Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0027497 (nausea)
 23,468 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This literature review compares the merits and disadvantages of the levonorgestrel-releasing IUD made by Leiras Pharmaceuticals, Turkey, Finland (LNG-IUD-20), with the Nova-T, Copper-T (TCu) and 220C, and Copper-T-38-Ag (TCu-380Ag). This IUD releases 20 mcg levonorgestrel daily from a Silastic sleeve on the vertical shaft containing 52 mg. The plasma level stabilized after a month at about 0.2 ng/ml, about half as high as that seen with Norplant implants. It is identical in size to the Nova-T. The Cu-T IUDs differ with respect to copper wire or sleeves, or silver-cored wire. The chief studies reviewed here were 2 multi-center trails primarily in European countries, and a 2 large multi-center trials in India. Cumulative pregnancy rates were 0.0 to 0.6 per 100 users for the LNG IUD, compared to slightly higher failures for inert or copper IUDs. While removal rates for bleeding, pain and pelvic inflammatory disease were lower for the LNG-IUD-20, removals for oligomenorrhea, amenorrhea and hormonal side effects were higher than for the other IUDS. In the Indian trials, removals for amenorrhea and irregular bleeding were much higher than rates reported in the European studies, resulting in significantly lower continuation rates overall. The results pointed to district benefits for the LNG-IUD-20, such as lower blood loss and anemia, relief of dysmenorrhea and menorrhagia, as well as possible lower risks of ectopic pregnancy in case of failure, less PID (pelvic inflammatory disease), and the claim by the maker that strictly correct placement is not necessary. Disadvantages of the LNG-IUD-20 are more difficult insertion due to the wider diameter; oligomenorrhea, amenorrhea and irregular bleeding; hormonal side effects such as acne, weight gain, nausea, headache and breast tension; and potential risk of functional ovarian cysts. The LNG-IUD-20 is considered comparable to copper IUDs in effectiveness, safety, longevity, and return to fertility after removal. Users should be counseled that the oligomenorrhea or amenorrhea is neither a medical problem or indicative of infertility, is common for the 1st 2 months, is reversible on removal, may signal an improved hemoglobin profile, relief of dysmenorrhea, and may be preferred to heavy bleeding from other IUDS. The program implications of this IUD are potential lower incidence of ectopic pregnancy and PID. The effect of its use on breast feeding, cost-effectiveness compared to Norplant, in-country manufacture, and cultural acceptance need to be determined in specific locales.
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PMID:An evaluation of the levonorgestrel-releasing IUD: its advantages and disadvantages when compared to the copper-releasing IUDs. 177 15

The International Planned Parenthood Federation (IPPF) new statement on the diagnosis of pregnancy was drawn up in April 1990. A pregnancy diagnosis includes clinical evaluation of the woman's history, symptoms, physical examination, and pregnancy tests. Pregnancy symptoms may include amenorrhea, nausea, vomiting, enlargement and tenderness of the breasts, frequent urination, and changes in appetite and food and drink habits. If biochemical testing is not possible, a reliable clinical diagnosis of pregnancy cannot take place before 6-8 weeks. At this time, the clinician can observe cervical softening and uterine softening and enlargement if a woman is pregnant. If the uterine size does not match the length of amenorrhea, clinicians should suspect the following: earlier or later conception than indicated, ectopic pregnancy, incomplete or missed spontaneous abortion, twin gestation, hydatidiform mole, or other uterine anomaly. They should suspect ectopic pregnancy in women with smaller than expected uterine size when they have been sterilized or are using an IUD or are using low-dose progestogen-only pills or Norplant. They should refer women with smaller than expected uterine size who are experiencing bleeding and/or pain to a more sophisticated clinical facility, where an accurate diagnosis of and adequate treatment for ectopic pregnancy can be done. Biochemical pregnancy tests consist of antibodies that mark human chorionic gonadotropin (hCG) from a urine or serum sample. hCG levels increase beginning about 10 days after fertilization. The most convenient and inexpensive pregnancy test for clinics is the immunoassay test (slide test), which requires a urine or serum sample. It can provide reliable results a few days after the missed menstrual period. Clinicians should provide appropriate counseling regardless of whether the client wishes to continue or terminate the pregnancy.
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PMID:New IPPF statement on the diagnosis of pregnancy. 192 37

