Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0030794 (pelvic pain)
 4,056 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

General practitioners and obstetrician-gynecologists referred 301 women who were or= 56 days pregnant and asked for an abortion to the Royal Infirmary of Edinburgh in Scotland. Physicians administered 1 mg of gemeprost alone every 6 hours up to 3 mg to the 151 women and 200-600 mg mifepristone (RU-486) followed by 1 mg gemeprost 2 days later to 150 women. Women who received RU-486 and gemeprost were more likely to experience a complete abortion than those who received only gemeprost (98% vs. 87.4%; p = .0004). There were no significant differences in the efficacy of 200, 400, or 600 mg of RU-486 followed by gemeprost. Women who received gemeprost alone suffered more pain than those who received RU-486 and gemeprost so they were more likely to need analgesics (p = .0001). Women who received gemeprost alone experienced considerable more abdominal and pelvic pain as time passed (p .001 and .0002, respectively). In addition, women treated with gemeprost alone had a significantly lower median concentration of serum human chorionic gonadotropin on day 8 than those treated with RU-486 and gemeprost (median 1.78% VS. 3.57%; P .00101), even though more of them still were pregnant. On the other hand, both groups of women experienced the same duration of bleeding, interval from abortion induction to menstruation, and change in hemoglobin concentration between days 1 and 8. In the gemeprost alone group, most abortions occurred on day 1 and most abortions occurred on day 3 in the RU-486 and gemeprost group. Women treated with gemeprost alone were required to spend 1 night in the hospital while none of the women in the other group did. The RU-486 and gemeprost regimen had considerable advantages over the gemeprost-alone regimen for inducing an early medical abortion. Yet when RU-486 is not available or contraindicated, physicians can use gemeprost alone.
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PMID:Medical abortion in women of less than or equal to 56 days amenorrhoea: a comparison between gemeprost (a PGE1 analogue) alone and mifepristone and gemeprost. 152 4

The American Association of Gynecologic Laparoscopists' (AAGL) 1988 membership survey on operative laparoscopy had a response rate of 24%. A total of 880 respondents reported performing 36,928 operative laparoscopy procedures. A total of 75% of the respondents reported performing 47 or fewer procedures. The most frequently reported conditions managed with operative laparoscopy were endometrial implants, extensive adhesions and ovarian cysts. Most operative laparoscopies were performed because of infertility (40%) or pelvic pain (41%). The overall serious complication rate was 15.4 per 1,000 procedures. Complications that occurred in greater than 1 per 1,000 procedures included hospitalization greater than 72 hours, persistent human chorionic gonadotropin titer elevation after ectopic pregnancy, hospital readmission and unintended laparotomy to manage bowel injury, urinary tract injury or hemorrhage. Two deaths (5.4 per 100,000 procedures) were reported.
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PMID:American Association of Gynecologic Laparoscopists' 1988 membership survey on operative laparoscopy. 214 40

Presented is the case of a 35-year-old woman with a biphasic basal body temperature record during an ectopic pregnancy. The patient's last menstrual period had occurred 29 days before she was admitted to the hospital with pelvic pain and vaginal spotting. The menses before this was 25 days earlier. A biphasic basal body temperature record was kept during the last menstrual cycle. Vaginal bleeding, which lasted 2 days, commenced at midcycle. 12 days after the temperature rise, the episode of vaginal bleeding that caused the patient to present at the hospital occurred. The human chorionic gonadotropin (hCG) titer was 3600 U/L at admission, 4900 U/L 3 days later, and 5600 U/L after 6 days. A vaginal scan failed to reveal a intrauterine sac, but laparoscopy showed a left ampullary pregnancy 4 x 4 x 5 cm in measurement. Given both the size of the gestation and the hCG levels, it was concluded that the ectopic pregnancy was conceived in the cycle before the most recent one. The biphasic basal body temperature record suggested that the patient had ovulated after implantation. Ovulation during pregnancy is hypothesized to be the cause of superfetation found in mares. In humans, superfetation has been recorded secondary to ovulation induced by clomiphene citrate. It is possible that some cases of presumed transmigration, where the corpus luteum is found on the ovary contralateral to the ectopic, ovulations superimposed on pregnancy may be present.
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PMID:A biphasic basal body temperature record during pregnancy. 248 83

