Comparison of paracervical block techniques during first trimester pregnancy termination.

OBJECTIVES: To determine whether variations in chloroprocaine placement in paracervical blocks influence effectiveness, whether chloroprocaine is superior to saline, and what factors influence pain perception. METHOD: Eighty-two women undergoing first trimester aspiration abortions were randomized to receive 1% chloroprocaine or saline at 3-5-7-9 or 4-8 o'clock positions. Using a 0--10 scale, women rated anxiety, dysmenorrhea, and pain associated with laminaria insertion, paracervical block, and aspiration. RESULTS: All four groups were similar in medical and demographic characteristics. Injection position did not influence pain ratings, but women who received chloroprocaine had less pain than those who received saline (6.3+/-2.3 vs. 7.8+/-2.0, P=0.002). Paracervical pain and dysmenorrhea were independently associated with aspiration pain scores (respective regression coefficients 0.49 and 0.26, P<0.008). CONCLUSIONS: There is no advantage to using a four-site paracervical block over a two-site technique, but chloroprocaine is superior to saline. Paracervical block may not provide adequate anesthesia during first trimester abortion, especially for women with significant dysmenorrhea.     

Sexual behavior during the first eight weeks after legal termination of pregnancy

BACKGROUND: The aim of the study was to describe sexual symptoms and resumption of sexual activity during the first 8 weeks after unrestricted first-trimester termination of pregnancy (TOP). METHODS: Questionnaires 2 and 8 weeks after legal first-trimester abortion in 1327 women. RESULTS: The 8-week questionnaire was returned by 941 (71%). Overall, 51.0% of the women recommenced coitus within 2 weeks after TOP. This figure was significantly higher among women aged 18-24 years (60.6%) than among women in higher age groups (41.7-47.8%). At 8 weeks follow-up coitus was reported by 86.9%, ranging from 65.8% of women not in a steady relationship to 93.7% of women in a relationship (p < 0.001), and age-related differences were insignificant. Long duration of vaginal bleeding, medical abortion and need for reevacuation of the uterus diminished the resumption frequency at 2 weeks follow-up, but 8 weeks after termination postabortion complications did not affect resumption. At 8 weeks follow-up 15.3% reported diminished sexual desire and 6.0% reported diminished orgasm ability comparing to prepregnancy level. Of the sexually active women 6.2% did not use sufficient contraception 8 weeks after termination. CONCLUSION: Coitus is recommenced shortly after termination of pregnancy but not always with sufficient contraception. Legal abortion is associated with few adverse effects on sexual function.     

Lipid and hormonal profile of Panamanian women during the menstrual cycle.

Forty-one women of reproductive age were included in the study, to establish the variation of serum lipids during the menstrual cycle and simultaneously, to determine the physiological fluctuation of FSH, LH, prolactin (PRL), progesterone (P4) and estradiol (E2) concentration in serum, during the menstrual cycle. A significant decrease of total serum cholesterol (165.29 +/- 3.6 mg/dl) and triglycerides (108.99 +/- 9.65) occurred during the luteal phase, as compared with the follicular phase (176.16 +/- 3.51, 108.99 +/- 9.65). Changes were not observed with HDL-cholesterol during the cycle. On the other hand, FSH showed an initial rise (mean 5 IU/l) followed by a surge (10 IU/l) and a progressive fall toward the midcycle. In contrast LH secretion showed a steady increase with a maximal concentration at surge (32.1 IU/l). PRL mean value was observed, with a discrete increase after day 13 of the menstrual cycle, that was more noticeable at the end of the cycle. Forty-eight hours after the FSH and LH midcycle surge, elevation of progesterone was observed, with maximal concentration occurring on day 24 (23 nmol/l) and later on progesterone levels fell rapidly. Thirty-six to 24 h before the surge of LH and FSH at midcycle was observed the peak serum concentration of estradiol (1300 pmol/l) followed by a progressive fall. Changes in the concentration of serum lipids during the menstrual cycle are presumably due to a direct or indirect effect of physiological fluctuation of sex hormones.     

