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This paper contains a review of the natural history of pituitary tumors in nonpregnant and pregnant patients. Data were drawn from previously published reports and from responses to a questionnaire and were analyzed by life-table techniques. Follow-up of 62 nonpregnant patients with untreated pituitary tumors with and without visual field changes revealed a median time to treatment of 15 1/2 years and similar, relatively constant hazard functions. In 91 pregnancies occurring in 73 women with previously untreated pituitary tumors, ovulation had occurred spontaneously in 9 per cent, headache occurred in 23 per cent, and visual disturbances in 25 per cent with 61 per cent remaining asymptomatic. In those patients who developed symptoms, median time to headache was 10 weeks and to visual disturbance, 14 weeks. The hazard functions were relatively constant and similar. The relative risk of developing symptoms is independent of whether or not the first or second pregnancy occurred in the presence of the pituitary tumor. Of the pregnant patients with previously untreated pituitary tumors, 30 per cent required surgery or radiation therapy. Median time to treatment was 19 weeks. None of the 69 pregnant women without pituitary therapy had permanent sequelae. Only four patients who underwent surgery or received radiation treatment developed permanent symptoms and none was serious. In 78 pregnancies occurring in 73 women with previously treated pituitary tumors, headache occurred in 4 per cent and visual disturbances in 5 per cent. Only one patient required therapy. Treatment during pregnancy results in significantly increased prematurity rates but unchanged abortion and perinatal mortality rates. Small pituitary tumors do not constitute a contraindication to either induction of ovulation or pregnancy.
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PMID:Pituitary tumors and pregnancy. 36 26

This case report describes a 20-year-old woman who developed acute group B streptococcal endocarditis after a saline-induced abortion. She was admitted 2 weeks after an uncomplicated saline-induced abortion for a 16-week pregnancy with a 1-week history of fever, headaches, dizziness, and shortness of breath. The patient showed poor response to antibiotic therapies (initially to nafcillin and gentamicin and then to aqueous penicillin G). 6 to 6 blood cultures after hospital admission showed group B streptococcus which was penicillin sensitive by tetracycline resistant. On Day 3 of admission, a pericardial friction rub was noted and repeat chest x-rays showed marked enlargement of the cardiac shadow. Surgery was performed, and the mitral valve posterior leaflet was necrotic, and a mitral valve prosthesis was placed and an aortic embolectomy was performed. Postoperatively, she was treated with an additional 6-week course of intravenous penicillin, and subsequently, she has remained asymptomatic after 6 months. An addendum to this report, which was only the 2nd such report of endocarditis after saline abortion, describes another case of group B streptococcal endocarditis in a drug abuser after a saline-induced abortion. She required tricuspid valvulectomy and is slowly improving postoperatively.
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PMID:Malignant group B streptococcal endocarditis associated with saline-induced abortion. 38 76

In order to quantify the pain associated with first trimester abortions and to analyze its influences, patient observations by doctors and attending counselors and patient interviews were conducted. Of the 2299 patients, 86% received 20 cc of lidocaine as paracervical anesthesia (14% received less) and 76% choose to receive 5 mg oral diazepam preoperatively (4% received 3-8 intravenously during the procedure). Patients compared their pain with other familiar types of pain. Doctors and counselors rated the pain during each of 8 specific stages of the abortion (examination, speculum insertion, tenaculum placement, administration of paracervical local anesthesia, uterine sounding, cervical dilatation, vacuum aspiration, and sharp curettage) as compared with the average pain they had observed. In addition, counselors rated the degree of apprehension with which the patient faced the procedure. These methods were analyzed on the basis of internal consistency among each group and agreement across the 3 sources and were found to be sufficiently dependable for the purpose at hand. The pain most often experienced was less severe than an earache or toothache, more severe than a menstrual pain or headache. Physicians and counselors agreed that vacuum aspiration is the most painful stage followed by dilatation and sharp curettage. Pain was positively associated with 1) age of 15 years or less, 2) with gestation of less than 7 weeks or more than 12 and with dilatation on a curvilnear basis, and 3) with patient fear. Despite expectations to the contrary, administration of 5 mg oral diazepam did not reduce pain.
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PMID:Pain of first-trimester abortion: its quantification and relations with other variables. 44 87

