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A study was conducted in Kamla Raja Hospital, G.R. Medical College, Gwalior, India to evaluate the efficacy of 1% ethacridine lactate and to compare the results with 20% hypertonic saline as abortifacients in midtrimester abortions. The abortions were performed using 1% ethacridine lactate in 65 patients with pregnancies between 12-20 weeks (group A). The patients were admitted to the hospital 1 day before the abortion. In a 2nd group of 65 patients (group B,), the abortion was done using 20% hypertonic saline. In this group oxytocin also was used as it had been with group A patients if the abortion did not occur with 24 hours. The mean induction abortion interval was lower with ethacridine lactate (37.82 hours) than with hypertonic saline (44.40 hours). This interval continued decreasing as the pregnancy advanced -- 12-14 weeks, 42.45 hours; 15-16 weeks, 36.05 hours; 17-20 weeks, 34.96 hours. In the hypertonic saline series, the induction abortion interval continued increasing as the pregnancy advanced -- 12-14 weeks, 44.30 hours; 15-16 weeks, 45.68 hours; and 17-20 weeks, 45.61 hours. With ethacridine lactate the abortion rate (24.62%) was significantly higher within the first 24 hours than with saline (9.23%), although the overall success rate was more with saline (96.92%) than with ethacridine lactate (90.77%). If reinstillation cases were included, the success rate with ethacridine lactate (95.39%) became almost similar to that of hypertonic saline. The complete expulsion rate with ethacridine lactate was only 35.38%, but it was 66.48% with hypertonic saline. The incidence of various side effects, such as headache, rigor, and vomiting, was more with hypertonic saline than with ethacridine lactate. Another advantage of ethacridine lactate was the fact that it can be used safely in patients with cardiovascular and renal diseases. The changes in the maternal coagulation system following intra-amniotic instillation of hyptonic saline, considered to be almost universal, were never encountered in ethacridine lactate induced abortions. Simplicity of technique and equipment required to perform ethacridine lactate instillation is a significant asset for India. Dangers of amniocentesis-like accidental injury to bowel and bladder are never encountered with ethacridine lactate instillation.
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PMID:Mid-trimester pregnancy termination with ethacridine lactate. 653 11

A case is presented of a 32-year old gravida 3, para 1, ab 1, presented at 26 weeks with chief complaints of periorbital edema, headaches, and blurred vision for about 1 week. 2 weeks prior to admission she had experienced shortness of breath and decreased fetal movement. Admission was at 28 weeks with uncontrolled hypertension, blood pressure 190/120, pulse 100/min. Temperature was 98.8 degrees. Attempted induction of labor with oxytocin was unsuccessful. A hydralazine infusion decreased the blood pressure to 180/100 and a 20 mg prostaglandin (PG) E2 suppository was inserted. A few hours later the blood pressure had dropped to 100/60 and the hydrazaline infusion was discontinued. About 3 hours later a stillborn female infant was born; post delivery examination revealed a large gap in the wall of the uterus extending into the lateral vaginal fornix. A total abdominal hysterectomy and right salpingo-oophorectomy was then performed and recovery was uneventful. PGE2 reliably initiates labor even in the presence of an "uninducible cervix" and is prone to increase intrauterine pressure to a level beyond that of normal labor with a lag in cervical changes. The 2 most common traumata reported following PG administration for therapeutic abortion are either cervico-vaginal fistulas or lateral tears. In this case since there was no indication of any congenital weakness of the uterine wall, it is reasonable to assume that the mechanism leading to the rupture was intense and prolonged uterine contractions combined with a rigid cervix.
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PMID:Uterine rupture associated with the use of vaginal prostaglandin E2 suppositories. 658 51

