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 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Progesterone receptor antagonists have been developed by substitutions at the 11-beta and 17 side-chain positions of the progestagen norethisterone. The most studied progesterone receptor antagonists are mifepristone (Mifegyne; Roussel-UCLAF; RU486) and ZK98734 and ZK98299 (Schering AG). These compounds bind avidly to the progesterone receptor and glucocorticoid receptor but have essentially no binding to the mineralocortocoid, oestrogen or androgen receptors. Mifepristone also binds avidly to albumin, resulting in a half-life of approximately 24 h after oral administration. Progesterone receptor antagonists can induce menstruation by a direct action upon the endometrium. They have also been shown to exert weak progesterone agonist actions in certain circumstances and to modulate pituitary hormone secretion by antagonizing the feedback actions of progesterone. Moreover, they release prostaglandin F2 alpha and E2 from human endometrium or early pregnancy decidua and reduce the metabolism of these eicosanoids. Clinically, progesterone receptor antagonists have been used in trials of menstrual regulation, abortion and induction of labour, and during treatment of breast or ovarian cancer, some forms of hypertension and meningioma. Progesterone receptor antagonists have been administered to approximately 70,000 women in 18 countries as medical abortifacients. They have been proven, especially when combined with prostaglandin analogues, to be as effective as surgical methods of termination of pregnancy. Progesterone receptor antagonists have focussed international attention on menstrual regulation, abortion and the rights of women to regulate their fertility.
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PMID:Progesterone receptor antagonists and prostaglandins in human fertility regulation: a clinical review. 196 97

Women on regular dialysis are usually infertile, but contraception should not be neglected. Pregnancy is invariably complicated and poses excessive risks, with an uncertain and low chance of success. Even when therapeutic abortion is excluded, the live birth outcome at best is 19%. Renal transplantation usually reverses abnormal reproductive function and comprehensive pre-pregnancy counseling is essential, with discussion of all implications, including the harsh realities of long-term maternal survival. In this survey of 2,309 pregnancies in 1,594 women, therapeutic abortion was undertaken in 27% of conceptions and the spontaneous abortion rate was 13%. Of the conceptions that continued beyond the first trimester, 92% ended successfully. In most, renal function was augmented in pregnancy, with transient deterioration in late pregnancy (with or without proteinuria). Permanent renal impairment occurred in 15% of pregnancies. There was a 30% chance of developing hypertension, preeclampsia or both. Preterm delivery occurred in 50%, and intrauterine growth retardation in 25% of pregnancies. Despite its pelvic location, the transplanted kidney rarely produced dystocia and was not injured during vaginal delivery. Cesarean section should be reserved for obstetric reasons only. Neonatal complications include respiratory distress syndrome, leukopenia, thrombocytopenia, adrenocortical insufficiency, and infection. No predominant or frequent developmental abnormalities have been described and data on infancy and childhood are encouraging. For the future more work is needed to improve pre-pregnancy assessment criteria, to understand the mechanisms of gestational renal dysfunction and proteinuria, to assess the side effects and implications of immunosuppression in pregnancy, and to elucidate the remote effects of pregnancy on both renal prognosis and the offspring.
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PMID:Dialysis, transplantation, and pregnancy. 195 48

A 23-year-old woman with Marfan's syndrome was scheduled for Cesarean section at 31 week gestation because of progressive aortic dissection. Since she had undergone two surgical corrections for scoliosis (Harrington rod instrumentation) 5 and 12 years ago, we selected general anesthesia. She had been taking diltiazem and propranolol for hypertension and tachycardia. Anesthesia was induced with thiopental 75 mg iv followed by O2-N2O-enflurane (4%) by face mask. Following iv administration of vecuronium 4 mg and tracheal injection of 4% lidocaine 120 mg, the trachea was intubated without a significant hemodynamic change. Anesthesia was maintained with O2-N2O-enflurane (0.5-1.5%) before delivery. Following delivery, enflurane was discontinued and small doses of fentanyl iv (total 0.2 mg) were given with iv infusion of nitroglycerin (0.2-0.5 micrograms.kg-1.min-1) during surgery. Bleeding after delivery was controllable by iv infusion of oxytocin. The Apgar score was good (9 at 1 min and 10 at 5 min respectively). Post-operative course was uneventful. Therapeutic abortion or Cesarean section should be performed as soon as possible in a patient with dissecting aortic aneurysm because of increasing risk of aneurysm rupture during pregnancy. During the surgery, minimal hemodynamic changes are required to prevent the rupture.
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PMID:[General anesthesia for cesarean section in a patient with Marfan's syndrome associated with dissecting aortic aneurysm]. 205 91

