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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

Clinical trials in Europe have found that a single oral dose of RU-486, followed by prostaglandin administration, effectively and safely terminates early pregnancy in about 95% of women. In a multicenter study carried out in France, 1 600-mg dose of RU-486, followed 36-48 hours later by intramuscular sulprostone or intravaginal gemeprost, induced complete abortion in 96% of 2000 women with up to 49 days of amenorrhea. In a British multicenter study, the combination of RU-486 and intravaginal gemeprost induced abortion in 95% of 600 women with up to 63 days of amenorrhea. RU-486 is not effective in aborting ectopic pregnancies. Bleeding usually starts 1-2 days after treatment and lasts for 1-2 weeks. About 1% of patients have required curettage since the amount of blood loss exceeds that in a normal menstrual period. The other side effects recorded with any frequency--abdominal cramping, nausea, vomiting, diarrhea, and headache--are all transitory and mild. Only 1 case of myocardial infarction has been reported in the more than 20,000 RU-486 acceptors studied. Endometritis and salpingitis are extremely rare complications. There have been no maternal deaths, and no fetal abnormalities have been observed in women who took RU-486 alone early in pregnancy and failed to abort.
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PMID:Mifepristone (RU 486). 224 20

Imipenem-cilastatin was given in doses of 1 g intravenously every 6 h to 31 patients. Twenty-five patients, with 27 infections, were clinically evaluable and received 20 to 210 g of imipenem for a duration of 5 to 56 days (average 16.3 days). Infections included seven cases of osteomyelitis, seven of bacteremia, five of cellulitis, two of pneumonia, three of pelvic cellulitis, two of intraabdominal abscess, and one each of empyema, mediastinitis, and endometritis. Fifty-five percent of the infections were caused by gram-negative bacilli, 33% were due to gram-positive organisms, and 10% were caused by anaerobes. Twenty-two patients (81%) were cured, three improved, one relapsed, and one became superinfected with a resistant organism. In 5 of 11 cases with Pseudomonas aeruginosa, the imipenem MIC for organisms isolated by the end of treatment was higher than it was initially, raising concern that imipenem should not be used alone to treat Pseudomonas aeruginosa infections. Twenty-one patients had no adverse reaction; of the remaining 10 patients, 4 had nausea, 1 had urticaria, and 6 had mild abnormalities in hepatic function; three episodes of diarrhea included two with Clostridium difficile toxin in stool and one with pseudomembranous colitis, as determined by sigmoidoscopy. Levels of creatinine, hemoglobin, leukocytes, platelets, prothrombin, and urine components were unchanged. Imipenem-cilastatin is a clinically effective antibiotic with freedom from nephrotoxicity and hematological abnormalities in the large doses used in this study.
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PMID:Safety and efficacy of high-dose treatment with imipenem-cilastatin in seriously ill patients. 386 Jan 87

The use of intraamniotic injection of hypertonic solutions for termination of pregnancy during the second trimester has been generally adopted. Because of side effects in such treatment with other agents, it was decided to use intraamniotic instillation of urea solution (Urevert) to induce midtrimester therapeutic abortion in 38 patients. The method was successful in 35 patients (92%) with a mean injection/abortion interval of 26.1 hours, shorter than that with the use of hypertonic saline or hypertonic glucose solutions. The side effects of headache, nausea, and vomiting were mild, and an endometritis in 1 patient responded well to antibiotic treatment. Intravenous oxytocin drip was necessary in patients with hypotonic contractions or in those who failed to react within 36 hours after injection. In 3 cases of missed labor, the urea solution injected induced labor within 5-8 hours, with no side effects. The mean in-patient hospital time was 4.3 days.
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PMID:Termination of midtrimester pregnancy by intramniotic injection of urea. 482 62

Vaginal suppositories containing (15S)-15-methyl prostaglandin F2 alpha methyl ester were administered to 40 subjects, in an attempt to induce an early abortion. All subjects were 49 days or less from their last menstrual period. Ten subjects received a 3-mg suppository followed in 3 hours by a 1 mg suppository, ten subjects received the 1-mg suppository followed in 3 hours by a 3-mg suppository, and twenty subjects received the 3-mg suppository followed in 1 hour by the 1-mg suppository. Twenty-four subjects (60%) had a successful termination of their pregnancy using the two vaginal prostaglandin suppository regimen. All subjects who aborted had 10 percent or less of their pretreatment levels of beta-hCG 7 to 22 days after therapy. Sixteen subjects (40%) did not abort. One of the subjects who failed treatment refused the second suppository due to gastrointestinal side effects and uterine cramping following the insertion of the 1-mg suppository. A second subject had an incomplete abortion and developed mild endometritis. Sixteen subjects reported side effects which included nausea, emesis, diarrhea, uterine cramping requiring analgesia, restlessness, shakiness, and dizziness. The addition of the second vaginal suppository containing this particular prostaglandin analogue did not significantly increase the overall abortifacient activity of this method.
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PMID:Termination of early gestation with (15S)-15-methyl prostaglandin F2 alpha methyl ester vaginal suppositories. 617 57

Abdominal pain and fever after an uncomplicated elective abortion usually point to incomplete abortion and endometritis. We treated a woman for acute suppurative appendicitis one week after such an abortion. When fever, nausea, vomiting and pain are not relieved by the standard doses of medication, acute appendicitis must be added to the usual gynecologic differential diagnoses.
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PMID:Ruptured appendix after elective abortion. A case report. 622 52

