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The effect and side reactions of bromocriptin of the firm "Richter" were evaluated in this study. Fifteen women with interrupted pregnancy between 14 and 28 gestational week were explored. To prevent the onset of lactation treatment was started within a few hours after abortion in dosage 2.5 mg (one tablet) twice daily, for 14 days. The prolactin-lowering action began to take effect 2 hours after ingestion of the first tablet, peak after 5 hours, and maintained for 8-12 hours. In course of treatment 14 days in dosage two times daily, the lactation was inhibited in 100% of the cases, in 65% of them she was stopped at the first three days of therapy, in 15% of the cases she was stopped between 3rd and 7th day, and in 20%--after the 7th day of the treatment. The adverse reactions nausea, dizziness, vomiting, diarrhoea, constipation, headache and orthostatic hypotension were transitory. They were observed rarely, and during the first 3-5 days of treatment disappeared.
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PMID:[The use of bromocryptin--Richter for the suppression of the onset of lactation after the interruption of pregnancy between the 14th and 28th gestational weeks--a preliminary report]. 1072 58

This study evaluated the effectiveness of a single dose of the abortifacient effect of vaginal misoprostol followed by prolonged observation. Women with < or =42 days of amenorrhea, pregnancy confirmed by ultrasound, and approved request for termination received 800 microg of vaginal misoprostol once and were observed for 1 week. The gestational sac was measured before misoprostol administration, and 24 h and 7 days afterward. Women reported bleeding, expulsion of sac, and other complaints. After 1 week, those who had not aborted received a second dose of 800 microg. Those who had not aborted by 24 h later were treated by vacuum aspiration of the endometrial cavity. Twenty-four hours after treatment, 71.8% had aborted, and 87.1% aborted 3 days after treatment. After the second dose, 7 days later, the cumulative abortion rate reached 92.1%. None of the subjects who aborted required curettage or vacuum aspiration. The main complaints were pain (84.5%), nausea (21.4%), and headache (17.5%). No clinical differences between responders and nonresponders was found. Vaginal misoprostol, 800 microg, is effective in inducing early termination of pregnancy, and there is no need for an additional dose within 72 h after the first administration of misoprostol.
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PMID:Termination of pregnancies of <6 weeks gestation with a single dose of 800 microg of vaginal misoprostol. 1074 69

Background: We investigated the outcomes of women under age 21 who participated in a multi-center case series of early medical abortion using methotrexate and misoprostol.Methods: We enrolled 1973 women in a case series for medical abortion in the first seven weeks of pregnancy, using a standardized protocol and consent for methotrexate (50 mg/m(2)) and misoprostol (800 mg vaginally, repeated as needed).For this study, women who presented for abortion prior to their 21(st) birthday were compared to older women. Outcomes of abortion were classified as complete medical abortion (CMA) and suction curettage (SC). Secondary outcomes included symptoms. We did an exit interview assessing patient satisfaction during the first year of the study, and have exit interview data for approximately half of the women enrolled.We assessed the relationship of age and outcomes first by bivariate analysis using SAS (SAS Institute, Inc., Cary, NC). A multiple logistic regression model was constructed using age, gestational age, and measures of parity.Results: There were 219 women who were under 21 (18 under the age of 18). Compared to older women, adolescents presented for abortion at the same gestational ages. Compared to older women, younger women were less likely to have finished college (2.8% vs. 38. 7%), and were less likely to have had previous pregnancies (45.4% vs 76.6%) and live births (20.2% vs. 51.3%)The distribution of symptoms during abortion, such as bleeding and cramping, was the same across age groups; the only symptom which was more frequently found in younger women was headache.Overall younger women had a slightly higher rate of CMA as older women (90.2% vs. 86.5%). However, the multiple regression (MR) model did not show an effect of the woman's age on CMA. MR demonstrated an adverse effect of prior live birth, and advancing gestational age on rates of CMA; younger women were less likely to have had prior live births.Younger women were just as likely to report overall satisfaction (86.7% vs. 84.6%) with the abortion procedure and other questions of satisfaction, but were less likely to agree that the bleeding and cramping were acceptable. Conclusions: Younger women having medical abortion with methotrexate and misoprostol have similar outcomes and satisfaction levels as do older women. There is no reason to discourage adolescents who seek abortion from using a medical technique.
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PMID:Early medical abortion with methotrexate. Outcome and satisfaction among women aged 15-20 years 1086 71