Clinical manifestations of hormonal changes in the menstrual cycle

The human female reproductive cycle is the result of repeated interactions--giving positive and negative feedback--of pituitary gonadotropic hormones and ovarian sex steroid hormones. If any of the pituitary or ovarian hormones becomes tonically elevated or suppressed, ovulation will cease. The charge to the clinician in evaluating disorders of ovulation is to determine which hormone(s) is tonically elevated or suppressed. Sex steroid hormones exert effects on their target tissues that can be observed directly. These changes aid the clinician in evaluating disorders of ovulation and establishing which hormone(s) is tonically elevated or suppressed. Changes in thermoregulation can be detected by the basal body temperature record. Changes in the vagina can be detected by cytologic examination. Changes in the endometrium can be observed by obtaining a biopsy specimen for histologic examination. Premenstrual molimina suggest to the woman and her clinician that ovulation has occurred. Utilization of these changes in clinical practice aids the clinician in making a specific diagnosis of the cause of anovulation and in developing a treatment plan. Moreover, when the woman is aware of these clinical changes, it makes her a more involved participant in her health care.     

Association between hormonal and haemorheological changes during the menstrual cycle in healthy women

Blood rheology was studied in 15 healthy women throughout a normal menstrual cycle. Significant increases in fibrinogen, blood and plasma viscosity, and a reduction of erythrocyte filtrability were demonstrated during the follicular and ovulatory phase in comparison with mid- and late luteal phase of the menstrual cycle. Positive correlations were found between oestradiol levels and the haemorheological variables. Our data suggest that ovarian hormonal activity influences haemorheology and blood flow in healthy women.     

Plasma c-AMP during the normal menstrual cycle and under different hormonal treatment

There is a highly significant difference between the plasma c-AMP value of the first and the second half of the normal menstrual cycle (days 1-12: 10.5 +/- 2.0 pmol, x +/- SEM; days 13-16: 21.9 +/- 4.5; days 17-28: 19.9 +/- 2.0; p less than 0.001). In amenorrheic patients plasma c-AMP levels were nearly the same as in normal women during the first half of the menstrual cycle (11.1 +/- 2.5). Plasma c-AMP of amenorrheic women was significantly higher under HMG treatment (16.7 +/- 2.5; p less than 0.01). Under oral contraception with estrogens (alone) or with low doses of gestagens the plasma c-AMP values were comparable to those of the amenorrheic women, but there was a dose-dependent increase of plasma c-AMP under gestagen application. It is concluded that the midcyclic plasma c-AMP increase is mainly caused by the gonadotropin effect, and is followed by the progesterone effect during the second half of the menstrual cycle. Therefore, plasma c-AMP levels are in accordance to the stages of the menstrual cycle reflecting their different endocrine pattern.     

Association between hormonal and haemorheological changes during the menstrual cycle in healthy women

Summary. Blood rheology was studied in 15 healthy women throughout a normal menstrual cycle. Significant increases in fibrinogen, blood and plasma viscosity, and a reduction of erythrocyte filtrability were demonstrated during the follicular and ovulatory phase in comparison with mid- and late luteal phase of the menstrual cycle. Positive correlations were found between oestradiol levels and the haemorheological variables. Our data suggest that ovarian hormonal activity influences haemorheology and blood flow in healthy women.     

Serum gonadotropin and steroid patterns during the normal menstrual cycle

At the University of Southern California School of Medicine, the reproductive hormones follicle-stimulating hormone (FSH), luteinizing hormone (LH), progesterone, and estradiol were measured in serum samples obtained daily from a group of women throughout a normal menstrual cycle. Competitive binding techniques were used for the analysis of aliquots from the 10 women, aged 20-28, whose hormonal levels were studied. The results were generally in agreement with those of previous investigators, whose separate researches were less extensive than the research described here. FSH showed an early follicular phase rise, a late follicular phase decline, and a midcycle peak occurring on the day of the LH peak or on the day before and followed by a luteal phase decline. LH showed a slight progressive rise in the follicular phase, a midcycle peak, and a slight fall in the luteal phase. Estradiol also reached a midcycle peak. After the midcycle peaks, a rise progesterone. Progesterone and estradiol fell a few days before menstruation.     