During the last decades the incidence of ectopic pregnancy has been steadily rising. The chosen therapy has usually been unilateral salpingectomy. Recently, different conservative (tube-preserving) treatment-modalities have been introduced in clinical practice. We have tried conservative treatment by local injection of prostaglandin F2a (total dose 2-4 mg) directly into the tubal pregnancy and, if feasible, also into the corpus luteum graviditate. The treatment was successful in 13 out of 16 patients. In one patient laparotomia was performed because of pain, and revealed a haematoma in fossa Douglasi. Reinjection of prostaglandin was necessary in one patient because of rising HCG titres. One patient was hospitalized for four days because of nausea and pain. The treatment was otherwise successful. The method may be useful as a non-surgical alternative in haemodynamically stable patients without tubal rupture. Further studies are needed to evaluate the outcome in terms of future fertility.
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PMID:[Conservative treatment of ectopic pregnancy]. 200 Jun 15

Risk factors for ectopic pregnancy include previous ectopic pregnancy, current intrauterine device use, prior fallopian tube surgery, previous pelvic inflammatory disease and a prior history of infertility. Abdominal pain is the most common symptom, followed by amenorrhea or vaginal bleeding, nausea, vomiting, syncope and dizziness. Referred shoulder pain following the onset of abdominal pain is characteristic of intraperitoneal bleeding and, in the appropriate clinical setting, strongly suggests a ruptured ectopic pregnancy. A coordinated evaluation includes measurement of serum human chorionic gonadotropin concentration and transabdominal or, preferably, transvaginal ultrasonography. Treatment is primarily by one of a variety of surgical techniques. Medical therapy with methotrexate or other drugs is currently under investigation.
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PMID:Management of ectopic pregnancy. 218 38

Mifepristone, a new steroid and progesterone antagonist, was administered to 150 women with amenorrhea of less than 42 days who were seeking abortions. A single dose of 600 mg was given to each woman to take orally at home in the evening. The clinical events that should occur were explained to the women and they were given a permanent emergency telephone number. Follow-up visits were scheduled on the 8th day, when clinical tests, ultrasound examinations, and blood sampling were performed. Success was assumed if vaginal bleeding occurred between days 3-8, ultrasonic examination confirmed uterine vacuity, and a decrease in plasma HCG level was observed. A total of 131 of the 150 women were considered to have had complete abortion. The remaining 19 women included 14 developing pregnancies, 2 curettages for heavy bleeding, and 1 extrauterine pregnancy. Daily amount and duration of bleeding were compared to abundant menstruation. Only 2 women reported heavy bleeding leading to curettage. Only 16 women had hemoglobin levels low enough to justify iron therapy. None needed a transfusion. Several other side effects were reported--uterine contractions and pelvic pain, transient asthenia, and slight nausea. All biological tests remained in the normal range. Having shown a success rate of 87.3% and with mild side effects, Mifepristone appears to be a simple and safe agent for termination of early pregnancy, and a good alternative to surgical abortion.
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PMID:Termination of early pregnancy by a single dose of mifepristone (RU 486), a progesterone antagonist. 320 66