Members of the genus Trypanosoma cause African trypanosomiasis in humans and animals in Africa. Infection of mammals by African trypanosomes is characterized by an upregulation of prostaglandin (PG) production in the plasma and cerebrospinal fluid. These metabolites of arachidonic acid (AA) may, in part, be responsible for symptoms such as fever, headache, immunosuppression, deep muscle hyperaesthesia, miscarriage, ovarian dysfunction, sleepiness, and other symptoms observed in patients with chronic African trypanosomiasis. Here, we show that the protozoan parasite T. brucei is involved in PG production and that it produces PGs enzymatically from AA and its metabolite, PGH(2). Among all PGs synthesized, PGF(2alpha) was the major prostanoid produced by trypanosome lysates. We have purified a novel T. brucei PGF(2alpha) synthase (TbPGFS) and cloned its cDNA. Phylogenetic analysis and molecular properties revealed that TbPGFS is completely distinct from mammalian PGF synthases. We also found that TbPGFS mRNA expression and TbPGFS activity were high in the early logarithmic growth phase and low during the stationary phase. The characterization of TbPGFS and its gene in T. brucei provides a basis for the molecular analysis of the role of parasite-derived PGF(2alpha) in the physiology of the parasite and the pathogenesis of African trypanosomiasis.
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PMID:Identification of a novel prostaglandin f(2alpha) synthase in Trypanosoma brucei. 1106 81

Caffeine is a methylated xanthine that acts as a mild central nervous system stimulant. It is present in many beverages, including coffee, tea, and colas, as well as chocolate. Caffeine constitutes 1-2% of roasted coffee beans, 3.5% of fresh tea leaves, and approximately 2% of mate leaves (Spiller, '84; Graham, '84a,b). Many over-the-counter medications, such as cold and allergy tablets, headache medicines, diuretics, and stimulants also contain caffeine, although they lead to relatively minimal intake (FDA, '86). In epidemiological studies, it is assumed that one cup of coffee contains < or =100 mg of caffeine, and soft drinks, such as colas, contain 10-50 mg of caffeine per 12-ounce serving. The per-capita consumption of caffeine from all sources is estimated to be about 3-7 mg/kg per day, or approximately 200 mg/day (Barone and Roberts, '96). Consumption of caffeinated beverages during pregnancy is quite common (Hill et al., '77) and is estimated to be approximately 144 mg/day, or 2.4 mg/kg for a 60-kg human (Morris and Weinstein, '81). However, pregnant women appear to consume slightly less than do other adults, approximately 1 mg/kg per day (Barone and Roberts, '96). This decrease may be interrelated with taste aversion (Hook, '76; Little, '82). The medical literature contains many varied references that appear to indicate that human adverse reproductive/developmental effects are produced by caffeine. If caffeine indeed causes such effects, the reproductive consequences could be very serious because caffeine-containing foods and beverages are consumed by most of the human populations of the world, and consumption in the United States is estimated to be 4.5-kg/person/year (Narod et al., '91). Therefore, the medical literature dealing with developmental and reproductive risks of caffeine was reviewed, and the biological plausibility of the epidemiological and animal findings, as well as the methods and conclusions of previous investigators, were evaluated. The epidemiological studies describe exposures of women to caffeine during pregnancy, as well as the occurrence of congenital malformations, fetal growth retardation, small-for-date babies, miscarriages (spontaneous abortions), behavioral effects, and maternal fertility problems that presumably resulted from the caffeine consumption. A few epidemiological studies were concerned with the genetic effects of preconception exposures to caffeine. Animal studies, conducted mostly in pregnant rats and mice, were designed to produce malformations. The objectives of the present review are to summarize the findings from the various clinical and animals studies, objectively discuss the merits and/or faults inherent in the studies and establish a global reproductive risk assessment for caffeine consumption in humans during pregnancy. It should be noted that evaluation of the developmental risks of caffeine based solely on epidemiological studies is difficult because the findings are inconsistent. Even more important, is the fact that caffeine users are subject to multiple confounding factors that make analyses difficult and prevent investigators from reaching definitive conclusions. For example, the caffeine content of foods and beverages can vary considerably, which can interfere with obtaining valid interpretations from many human studies. Isolated epidemiological studies dealing with the risk of abortion, without evaluating other developmental and reproductive effects, are the most difficult to interpret, because they present special problems that are sometimes ignored in epidemiological studies. The results of animal studies are probably most helpful in solving some of the dilemmas created by the epidemiological studies. An animal study reported in 1960 first focused our attention on the potential developmental effects of caffeine. However, the exposure reported by Nishimura and Nakai ('60) was an intraperitoneal dosage of 250 mg/kg in the mouse, an extremely high dosage that would result in a blood plasma level that could never be obtained from consuming caffeine containing products. More recent animal studies have demonstrated, that depending on the method of administration and species, the developmental NOEL in rodents is approximately 30 mg/kg per day, the teratogenic NOEL is 8,100 mg/kg per day, and the reproductive NOEL approximately 80-120 mg/kg per day. Lack of biological plausibility to support the concept that caffeine has been responsible for human malformations is another important part of this analysis. For example, no one has described the Caffeine "teratogenic syndrome," a cluster of malformations associated with caffeine ingestion. Proven human teratogens have an identifiable syndrome. The malformations described in the animal studies at very high doses fit the description of vascular disruptive types of malformations. (ABSTRACT TRUNCATED)
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PMID:Teratogen update: evaluation of the reproductive and developmental risks of caffeine. 1141 Sep 11