Sixty-nine pregnancies were observed in 57 hyperprolactinemic women (5 with pituitary macroadenoma, 20 with microadenoma, and 32 with normal tomography of the sella turcica). Ten of these pregnancies took place spontaneously in women with mild to moderate hyperprolactinemia (up to 70 ng/ml); 2 were induced by exogenous gonadotropins, 2 by clomiphene, 42 by bromocriptine, and 9 by metergoline; and 4 occurred after pituitary selective adenomectomy. The observed complications included spontaneous abortion (10 cases); headache (7 cases); sellar enlargement (5 cases); and bitemporal hemianopsia (1 subject with macroadenoma). Among 24 women in whom prolactin levels were reevaluated at least 1 month after parturition and/or lactation, 8 showed a decrease in prolactin concentration (less than 50% of pregestational levels), with actual prolactin normalization in 3 and resumption of cyclic menses in 2 previously amenorrheic women. In contrast, no changes in prolactin levels occurred after pregnancies that ended in abortion. These data suggest the following: 1) conception is not uncommon in women with moderate hyperprolactinemia; and 2) pregnancy may be safely induced without prior surgery and/or radiotherapy in hyperprolactinemic women, except those with large pituitary adenomas, and a considerable number of these patients even show a clinical and biochemical improvement after pregnancy.
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PMID:Spontaneous and induced pregnancies in hyperprolactinemic women. 679 19

There are currently numerous well-woman clinics in Britain which emphasize a specific aspect of health care, including cervical cancer screening (134 centers), family planning (142 centers), antenatal care (162 clinics), and venereal disease control (15 clinics). However, care provided in these clinics is fragmentary and excludes certain population groups from coverage. For example, cervical cancer smears are largely sought by upper class women under age 35, although this cancer has a higher incidence among older women from the lower social classes. Similarly, family planning clinics are not attracting women at highest risk of repeat abortion. Antenatal clinics, although effective in reducing perinatal and maternal mortality, exclude women beyond the childbearing years. At present, there are less than 10 comprehensive well-woman clinics in Britain. However, an estimated 17 million women could benefit from such a service, especially if cervical cytology screening was absorbed within it. A comprehensive clinic could focus on medical problems common to women, including menopause, frigidity, child abuse, obesity, thyroid disease, and depression. Omissions created by fragmented care, such as failure to test for conditions like anemia, could be avoided. The Manchester well-woman clinic, set up in 1981, provides an example of the role such clinics could play. The clinic is targeted at women who rarely see a general practitioner, e.g., poor, infertile, older women. Its emphasis is on the prevention and early detection of disease. Treatment is limited to self-help support groups and discussions with staff; however, new attendees are screened by a physician and nurse. 99% of attendees were found to have at least 1 medical problem. 2/3 of these problems, including breast problems, vaginal discharge, menopause problems, depression, and headache, were not already being treated. This experience suggests that there is an untapped need for such a facility, especially among women between menopause and old age.
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PMID:Evaluating well-woman clinics. 688 41