Tubal abortion is the term used when an intact, viable pregnancy is surgically removed during an operative intervention in an ectopic pregnancy. Tubal abortion can follow several courses: resorption of the products of conception; intraluminal extension with expulsion of gestational products; and perforation and rupture into the peritoneal cavity. Spontaneous resorption occurs with very early embryonic death, and is usually symptomless and undiagnosed. Such spontaneously regressing tubal pregnancies are more easily detected with today's more sensitive and refined diagnostic capabilities that have detected previously unsuspected tubal pregnancies. Intraluminal extension results in hemorrhage and expulsion of the gestational products into the tubal lumen, but terminology about this is unclear. If the ovum remains attached to the implantation site, the term incomplete tubal abortion should be used. If the ovum completely separates from the tubal wall and is expelled, it should be termed complete tubal abortion. Stringent pathologic criteria are used for the diagnosis of tubal abortion, and earlier diagnosis and management have led to a decrease in the percentage of ruptured tubal pregnancy. Clinical presentation of tubal abortion includes symptoms of colicky pain, nausea, vomiting, faintness, and signs of peritoneal irritation and shock. In the past, salpingectomy was the treatment of choice for tubal abortions, but conservative techniques can be used to preserve the tube, depending on factors such as the state of the tube, stage of the abortion, and degree of associated bleeding. The method chosen can affect fertility after tubal abortion, although unruptured tubal pregnancies carry a more favorable prognosis for future fertility than do ruptured tubal pregnancies. Fimbrial evacuation, a conservative technique, is one of the least used intervention methods, but the data about later complications are controversial. BhCG levels may serve to determine whether fimbrial evacuation should be used. More experience and proper patient selection is needed before more definite recommendations can be made.
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PMID:Tubal abortion and infundibular ectopic pregnancy. 358 54

Existing international literature concerning complications stemming from the use of the IUD is reviewed. They are either immediate or delayed. Immediate complications are (partial) perforation of the uterus, vagal reaction, bleeding, and pain. Perforation should be followed up by echography or radiography. Hysteroscopy or celioscopy allows for recovery of the device. Vagal reaction, manifested by bradycardia, hypotension, pallor, sudation, nausea, even cardiac arrest, occurs with stenosis of the cervical canal predominantly in emotive and/or nulliparous women. Bleeding occurs from trauma caused by the IUD to the mucus of the endocervix and/or endometrium. Pain is an almost constant symptom that appears at the moment of insertion, more frequently in young nulliparae than multiparae, and disappears spontaneously after 5-10 minutes. Delayed complications are menometrorrhagia, often accompanied by dysmenorrhea, lost IUD, total or partial expulsion, ectopic pregnancy and pelvic infections (PID). Menometrorrhagia seems imputable more to an increase of fibrinolytic activity of the endometrium in contact with the IUD than to plasmatic alterations of the progesterone, estradiol or gonadotropin. Lost IUD generally is due to rotation caused by uterine contractions, or the thread being cut off too close to the mouth of the external uterus. Fracture of the IUD as well as migration toward the fallopian tubes are very rare. The FDA reports, in 1979, that ectopic pregnancy is verified more frequently in women carrying the device medicated with progesterone. PID are 10 times more frequent in young women having used the IUD for at least 2 years. A significant increase in PID is also reported for women who use the device for more than 5 years.
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PMID:[Side effects and complications of intrauterine devices with special reference to pelvic infection]. 380 30

