular stimulation with recombinant follicle stimulating hormone (rFSH) after pituitary down-regulation. Group A comprised 122 cycles administered rFSH and rLH while group B included 331 cycles using rFSH only during the same period of treatment. There was no significant difference in any of the endocrine, embryological and outcome parameters measured. The implantation rate of 14.2% for group A compared with 9.8% for group B showed a positive trend (P = 0.055), but for patients in whom LH concentration was <1.0 IU/l at down-regulation or required excessive FSH stimulation, there was an increased incidence of implantation if rLH was supplemented. It was concluded that the addition of exogenous rLH to an unselected group of 'down-regulated' patients stimulated with rFSH appears to offer little benefit, but in the event of profound LH down-regulation or requirement for excessive exogenous FSH (>2500 IU), the rate of implantation might be improved.