It used to be rare for multiple pregnancies to occur but we have seen a spectacular rise in them in France between 1970 and 1986. Triplet deliveries increased threefold. The authors analyse a personal series of 23 pregnancies (19 triplets, 3 quadruplets and 1 quintuplet pregnancy). Sixteen of these 23 were medically induced. The main complications that have been observed were: threatened premature delivery in 86%, high blood pressure in 34.7%, anaemia in 50%, and urinary tract infections in 30.4%, 6.8% of the babies had congenital malformations. Reviewing the literature has made it possible to discern the epidemiological factors causing multi-fetal pregnancies: family history, high female fertility, maternal age, ethnic factors, hormonal contraception etc... At present it is medically assisted reproduction that is the big supplier of multi-fetal pregnancies in developed countries. We have reviews of several maternal as well as fetal complications: the ovarian hyperstimulation syndrome, extra-uterine pregnancy, hypertension, anaemia, spontaneous abortion, prematurity, intra-uterine growth retardation and malformations.
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PMID:[Multiple pregnancies. II. Epidemiology, clinical aspects]. 219 59

Current practice of investigating abnormal uterine bleeding via dilatation and curettage is sometimes open to question, and outpatient procedures are emphasised. The therapeutic effect of curettage in normalising menstrual patterns is being discussed. In a prospective study we answered the question of diagnostic and therapeutic effects of curettage. Over a period of 6 months, all patients with curettage treated in our department were investigated (history, risk factors, previous hormonal treatment, preoperative haemoglobin value, type of anaesthesia, complications, histology). Curettages performed for the purpose of abortion, as well as in combination with conisation of the uterine cervix, were not included in the study. 234 curettages were carried out. Clinical indications were as follows: in 29% of the cases recurrent preclimacteric metrorrhagia, in 27% climacteric metrorrhagia, in 24% PMB (postmenopausal bleeding). In 19 cases we found an Hb value lower than 10.5 g%. Risk factors (obesity, hypertension, diabetes mellitus) for endometrial cancer were found in 38% of MB and in 20% of climacteric metrorrhagia. In 9 cases, the histological diagnosis was endometrial cancer (clinical indications: 5 PMB, 3 climacteric metrorrhagia, 1 recurrent preclimacteric metrorrhagia). Our study shows, that the indication for curettage should be applied generously, especially in cases of abnormal postmenopausal and perimenopausal bleeding.
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PMID:[The value of curettage in the assessment of abnormal uterine bleeding]. 221 Mar 9

The aim of this article is to investigate to what extent physical exercise and pregnancy affect each other. Despite an increase in metabolism at rest, the amount of oxygen available for exercise is virtually unaffected by pregnancy. The capability to perform exercise (in W) is equally unaffected, but body weight increases. As a result the maximal running speed and/or distance decreases during pregnancy. The fetus needs a constant supply of oxygen and nutrients. During exercise uterine blood flow decreases. This decrease is linearly correlated with the intensity and the duration of exercise and the maximal reduction averages approximately 25%. Nonetheless, uterine oxygen consumption is maintained. This is the result of compensation through hemoconcentration, redistribution of blood flow within the uterus, and increased oxygen extraction. A harmful effect of physical exercise on the child in utero, such as abortion, hypoxia, or growth retardation, has not been demonstrated so far. Although exercise does not seem to be harmful during normal gestation, one should be careful in case of pregnancy complications such as pregnancy-induced hypertension or premature contractions.
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PMID:[Sports during pregnancy]. 221 91

Eight patients with end-stage renal disease secondary to systemic lupus erythematosus (SLE) received 8 cadaveric renal allograft. Patient and graft survival was 100 and 87%, respectively. None of them showed extrarenal manifestations of SLE or recurrence of lupus nephritis after grafting. One graft was lost because of chronic rejection. In another patient, an episode of graft function deterioration due to bad control of arterial hypertension was observed. Three patients were transplanted during their first year on hemodialysis. Two women became pregnant after successful kidney transplantation; one suffered a spontaneous abortion and the other had a successful delivery. In neither of them, was SLE observed during or after pregnancy. Morbidity was low in this series, and infections were the most frequent complication. In summary, our experience with renal transplantation in SLE patients compares, favorably with the general nodiabetic transplanted population.
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PMID:Kidney transplantation in systemic lupus erythematosus nephritis: a one-center experience. 224 69