Postcoital contraceptives, the so-called "morning after pill," are agents used as emergency treatment to prevent pregnancy after unprotected intercourse or contraceptive accidents. In the 1960s and early 1970s high doses of estrogens were used in 5-day courses such as diethylstilbestrol 25-50 mg a day or ethinyl estradiol 0.5-5 mg a day begun within 72 hours after coitus. Although effective, a considerable drawback of the associated nausea and vomiting as well as an increased risk of menstrual disturbance during the treatment cycle. Norgestrel alone in various dosages has been used postcoitally. Quingestanol has been used as a continuing postcoital agent in Latin America but proved unacceptable owing to nausea and irregular bleeding. In China "visiting pills" have been devised containing anordrin. In the West regimens of this sort have been superseded by the Yuzpe treatment of 100 mcg ethinylestradiol and 0.5 mg levonorgestrel initially, repeated after precisely 12 hours. The treatment must be initiated within 72 hours of exposure. Postcoital contraceptives act by combinations of mechanisms--the function of the corpus luteum is disrupted, tubal motility may be affected, and changes in endometrial biochemistry prevent ovoimplantation. In a multicenter trial involving 602 women Yuzpe reported a pregnancy rate of 1.6%. Other workers show comparable figures of 0-3%. The primary side effects of the current hormonal method are nausea, which occurs in 61% of cases, and vomiting, 20% of cases. Both are mild and of short duration. All postcoital methods carry a risk of ectopic pregnancy should the treatment fail. 3 ectopic pregnancies were recorded with diethylstilbestrol and 1 recently with the Yuzpe regimen. There have been no reports of thromboembolic complications. If a hormonal form of postcoital treatment fails, the theoretical possibility of the pregnancy being harmed cannot be ruled out. The patient needs to be counseled about this, and careful records should be kept. Also important is the taking of an accurate menstrual and coital history to exclude exposures earlier in the menstrual cycle. Lippes and coworkers showed the efficacy of copper IUDs as postcoital agents. These can be used up to 5 days from intercourse. An IUD is preferred if hormones are contraindictated, if exposure was more than 72 hours beforehand, if the woman desires the most effective method, and if she wants the IUD for longterm contraception. Postcoital contraception, however defined, raises ethical questions. Postcoital methods could be classed as contraceptive rather than abortive within the maximum period (defined by medical scientific consensus) that may elapse between intercourse and nidation.
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PMID:Postcoital contraception. 613 82

Postcoital contraception, or "interception" of the blastocyte before it implants in the uterus, is an effective method of contraception which is recommended for more frequent use, though only as indicated in emergencies such as rape, rupture of condom, 1st sexual experience without contraception, and isolated sexual relations without contraception. General contraindications include already existing pregnancy and multiple risk of pregnancy in a single menstrual cycle. There are 3 types of accepted hormonal postcoital contraception--estragens alone, progestagens alone, and combined estrogen and progestagen-- which must begin within 48-72 hours after intercourse. Estrogens most commonly suggested are 1) diethylstilbestrol (DES), 50 mg daily for 5 days, 2) conjugated estrogens, 10 mg daily for 5-6 days, and 3) ethinyl estradiol (EE), 5 mg daily for 5 days. The high dosages required for effectiveness can cause complications, the most severe being ectopic pregnancy, but the failure rate of this method is only .7%. The failure rate using progestagens alone is inversely proportional to the administered dose (i.e., 1% for 1 mg of D-norgestrel or levonorgestrel). Norgestrel and quingestanol are used most frequently with the most severe complication being disturbance of the cycle. Oral administration of the combination pill containing .05 mg EE and .25 mg D-norgestrel, at a 12-hour interval is the most widely accepted hormonal method, as the short treatment period assures patient compliance, the low estrogen dosages reduce the occurrence of side effects, although 40-50% still experience nausea, and the contraindications are the same as for general estrogens-progestagens. Intrauterine postcoital contraception involves insertion of a coil, which prevents implantation of the blastocyte in the uterus, and has been shown to be 100% effective, although no extensive series have been publicized as compared with the hormonal methods. Where postcoital contraception is used, a detailed history should be obtained to determine risk of pregnancy and possible contraindications, and the patient should be informed of the side effects and procedural methods.
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PMID:[Postcoital contraception (without prostaglandins)]. 648 43

Maternal and fetal events of the first trimester are examined with emphasis on the more common physiologic changes that occur. Suggestions are given for the management of nausea, breast tenderness, frequency of urination, and fatigue. Critical components of initial prenatal care are discussed and timing of subsequent visits recommended. The most common complications of early pregnancy, spontaneous abortion, and ectopic pregnancy are reviewed.
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PMID:The first trimester. 656 67


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