Growth patterns of nondominant ovarian follicles during the normal menstrual cycle

Transvaginal ultrasound examinations were performed in seven normally cycling women to characterize growth of nondominant follicles in both ovaries. Mean follicle number showed little variation throughout the menstrual cycle with no differences between dominant and nondominant ovaries. Up to 11 follicles (greater than or equal to 2 mm) were observed in any one ovary. From observations of the first appearance of the dominant follicle (mean size 9.9 +/- 3.0 [SD] mm), selection was assumed to take place on cycle day 6.3 +/- 2.3. The diameter of nondominant follicles always remained less than 11 mm. Growth of small follicles was established in both dominant and nondominant ovaries up to the time of selection. The late follicular and luteal phases were characterized by a decrease in mean growth slopes of nondominant follicles in the dominant ovary only. These observations may provide in vivo evidence for the concept of intraovarian paracrine mechanisms and may have implications for the sonographic diagnosis of anovulation and monitoring of ovulation induction.     

Changes in serum immunoreactive erythropoietin during the menstrual cycle and normal pregnancy

Immunoreactive erythropoietin was estimated in samples of serum collected during the follicular and luteal phases of the menstrual cycle in seven women and in sera collected sequentially throughout normal pregnancy in these and three other women. Estimates of serum erythropoietin during the follicular and luteal phases of the menstrual cycle were almost identical. During pregnancy in all 10 subjects serum erythropoietin increased at some time after 8 weeks gestation. These changes were not related to other endocrine values, to indicators of haematological and renal function or to infant birthweight except that changes in serum erythropoietin and placental lactogen were related (P less than 0.00001). In one other woman treated over 17 weeks of pregnancy with continuous intravenous infusion of salbutamol, erythropoietin levels were within the range found in normal pregnancies.     

Changes in serum immunoreactive erythropoietin during the menstrual cycle and normal pregnancy

Summary. Immunoreactive erythropoietin was estimated in samples of serum collected during the follicular and luteal phases of the menstrual cycle in seven women and in sera collected sequentially throughout normal pregnancy in these and three other women. Estimates of serum erythropoietin during the follicular and luteal phases of the menstrual cycle were almost identical. During pregnancy in all 10 subjects serum erythropoietin increased at some time after 8 weeks gestation. These changes were not related to other endocrine values, to indicators of haematological and renal function or to infant birthweight except that changes in serum erythropoietin and placental lactogen were related ( P < 0.00001). In one other woman treated over 17 weeks of pregnancy with continuous intravenous infusion of salbutamol, erythropoietin levels were within the range found in normal pregnancies.     

Estrogen receptor in human endometrium during the menstrual cycle and early pregnancy

Available estrogen receptor has been estimated in endometrial tissue obtained from 8 women on the eighth and twenty-first days of the same menstrual cycle. Respective concentrations were 3.8 ± 1.1 and 6.0 ± 2.5 femtomoles (fmoles) per milligram of wet tissue during 5 ovulatory cycles and were 8.1 ± 3.7 and 2.9 ± 0.3 fmoles per milligram during 3 anovulatory cycles. The latter cycles appear to be associated with elevated endometrial receptor concentration on Day 8, and a marked drop between Days 8 and 21. In decidual tissue obtained from 4 patients who were 9 to 18 weeks pregnant, receptor concentration is low. The data indicate that available receptor concentration in human endometrium changes with hormonal status.     

Histology of the baboon endometrium during the menstrual cycle and pregnancy.

The histologic characteristics of baboon endometrium during the menstrual cycle and pregnancy were studied and compared with those of human endometrium. Eight phases of endometrial change during the menstrual cycle are described. The samples were dated on the basis of sex skin changes. The basic histology of the baboon endometrium is similar to that of human endometrium, but some differences were observed. The growth of baboon endometrium is more sluggish, secretion is less intense, and many of the changes, especially in the stroma, are localized, less diffuse than they are in human endometrium. During pregnancy, decidual transformation in the baboon is much less intense than that in the human. No differences were observed between endometrium in association with preimplantation embryos and that from nonpregnant animals at comparable times following ovulation.