In this study, plasma levels of magnesium, calcium, zinc and copper were simultaneously determined in pregnancies complicated by either abortion, intrauterine growth retardation (IUGR), diabetes or EPH (edema, proteinuria, hypertension) gestosis. The levels of the four cations in non-pregnant women and in healthy, pregnant women were also determined. Compared with controls, a significant decrease in magnesium, with increase of the Ca/Mg ratio, was found in spontaneous abortions, but not when patients had a successful continuation of pregnancy. In EPH gestosis, total calcium was reduced, with a significant decrease of the plasma Ca/Mg ratio. A slight, but significant, increase in plasma zinc was observed in women affected by either diabetes or IUGR, probably as a result of reduced zinc uptake by the fetus. In addition, higher copper levels were found in the pathologies studied, with the exception of missed abortions. The possible role of an altered Ca/Mg ratio homeostasis in relation to gestational pathologies is discussed.
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PMID:Maternal plasma concentrations of magnesium, calcium, zinc and copper in normal and pathological pregnancies. 227 Apr 73

Waning fertility, contraceptive use, beliefs about fertility, contraceptive choices, and implications for health care are discussed in relation to women at midlife. Contraceptive choices are limited, but pregnancy is still a possibility. assessment of women in midlife should include fertility status and future pregnancy goals. Teaching, counseling, and contraceptive techniques should be made available and be appropriate for current and future needs. Consideration must be given to a Women's physiological status as well as her personal preferences. If abortion is not an option, then reliable contraception is a necessity. The perimenopausal period between the ages of 35-50 is characterized by increasingly variable menstrual cycles and questionable fertility. In 1985, there were 4 live births/1000 women 40-44 years and .2/1000 women 45-49. Hypothalamic/pituitary/ovarian system changes and uterine integrity account for the decrease in fertility, i.e., change in cycle length. It can last from 1 to 10 years, with cycles ranging from 26 to 32 days. Prolonged cycles are not uncommon and signal many false alarms. During this transition phase, it has been shown that there are gradual increases is follicle stimulating hormone, particularly 5-6 years before menopause. luteinizing hormone levels rise 3-4 years before menopause. Sometimes there are lower levels of midfollicular and midluteal levels of estrogens and midluteal levels of progesterones. It is hypothesized that hormonal changes may be due to a depleting supply and eventual absence of primordial follicles, or follicles in various states of atresia, and hence no longer sensitive to gonadotropin stimulation. Inhibin is also decreased. irregularity does not mean sterility. Survey Data indicate that 26% of 40-44 year olds could become pregnant. There is sometimes the false belief that unprotected sex and not becoming pregnant means infertility. Contraception is recommended for 2 years after cessation of menses. Birth control pills are usually contraindicated. However, the FDA suggests low dose estrogen pills for those who do not smoke, are not obese, hypertensive, diabetic, lipidemic, or have a history of thrombosis, heart disease, or pregnancy-induced hypertension. The IUD is a possibility unless there is a history of problems with menorrhagia, fibroids, or prior cervical surgery. Barrier methods are the most commonly used: condoms, Contraceptive foam, diaphragms, either alone or in conjunction with rhythm or fertility awareness. The symptothermal method is recommended. Menstrual assessment, annually, should include length of cycles, length and nature of flow (number of tampons/napkins per day), and any changes in flow, spotting, metrorrhagia, or dysmenorrhea. Women's knowledge and feelings about fertility needs to be assessed.
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PMID:The contraceptive needs of midlife women. 186 2

There were 39 maternal deaths at Harare Hospital during 1987, giving a maternal mortality rate of 122/100,000 live births. If women who lived outside the Harare Municipality were excluded, the maternal mortality rate for the Greater Harare Maternity Unit was 53/100,000 live births. The cases were reviewed at monthly meetings in the Department of Obstetrics and Gynaecology. Hypertensive disease in pregnancy caused 28pc of the deaths with haemorrhage, puerperal sepsis and abortion accounting for 18pc each. Avoidable factors were felt to be present in 88pc of cases and these are discussed.
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PMID:Harare Hospital maternal mortality report for 1987 and a comparison with previous reports. 228 30


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