139 women at risk pregnancy (due to unprotected sexual intercourse) participated in a multicenter assessment of the efficacy and tolerability of RU 486 prescribed as a late luteal contragestive agent. 24 women received 400 mg of RU 486 and the remaining 115 women received 600 mg on the day before the expected menses. 48 women (35%) were found to be pregnant (positive plasma beta-human chorionic gonadotropin) at the time of RU 486 intake. An ongoing pregnancy after RU 486 treatment was found in 9 cases (failure rate, 19%). Bleeding occurred in all but 6 women, 1 of whom was pregnant. The duration of bleeding was 4.6 + or - 2.9 days in pregnant women and 3.8 + or - 1.2 days in nonpregnant women. A posttreatment menstrual period occurred 31.8 + or - 6.2 days after the onset of RU 486-induced bleeding in pregnant women and 30.0 + or - 5.3 days afterwards in nonpregnant women. Few side effects were reported (asthenia, pelvic pain, headache, mailase, and dizziness), and none required specific measures. These results indicate that, when it is too late for postcoital contragestive methods and too early for vacuum aspiration abortion, RU 486 constitutes a technique with at least as much effectiveness as high-dose estrogen therapy and fewer side effects and disturbances in the menstrual cycle. However, since the success rate is only 80%, it is essential to schedule a posttreatment visit to identify women with ongoing pregnancies or incomplete uterine evacuation.
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PMID:Contragestion with late luteal administration of RU 486 (Mifepristone). 304 66

In most developed countries in which therapeutic abortions are legal, termination of pregnancy is performed at between 8 and 12 weeks of gestation. Because the complication rate after this procedure rises with increasing gestation, there would be many advantages in inducing abortion before the eighth week ('menstrual induction'). With the increasing availability of highly sensitive methods of detecting human chorionic gonadotropin, pregnancy can now be diagnosed as early as 10-14 days after conception. The uterus can be surgically evacuated safely and simply by suction aspiration under local anaesthesia. However, a safe and effective method of inducing abortion by medical means would be a useful and cheaper alternative. Of the potentially useful compounds, only derivatives of prostaglandins E and F administered by vaginal pessary have so far been shown to be effective. Although the rate of haemorrhage and infection is low, 10-30% of women experience moderate side-effects of pelvic pain, diarrhoea and/or vomiting. The possibilities are discussed of reducing the incidence of side-effects by different methods of release or using prostaglandins in combination with other compounds such as antigestogens which might lower the therapeutic threshold.
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PMID:Menstrual induction: surgery versus prostaglandins. 386 9

Commonly used preoperative diagnostic procedures were analyzed for their ability to predict the presence of early ectopic pregnancy. Patients presenting to the emergency room with acute onset of pelvic pain were evaluated with culdocentesis, pelvic ultrasonography, and qualitative serum and urine pregnancy testing. Clinical examination and urine pregnancy testing were found to be poor predictors of either the presence or absence of an early ectopic pregnancy. The combination of a sensitive serum human chorionic gonadotropin (hCG) determination and pelvic ultrasonography accurately predicted ectopic pregnancy in 93% of proved cases. This predicted accuracy was superior to that of culdocentesis alone or in combinations of culdocentesis and ultrasound or qualitative serum pregnancy testing.
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PMID:Accurate diagnosis of early ectopic pregnancy. 388 66

Metastatic choriocarcinoma was suspected in a 39-year-old woman who presented 7 months postpartum with fatigue, pelvic pain, a massive pleural effusion, and a positive urine pregnancy test. Subsequent evaluation resulted in discovery of the isolated production of the free beta-subunit of chorionic gonadotropin (CG-beta) by a widespread, poorly differentiated epidermoid carcinoma. Chemotherapy was ineffective, the woman died, and at autopsy the primary site of the tumor could not be determined. The patient's serum (185 ng/ml) and a tumor metastasis (720 ng/g) contained large amounts of immunoactive material that diluted in parallel to CG-beta standard, but neither chorionic gonadotropin (CG), its alpha subunit, nor other placental proteins were detected. A monoclonal antibody that recognizes free CG-beta, but not intact CG, was instrumental in implicating an ectopic source of the CG-beta before a tissue diagnosis was obtained. When the patient's serum was chromatographed on a dextran gel, the CG-beta immunoactivity eluted in a position of higher apparent molecular weight than either standard CG or CG-beta, suggesting that this neoplasm secreted an altered molecular form of the CG-beta subunit.
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PMID:Isolated ectopic production of the free beta subunit of chorionic gonadotropin by an epidermoid carcinoma of unknown primary site. 403 15