Medicaments are used to prepare for instrument abortions in the 1st trimester and as inducers of abortion in the 2nd trimester. The effects, side effects, and dangers depend on the substances used and the route of application, which can be vaginal, cervical, injection, instillation, extraamniotic, intraamniotic, intravenous, or intramuscular. In the past, intraamniotic instillation of a 20% salt solution was the most common 2nd trimester method in Japan, the US, and Eastern Europe, giving a success rate of 90%. Serious side effects prompted substitution of extraamniotic instillation, which rarely produces serious side effects. Instillation of a 60% urea solution into the amniotic fluid in combination with oxytocin or prostaglandin produces an abortion in 13-21 hours, with a failure rate of 3% and a frequency of cervical laceration of under 1%. Extraamniotic use of a .1% solution of rivanol yields a success rate of about 85%, with a relatively long average time to explusion of 24-41 hours. In case of failure the procedure can be repeated. The advantage of the Rivanol method is the rarity of infectious complications. Alcohol is not used as a human abortifacient because it produces necrosis in the decidua and placenta. Prostaglandins are used in most 2nd trimester abortions. Research is underway to identify derivatives that will have an extended uterine impact without serious side effects. Different routes of administration have different effectiveness rates and dangers. All prostaglandins cause side effects including pain during uterine contractions, gastro-intestinal reactions, nausea, vomiting, fever, and headaches. Specific preparations are associated with other effects, some of them life-threatening. Emergency treatment should be available when these substances are used. Adjuvant measures may be employed before adminstration of an abortifacient agent to soften the cervix, or after administration to hasten the procedure. The choice of procedure depends upon the personality, health, and other characteristics of the woman and the experience of the doctor and the clinic.
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PMID:[Chemical methods of abortion]. 48 68

Sixty-one patients received nitrazepam 5 mg by mouth on the night before operation, followed by 2.5 mg given on the morning of operation and were compared with 60 patients who received no premedication. All were undergoing either therapeutic abortion, by dilatation and curettage, or explorative curettage. The plasma concentrations of nitrazepam were determined by gas chromatography and compared with the clinical effects of the drug. The premedicated patients slept better on the night before operation, and were more sedated and less apprehensive. Headache was more frequent following nitrazepam. There was no significant difference between the groups in respect of dizziness and nausea. The unpremedicated patients had a faster average heart rate. There was no obvious relationship between the plasma concentration of nitrazepam and the quality of sleep, degree of sedation, apprehension, excitement or headache.
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PMID:Nitrazepam premedication for minor surgery. 58 95

A review is made of the clinical use of prostaglandins in obstetrics and gynecology. Second trimester abortions can be induced by the transcervical extraamniotic, transabdominal intraamniotic, or intravenous injection of PGF2 alpha or PGE2. The use of these agents is currently the method of choice for this procedure. Studies have been made of methods of application which will lead to improved effectiveness and of the use of prostaglandins in combination with oxytocin. The use of prostaglandin analogues, which are metabolized more slowly than the natural prostaglandins, provides the advantages of decreased side effects and a decreased need of additional doses. The side effects associated with prostaglandin use include nausea, vomiting, diarrhea, heat waves, shivering, headache, dizziness, elevated temperatures, and leucocytosis. The mortality rate reported in a 4-year survey is 10.5/100,000 which compared favorably with the 17.7/100,000 for saline abortions. Prostaglandin gels can be used to soften and dilate the cervix in preparation for an abortion or induction of labor with no undesired side effects and without the use of laminarias. Labor can be induced by the administration of the prostaglandins F2 alpha and E2 either intravenously or, in the case of the latter, orally. Treatment with PGE2 can also continue parturition in cases of secondary insufficiency of labor. Research is currently being conducted in the use of these substances for fertility control.
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PMID:Application of prostaglandins in obstetrics and gynecology. 74 14

3 cases of intravascular spill of hyperosmolar urea during induced midtrimester abortion are reported. In each case 80 gm of urea had been infused. Although urea may pose less concern than hypertonic sodium chloride because of its ability to readily cross cell membranes and its action as an osmotic diuretic, inadvertent intravascular spill can produce symptoms that include nausea, headache, sensations of warmth, and intense uterine cramping. Also, abnormal blood pigments may occasionally be noted in the urine. The 3 patients were 23, 20, and 24 years old, all para 0. The symptoms generally subsided after 30 minutes, and serum and urinary abnormalities returned to normal within 24 hours. Treatment included iv hydration, careful monitoring of fluid/electrolyte balance and renal function, and avoiding the use of oxytocic agents for at least 24 hours. The 3 patients eventually underwent successful abortions, 1 with intraamniotic prostaglandin F2 alpha (PGF2a), and 1 with urea-PGF2a abortion, without further complications.
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PMID:Intravascular spill of hyperosmolar urea during induced midtrimester abortion. 76 12