A randomised prospective clinico-laboratory evaluation of the efficacy of ornidazole versus clindamycin in anaerobic infections was performed in 140 patients; 67 were given ornidazole and 73 received clindamycin. Patients were mainly suffering from peritonitis, pelvic cellulitis, endometritis, soft tissue infections and abdominal abscesses, which were distributed rather equally in both groups. Ornidazole was administered at a dose of 500 mg every 12 h i.v. or/and orally, and clindamycin 600 mg every 8 h i.v. for 7-60 days. In pus cultures, Escherichia coli and Bacteroides fragilis were the main isolates. The coexistence of aerobes necessitated the addition of an aminoglycoside in 111 patients, while six times chloramphenicol had proved ineffective against anaerobes. Between the two groups no statistically significant difference was found in the excellent response rate, although the overall cure rate was superior in the ornidazole group (80.6 vs. 68.5%), with a prompt response within less than 48 h in the case of ornidazole. Side effects necessitating discontinuation of chemotherapy included severe nausea in 1 patient treated with ornidazole and diarrhea in 8 patients given clindamycin.
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PMID:Ornidazole versus clindamycin: comparative evaluation in the treatment of 140 serious anaerobic infections. 676 Oct 82

Antibiotic use was evaluated retrospectively in 1229 patients of a university hospital (Basle, Switzerland). The frequency with which antibiotics were prescribed, the indication, duration of treatment, side-effects and clinical results were compared in relation to various subspecialities. 38.1% of medical, 36.4% of surgical and 24.4% of gynecological patients received one or more antibiotic during hospitalization. The main indications for antibiotic treatment were respiratory infection (57.8%) and urinary tract infections (21%) in medical patients, prophylaxis (38%) and urinary tract infections (23%) in surgery, and urinary tract infections (43%) and adnexitis or endometritis (23%) in gynecology. Amoxycillin or penicillin G were the first-line drugs for respiratory infection, cotrimoxazole for urinary tract infection and cefalothin or cefacetrile for surgical prophylaxis. Patients with endometritis or adnexitis usually received clindamycin in combination with an aminopenicillin. Aminoglycosides were employed in only 9.5% of antibiotic courses. Information on adverse reactions in the records was scanty, only generalized exanthem (13 cases) and nausea/vomiting (2 cases) being specifically mentioned. The therapeutic result was classified by the responsible physician as cure in 50.8% or definite improvement in 16.4% of patients. However, in 118 cases (29.7%) the contribution of antibiotics to the clinical outcome could not be evaluated retrospectively.
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PMID:[Use of antibiotics in hospitalized patients. Comparison of medical, surgical and gynecological units]. 720 74

The levonorgestrel (LNg) IUD releases 20 mcg LNg/day and protects against pregnancy for 5 years (Pearl index = 0.1/100 women years of use). Its mode of action is reduced amount of cervical mucus and suppression of the endometrium. A multicenter study in Denmark, Finland, Hungary, and Sweden comparing the LNg IUD and the Nova T IUD found the 5-year continuation rate of the LNg IUD to be 46.9% (44.5% for Nova T). The leading reasons for LNg IUD removal at 5 years were planning pregnancy (15.2%), bleeding (13.7%), and hormonal reasons (11.9%). Bleeding disturbances occurred significantly less often in the LNg IUD users than in the Nova T users (13.7% vs. 20.7%; p = .002). Since LNg has a strong effect on endometrium suppression, LNg IUD users were more likely to quit using the IUD due to amenorrhea than Nova T users (6% vs. 0; p = .0001). The cumulative gross expulsion rate after 5 years was 5.8. Termination for genital infections was more likely in Nova T users than LNg IUD users, especially when the infections were pelvic inflammatory disease (2.2% vs. 0.8%; p .01) and endometritis (4% vs. 1.5%; p .01). Hormonal side effects were acne, hirsutism, weight changes, mood changes, breast tenderness, nausea, and headache. Women in the LNg IUD group experienced return to fertility at a higher rate than those in the Nova T group (79.1% at 12 months and 86.6% at 24 months vs. 71.2% and 79.7%, respectively), but the differences were not significant. Progestin-releasing IUDs can be used to treat menorrhagia, thereby making them an alternative to hysterectomy or endometrial resection. The LNg IUD reduced menstrual blood loss by 86% at 3 months and by 97% at 12 months in women with menorrhagia, resulting in an increase in hemoglobin and serum ferritin. This IUD also effectively opposes the proliferative effect of estrogen on the endometrium in women on hormonal replacement therapy.
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PMID:Hormonal intrauterine devices. 848 51

Side effects are an expected part of medical abortion; some, such as pain and bleeding, result from the abortion process itself and are generally managed with orally administered analgesics and counseling. True medication side effects most commonly include nausea, vomiting, diarrhea, and warmth or chills. Complications of medical abortion usually represent an extreme or severe side effect. Large series have reported transfusion rates of <1%. Because of the infrequency of uterine instrumentation, postabortal endometritis appears to be rare with medical abortion. As with early surgical abortion, the clinician must remain aware of the possibility for ectopic pregnancy. Overall approximately 2% to 10% of patients will require surgical intervention for control of bleeding, resolution of incomplete expulsion, or termination of a continuing pregnancy. Understanding the types of side effects and complications that can occur will enable the clinician to counsel patients properly as well as to understand when medical intervention is necessary during the medical abortion process.
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PMID:Management of side effects and complications in medical abortion. 1094 71


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