A retrospective analysis was made of 265 female outpatients who initially presented to an emergency department with a complaint of amenorrhea, vaginal bleeding, or abdominal/pelvic pain. The patients were discharged from the emergency department pending results of a serum pregnancy test. Forty-five of the patients were subsequently found to have an elevated (greater than 5 mIU/mL) beta human chorionic gonadotropin (HCG) level. Six of the patients had an ectopic pregnancy; their beta HCG levels ranged from 19 to 265 mIU/mL. A detectable beta HCG level less than 500 mIU/mL had a 33% probability of an ectopic pregnancy in the study group. Historical features, physical examination, and laboratory parameters were of limited value for identification of minimally symptomatic outpatients at risk for an ectopic pregnancy. No study patient had a systolic blood pressure of less than 86 mm Hg on presentation. A comparison group of 29 patients admitted to the hospital directly from the emergency department with a diagnosis of "rule out ectopic pregnancy" during the same time interval was identified. Nine of the directly admitted patients were found to have ectopic pregnancies. A statistically greater proportion of the directly admitted patients had a hematocrit less than 35% and a positive urine (tube) pregnancy test than that found for the study group. Five of the comparison group patients were noted to have a systolic blood pressure of less than or equal to 80 mm Hg. The beta HCG was found to be an essential tool in the evaluation of potential ectopic pregnancy in patients with minimal symptomatology.
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PMID:Detection of ectopic pregnancy in an outpatient population: the role of the beta-HCG level. 608 71

Ectopic pregnancy is the leading cause of maternal death in the first trimester. Its incidence is increasing, probably owing to the increasing incidence of pelvic inflammatory disease. Although up to 15% of patients have been reported to present in shock, a large number seek care earlier because of pelvic pain and irregular menses. With strong clinical suspicion and the use of culdocentesis, assays of the beta subunit of human chorionic gonadotropin in the blood and ultrasonography, the diagnosis can be made before rupture occurs. Although the woman's subsequent fertility has traditionally been poor, some improvement has been achieved with the use of conservative surgical techniques. Early diagnosis facilitates this approach.
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PMID:Update on ectopic pregnancy. 622 91

The objectives of this study were to determine the optimal cutoff value (CV) and utility of a single serum beta human chorionic gonadotropin hormone (HCG) level in assessing the likelihood of ectopic pregnancy (ECP). A retrospective chart review was performed at an urban county hospital. The optimal CV was determined by comparing all available patients diagnosed with ECP and patients diagnosed with threatened abortion (TA) in the Emergency Department (ED) who subsequently delivered a baby at the same hospital. The utility of the test was assessed in a group of all known patients who presented to the ED with lower abdominal or pelvic pain or vaginal bleeding between 6 and 13 weeks estimated gestational age (EGA). There were 212 ECPs with measured HCGs. Only nine presented after 13 weeks EGA. The mean HCG value was 5,378 mIU/mL. There was no significant correlation between HCG and EGA. There were 132 TAs with measured HCGs who subsequently delivered. Only four TAs presented before 6 weeks EGA. Regarding the TA patients who presented between 6 and 13 weeks EGA, there were 81 with a mean HCG of 83,810 mIU/mL. Between 6 and 13 weeks EGA, HCG was not significantly correlated with EGA. The entire ECP group was compared with the TA group with 6-13 week EGA. A receiver-operating characteristic curve with nine HCG cutoff values was constructed. Clinically, the optimal CV was 40K. At this level, a test for the condition "absence of ECP" had a specificity of 99%, and only two of 212 ECPs in our group would test false-positive with an HCG value over 40K. When the test was applied to a group of 175 women who presented with pain or bleeding between 6 and 13 weeks EGA, the sensitivity and positive predictive value for an intrauterine pregnancy were 24% and 99.9 %, respectively. However, if this test was applied to all patients regardless of clinical findings, and then an ultrasound (U/S) algorithm was applied to the patients who had an HCG of less than 40K, it would predictably increase the rate of ECPs falsely identified as intrauterine pregnancies (IUPs) by 1%, regardless of the false-positive rate of the U/S algorithm itself. Given the potential morbidity and mortality of undiagnosed ectopic pregnancy, ultimately neither this test nor any other that is less than 100% specific for IUP can be recommended instead of an initial U/S evaluation for patients who present at risk for ECP.
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PMID:Utility of a single beta HCG measurement to evaluate for absence of ectopic pregnancy. 1033 31


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