Atypical teratoid/rhabdoid tumors (AT/RT) of the central nervous system are rare and extremely aggressive malignancies of early childhood. We report a case of AT/RT in an adult patient. A 30-year-old woman presented with headache, vomiting and ataxia during the second trimester of pregnancy. Magnetic resonance imaging revealed a posterior fossa mass. A gross total resection was performed. Pathological examination revealed an AT/RT. Despite the dismal prognosis the patient decided not to undergo an abortion. For this reason postoperative accelerated hyperfractionated radiotherapy was limited to the tumor region. Six months later the woman delivered a healthy baby. One week postpartum, a central nervous system recurrence localized apart from the primary lesion was treated with radiosurgery. Two months later a diffuse progression was noted. Despite a 6 week course of oral temozolomide, the tumor progressed and the patient died 11 months after diagnosis. Although survival was short, surgery and involved field radiotherapy yielded a progression-free interval of 9 months. This allowed the patient to carry pregnancy to term. Radiosurgery resulted in a complete remission of the first recurrence. Oral chemotherapy was not effective in controlling diffuse tumor spread.
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PMID:Atypical teratoid/rhabdoid tumors in adult patients: case report and review of the literature. 1145 Dec 2

In developing countries, 60-80% of births are conducted by traditional births attendants (TBAs), especially in rural areas without access to obstetrical service. During 1976 and 1985 a total of 24,000 pregnant women received prenatal assistance from a home obstetric service in a suburban zone of the city of Benin, Bendel state, Nigeria, which was set up in 1976 to care for 90,000 people. During the study period of 1982-85 a total of 12,052 women received prenatal assistance. A sample of 600 women with an average age of 24, an average of 3.5 pregnancies, and 3.5 births/mother was interviewed by a questionnaire: the abortion rate was 32/1000 pregnancies, maternal mortality was 13/1000 live births, neonatal mortality was 19/1000 live births, and child mortality under 5 was 133/1000 live births. 204 of the 600 women had complaints including 62 cases of pain in the abdomen, 46 cases of headache, and 21 cases of feebleness and dizziness. 478 women gave birth in their homes, but 9 of them were hospitalized with hypertension, or premature or difficult birth. 196 of this group received assistance from midwives at home or in the maternity unit, and the rest were assisted by TBAs without the supervision of a midwife. 11 cases of neonatal deaths occurred. 51 of 54 mothers interviewed subsequently stated that they would recommend the service, 22 had used it for more than 1 pregnancy, and 39 had given birth at home with the assistance of a TBA without the help of a midwife. 14 TBAs were also interviewed who said that they were willing to work with qualified midwives, and 11 already had done so. Delivery at home with the assistance of midwives decreased from 9.7% in 1982 to .9% in 1985, while births assisted by TBAs increased by 2% in the maternity unit and by more than 6.5% in the home, a fact that points to the role and importance of TBAs particularly in view of difficulties with transportation.
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PMID:[Integration of traditional midwives in primary health care]. 1217 54