General anesthesia offers greater comfort for both the abortion patient and the operator. The combination of diazepam and ketamine which is rapidly reversible and offers a moderately deep anesthesia was used in 127 voluntary abortions and 3 therapeutic abortions. Patients ranged in age from 14-40 years and averaged 26, with 58% under 26. Patient weights ranged from 40-82 kg and averaged 56 kg. 43% were primaparas and average parity was 2.5. The average duration of the prenancy was 8.1 weeks. 10 patients were obese, 1 was asthmatic, 1 was a controlled hypertensive, 3 had cardiopathies, and 4 each had hepatitis and meningitis. 1 had treated epilepsy and 2 had serious depressive syndromes. 3 women had previously had voluntary abortions, 9 had had miscarriages, and 1 had had an extrauterine pregnancy. 17% had no fear or anxiety before the procedure, 56% had moderate levels, 28% had significant levels, and 19% had very high levels. 94% of the procedures were done by aspiration and in most cases a preliminary insertion of laminaria was done. The average duration of the procedure was 5 minutes, with extremes of 2 and 25 minutes. Patients were premedicated 1 hour before the procedure with intramuscular injections of 10 mg diazepam and 1/4 mg of atropine. For the induction, a butterfly needle with an antireturn system was used to inject 10 mg of diazepam and 1/4 mg of atropine diluted in 20 ml of distilled water. The patient was placed in the gynecological position and, if necessary, 5 mg of diazepam were added. Between .5-1 mg/kg of ketamine were injected in 10-15 seconds. The same dose was reinjected if the anesthesia was insufficient or the procedure was prolonged. A mixture of 40% oxygen and 60% nitrous oxide was administered if necessary. Patients remained in bed for 6 hours after awakening. 85% of patients received total doses of ketamine of .70mg/kg or less. Average duration of anesthesia was 9.2 minutes, with durations of less than 15 minutes in 94% of cases. On awakening 5% of patients had nausea and vomiting. 16% had minor psychic disturbances or disorientation, 8% had moderate problems with vocalization, and 2% had hallucinatory delirium with agitation. Overall, 20% of patients experienced headaches, 11% nausea, and 9% dizziness. It was concluded that the combination of diazepam .2 mg/kg and ketamine .5-.7 mg/kg provides well tolerated light anesthesia utilizable for outpatient abortions.
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PMID:[Diazepam and ketamine for voluntary interruptions of pregnancy]. 692 72

A survey of women undergoing pregnancy termination as 1-day outpatients (8 AM-6 PM) asking for their reactions after recovery in hospital and during the following day at home was prompted by a study which revealed unexpectedly high subsequent morbidity among a group of outpatient abortion cases. 65 patients were given a questionnaire and 50 were returned. Anesthesias used for operations studied were thiopentone, diazepam, pethidine, atropine with ergometrine, and methohexitone (obese patients were given halothane as supplement to nitrous oxide and oxygen). The survey bias was toward discovering any anesthetic-related sequelae. 86% of responders reported being well on the journey home. 52% resumed activities on the first postoperative day. 96% recollected preoperative advice of not eating or drinking and 94% remembered being told not to drive. Only 34% of patients were driving, cooking, or operating machines by the second postoperative day. 50% felt confident to do so, however. 2% consumed alcohol on the first postoperative day but none reported an increased effect. As an outpatient only 6% would be happy to receive the same anesthetic; 88% would take it as an inpatient. 70% found the anesthetic favorable vs. 2% who did not. 88% found hospital stay favorable vs. 2%. 20% had developed headache or drowsiness the day after surgery. Anesthesias which don't cause such a high rate of hangover effect should be developed for these 1-day outpatient procedures.
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PMID:The acceptability of day stay for termination of pregnancy. 730 56

This prospective study of 122 Black and Hispanic inner-city adolescent Norplant users recruited from a teen clinic in Rochester, New York, was the first to include a two-year follow-up period. The study period extended from June 1, 1991, to June 30, 1993. The mean age of Norplant acceptors was 17.4 years; 76% had a parity of at least one. Recorded was a one-year retention rate of 71% and a two-year rate of 62%. The greatest number of removals occurred in the first three months after insertion. There was no association between Norplant retention and age, weight, race, parity, or school status. The only significant predictor of Norplant continuation was a history of at least one induced abortion. The reasons most frequently cited by the 30 adolescents who discontinued Norplant were headache, fatigue, hair loss, nausea, weight changes, breast symptoms, and appetite changes. Menstruation irregularities were reported only by terminators in the 3-6 month use interval. Considering the high continuation rates recorded in this survey and the method's proven effectiveness, Norplant has the potential to widen substantially the birth interval between adolescent pregnancies.
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PMID:Contraceptive implant use among inner city teens. 766 90