15-methyl-prostaglandin F2 alpha (PGF2a) was injected extraamniotically .92 mg in 5.5 ml Hyskon (dextran 70, 32%) in 660 women 10-20 weeks' pregnant for abortion. 72.6% aborted within 36 hours and 80.3% within 36 hours, but only 32.2% had complete abortions. Mean abortion intervals were 13.1 hours in multigravidae and 16.2 in primigravidae. Infrequent complaints included flushing, nausea, dyspnea, chest pain, headache, and shivering. 1 cervical laceration was reported. 6 woemn required readmission for bleeding or infection of the 53% attending for follow-up. It is concluded that this method is safe and effective for abortion.
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PMID:Prostaglandins and abortion. II. Single extra-amniotic administration of 0.92 mg. of 15-methyl prostaglandin F2alpha in Hyskon for termination of pregnancies in weeks 10 to 20 of gestation: an international multicenter study. World Health Organization Task Force on the Use of Prostaglandins for the Regulation of Fertility. 92 Jul 60

The authors have studied the influence of mechanical and hormonal contraceptives on the organism of women, more specifically on their menstrual and child-bearing function. The studied women were divided into 2 groups: in the 1st group were 1532 women wearing intrauterine devices and 200 women examined in the remote period. The 2nd group consisted of 218 women using Infecundin for contraceptive purposes. The length of the observation period varied from 1 to 7 years. All women observed were healthy and of reproductive age. They were between 20 and 45 years of age. They all had a 2-phase menstrual cycle until they started to use a contraceptive. The women wearing IUD's had been using them for 6 months to 5 years. 93.4% did not show any sign of complication; 7.9% were experiencing various complications such as menstrual disorders, acute inflammations of the sexual organs; 38 women became pregnant; there was one case of spontaneous abortion; and 2 cases of extra-uterine pregnancy. 23 pregnancies went to term normally and 12 cases necessitated an induced abortion. The women from the 2nd group had been taking Infecundin for 3 months, 6 months, 12 months and over 1 year. 17 of these women were complaining of side effects such as nausea, vomiting, cardiac pain, swelling of the mammary glands, weight gain, headaches and hepatic disorders. Some histological examinations of the endometrium showed signs of endometritis. 10 women discontinued the use of Infecundin. On the whole, hormonal and mechanical contraceptives are of satisfying efficiency. They do not appear to provoke any significant complications in the menstrual and child-bearing functions of the woman. However the use of oral contraceptives tends to provoke a pronounced atrophy of the mucous membrane in the uterus. Therefore it is advisable to prescribe oral contraceptives in cycles separated by 2 to 3 month interruptions.
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PMID:[Menstrual and child-bearing functions of women using mechanical and hormonal contraceptives]. 99 12

This study was designed to see whether covering of the eyes during and after ketamine anaesthesia would reduce the incidence of dreams. One hundred and fifty patients, randomly divided into three groups, underwent therapeutic abortion with ketamine as the sole anaesthesia. One hundred patients had their eyes completely covered, 50 in the operating room only and 50 in the operating room and in the recovery room. The third 50 were controls, with their eyes uncovered. All patients were questioned post-operatively about dreams, nausea and vomiting, headache, dizziness and experiences, and also how frequently they dreamed at home. Although covering the eyes in the recovery room only reduced the incidence of dreams marginally, it became obvious that the patients who dreamed after ketamine (in all 3 groups) were those who normally dreamed at home. There were 82 patients who were recorded as not being home-dreamers, and only two of these dreamed after ketamine. In contrast, of the 68 home-dreamers, 50 dreamed after ketamine, and 17 of these had unpleasant dreams. In the home-dreamers, covering the eyes reduced the incidence of dreams from 86 per cent in Group 1 to 72 per cent in Group 2 and 64 per cent in Group 3. It is suggested that goggles may be advantageous when dealing with home-dreamers, and a question about the patient's tendency to dream should be included in the preoperative questioning. Alterations in premedication and the use of a quiet dark room during recovery may even further reduce unpleasant dreams in this group.
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PMID:A consideration of ketamine dreams. 110 98


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