Included in this article is a table adapted from World Health Organization medical eligibility guidelines developed to assist practitioners in the prescription of low-dose oral contraceptives (OCs). These guidelines are part of a broader project aimed at improving access to all available methods of contraception without creating unacceptable risk. They were formulated in response to concerns that current practices are based on scientific studies of contraceptive products that are no longer in wide use, the bias of service providers, and a tendency to render relative contraindications absolute. If the presence of a condition creates no obstacle to method use, a Category I rating is assigned. If the benefits of a method generally outweigh the risks, the condition receives a Category 2 rating. Category 3 applies to conditions carrying risks that generally outweigh benefits, while Category 4 applies to conditions carrying unacceptable health risks. Health conditions categorized in association with low-dose OC use are post-abortion, diabetes, superficial venous thrombosis, known hyperlipidemias, headaches, vaginal bleeding patterns, unexplained vaginal bleeding, breast disease, pelvic inflammatory disease, sexually transmitted diseases, HIV/AIDS, viral hepatitis, uterine fibroids, past ectopic pregnancy, obesity, thyroid disorders, trophoblast disease, and sickle cell disease.
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PMID:Increasing access to combination oral contraceptives. 1229 65

Battering or physical abuse of women by their husbands or partners is not only a serious problem, but also a major public health problem. Battering during pregnancy affected 4-8% of pregnant women presenting to public and private prenatal clinics in rural and metropolitan areas, of which 11-23% had been physically abused. The American College of Obstetricians and Gynecologists provides standardized protocols to help hospital personnel identify battered women among trauma patients in emergency departments. These include headaches, insomnia, choking sensation, hyperventilation, shyness, fright, embarrassment, and others. Battering may be associated with adverse pregnancy outcomes such as low birth-weight infants, handicapped children secondary to trauma received during antenatal period, and miscarriage. Interventions strategies include: 1) increased education for physicians and easy availability of information about abuse; 2) physically abused women are given information about women's rights, available community resources, and strategies dealing with abusive relationships; and 3) community prevention programs.
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PMID:Battering during pregnancy: a role for physicians. 1229 34

Although the standard argument for distributing birth control pills throughout the Third World is that they are less dangerous than pregnancy or abortion, irregular use of the pill increases riks of both. The irregularity of use can be attributed to both poor delivery systems and side effects. Side effects occur because of poor screening and lack of alternative dosages. Because of the lower price of buying in bulk, family planning groups distribute only 1 kind of pill. The woman who experiences side effects, e.g. headache, dizziness, weight gain, depression, has no choice but to discontinue use. Few women are screened by having their blood pressure taken, therefore the pill exacerbates illness in those with circulation problems. Breast-feeding mothers who take the pill provide less sustenance from their breastmilk, which can increase infant mortality rates. In Bangladesh a USAID-funded study on contractive distribution found that the "trained" family planning workers did not know what advice to give a woman who missed her pill on 5 consecutive days, or what type of side effects might be anticipated, or how many days after the onset of menstruation a woman should begin the pill. A more level headed approach to delivery of contraceptives in developing countries is needed.
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PMID:The small miracle. 1230 61

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