In Egypt, 400 randomly selected pregnant women attending prenatal clinics affiliated with El-Shatby Maternity Hospital, Dar El-Welada Hospital, Gamal Abdel Nasser Hospital, Boharram Bay Maternal and Child Health Center, and Bacous Maternal and Child Health Center were interviewed to determine their knowledge of and practices related to drug intake during pregnancy. 47.7% had adequate knowledge (i.e., 75% correct answers) of drug use during pregnancy. Only 14% did not use any drugs during pregnancy. The remaining 86% used drugs without a prescription. The most common drugs used were vitamins and tonics (78.8%), antacids (66.5%), analgesics (41.8%), and antiemetics (35.5%). The leading reasons for drug use included general weakness (78.8%), heart burn and indigestion (66.5%), headaches (41.8%), vomiting (35.5%), and cough and insomnia (27.5%). Factors associated with poor knowledge of drug use during pregnancy were: younger than 30, illiteracy, being a housewife, primigravidity, and history of abortion (p 0.05 for all factors). These findings indicate a need to inform pregnant women about the dangers of drug use during pregnancy, especially during the first 12 weeks of pregnancy. Nurses should play a key role in communicating these risks.
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PMID:Knowledge and practices of pregnant women in relation to the intake of drugs during pregnancy. 777 81

Australian women face compliance, availability, and cost problems with contraceptives. In reality, oral contraceptives (OCs) have a high failure rate. An abortion survey in New South Wales in 1992 found that 14.4% of women were using OCs at the time of conception. Complete compliance with OCs is uncommon (28-40%). Abrupt cessation of OC use and forgetting to use pills at either end of the pill cycle are major reasons for noncompliance. Leading reasons for abrupt cessation of OCs are concerns about OCs, poor cycle control, weight gain, and headaches. Some ways to improve OC compliance are improved packaging, uniform missed pill instructions, clearer and more readable package inserts, improved verbal and written counseling, and detailed instructions on how to take the pills and what to do when one misses a pill. The abortion survey found that 22% of women seeking an abortion were using condoms at the time of conception. Many report a broken or slipped condom, both of which are generally caused by incorrect usage. Women who use the diaphragm only when they have intercourse have a higher failure rate than those who keep it in place for 24 hours, even though the latter do not use spermicides. Women are less likely to use their contraceptive method if the instructions are difficult and complicated. The vaginal ring has potential because it does not require action every day and can be left in place. The mass media and attitudes of providers influence women's choice of contraceptives. In New South Wales, only 50% of general practitioners discuss IUDs when they talk to women about contraception. 11% of women in the abortion survey could not obtain postcoital contraception from their physicians. A postcoital contraceptive and low dose OCs should be readily available in Australia. Contraceptives are expensive in Australia. Some contraceptives which are unavailable in Australia are OCs with gestodene, postcoital contraceptives, the levonorgestrel-releasing IUD, Norplant, the vaginal sponge, the female condom, and RU-486.
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PMID:Practical problems which women encounter with available contraception in Australia. 784 7

An examination has been carried out of 46 patients (33 females, 13 males, a mean age 40) with Sneddon's syndrome characterized by cerebrovascular disturbances and marked livedo. A clinical spectrum of the syndrome included miscarriage and intrauterine death of the fetus (20 cases), peripheral vein thromboses (12 cases), coronary heart disease (18 cases), thrombocytopenia (8 cases), arterial hypertension (27 cases), headache (39 cases), epileptic seizures (5 cases). Similar manifestations are usually seen in antiphospholipid syndrome (AFLS). Antibodies to phospholipids, those to cardiolipin, lupus anticoagulant were detectable in 78, 50 and 61% of the cases, respectively. Clinical and immunological signs of AFLS in the absence of SLE-typical symptoms provided grounds for considering them primary AFLS. Similar clinical patterns in 36 patients with cardiolipin antibodies and/or lupus anticoagulant and 10 patients without the antibodies and anticoagulant suggest these cases to be AFLS too.
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PMID:[Sneddon's syndrome and the primary antiphospholipid syndrome]. 805 89


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