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In selected patients with episodic behavioral disorders, rapidly absorbed benzodiazepines can be given orally to abort paroxysmal symptoms in their prodromal stages or to disrupt a cycle of continuous, serial symptoms. A case example illustrates each use.
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Studies covering all aspects of bovine viral diarrhoea virus (BVDV) have been conducted in several countries in Europe, Asia and America. In southern Africa, more information is required about the nature of BVDV infection, the prevalence of different strains and the economic importance of the disease. The presence of BVDV in southern Africa has been known since the early 1970s through serological surveys but few reports confirming its presence by virus isolation and correlation with clinical disease are available. Specimens (n = 312) collected in 1998/99, from live and dead cattle from different farming systems, were obtained from private practitioners, feedlot consultants and abattoirs throughout the country. Specimens (n = 37) from African buffaloes (Syncerus caffer) in the Kruger National Park were also included. All specimens were processed for virus isolation in cell culture with confirmation by means of immunofluorescent antibody tests and some also by means of an antigen capture ELISA. BVDV was isolated from 15 (4.7%) cattle and were all noncytopathic biotypes. BVDV was not detected in 37 lymph nodes obtained from buffaloes in the Kruger National Park. Of the clinical signs in cattle from which virus were isolated, respiratory signs was the most frequent (10/15), followed by diarrhoea (5/15). Abortion, congenital malformations, haemorrhagic diarrhoea and poor growth were also included as criteria for selection of animals for specimen collection, but no BVD viruses were isolated from cattle manifesting these clinical signs.
OBJECTIVES: To describe the evolution of medical practices in breech presentation at term and to compare early neonatal complications according to initial obstetrical decision on the type of delivery. METHODS: 71919 pregnancies are included in the AUDIPOG Database from 1994 to 2000. Among this cohort, pregnant women with a singleton in breech, at term were selected which represented 2136 women after the exclusion of in utero deaths and medical abortions. The first outcome was global criteria of severe early neonatal complications ("death during per or immediate post partum or transfer of the newborns to an intensive care or surgery unit"). The size of the sample authorized a power of 90%. RESULTS: The rate of cesarean section before labor was 40%. We found 2.3% of early neonatal complications in the group in which labor was accepted vs. 1.9% in the group with cesarean section performed before labor (p>0.05). After having taken into account prognostic factors, we do not see a significant difference for the risk of neonatal complications between the two groups (OR=1.33; 95% CI: 0.63-2.80). CONCLUSION: The analysis of the AUDIPOG Database describes the French obstetrical practice in breech presentation at term. We do not find a different risk in morbi-mortality as regards to the initial obstetrical choice regarding the type of delivery, but the absence of randomization in our study does not authorize a strong medical evidence to guide national recommendations.
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The clinical course of 40 patients with a uterine scar who were undergoing second-trimester abortion induced with either hypertonic saline or prostaglandin F2 alpha, was reviewed. In the 38 patients with a previous cesarean scar, and in the 2 patients with a hysterotomy scar, the uterine contents were evacuated with no evidence of uterine rupture. A review of the literature dealing with uterine rupture subsequent to induced midtrimester abortion revealed that the typical multiparous uterus was more prone to rupture if oxytocin was used in conjunction with or a few hours after instillation of the abortifacient, or if oxytocin was used continuously for more than 12 hours. Although rupture after use of prostaglandin in a previously scarred uterus has been reported, there is no case reported of rupture after use of hypertonic saline. This review and the authors' experience lead them to conclude that hypertonic saline is a safe abortifacient during the second trimester, especially between 18 and 22 weeks' gestation, in a previously scarred uterus when careful monitoring is employed and oxytocic agents are used judiciously.
In a background of very high prevalence of human immunodeficiency virus (HIV) infection among women of childbearing age and the increasing demand for treatment to prevent mother-to-child transmission, we investigated the desire for a future pregnancy among women in Zimbabwe in relation to (1) self-perceived risk of HIV infection, (2) child mortality, and (3) spontaneous abortion. A random cross-sectional sample of 2250 ever-married women aged 15-49 years was selected from 6,828 households in rural and urban Zimbabwe. The sample was representative of the geographic distribution of women. One eligible subject was selected per household for a structured interview on factors associated with the desire for future pregnancy. Overall, 54% of the participants desired to get pregnant in future; 55% perceived themselves at high risk for HIV infection; 6% reported the death of at least one child less than the age of 5 years in the last 5 years; and 12% reported at least one spontaneous abortion in the last 5 years. In multiple logistic regression analysis, reporting at least one child's death (OR = 1.77; 95% CI 1.13-2.78) and at least one spontaneous abortion in the last 5 years (OR = 1.81; 95% CI 1.08-3.04) were significantly associated with a higher desire to get pregnant; however, high self-perceived risk for HIV infection was not (OR = 0.85; 95% CI 0.67-1.09). High self-perceived risk for infection with HIV was not associated with a lower desire for a future pregnancy among women in Zimbabwe in a high-prevalence area. In fact, our data suggest an increased desire for future pregnancy to replace childhood deaths or spontaneous abortions that may result from HIV infection. Voluntary HIV testing services are challenged with balancing counseling messages on the strong desire for children, the risk of mother-to-child transmission, and poor fetal outcomes. Further research is needed to explore utilitarian-economic, social, and psychological values attributed to children by women and their partners. The involvement of men as partners in childbearing should be explored, as their desire for children may be the primary barrier to protective behavior change among women.
The 5-HT(1B/1D) receptor agonist sumatriptan is effective in aborting acute attacks of migraine and is known to cause constriction of cranial arteries as well as some peripheral blood vessels. The present study set out to investigate whether 5-HT(1B) and/or 5-HT(1D) receptors mediate contractions of the human isolated middle meningeal and temporal arteries (models for anti-migraine efficacy) and coronary artery and saphenous vein (models for side-effect potential). Concentration-response curves were made with sumatriptan (1 nm-100 microm) in blood vessels in the absence or presence of selective antagonists at 5-HT(1B) (SB224289) and 5-HT(1D) (BRL15572) receptors. SB224289 antagonized sumatriptan-induced contractions in all blood vessels, although the antagonism profile was different amongst these blood vessels. In the temporal artery, SB224289 abolished contraction to sumatriptan, whereas in the middle meningeal artery and saphenous vein sumatriptan-induced contractions were blocked in an insurmountable fashion. Moreover, SB224289 acted as a weak surmountable antagonist in the coronary artery (pK(B): 6.4 +/- 0.2). In contrast, BRL15572 had little or no effect on sumatriptan-induced contractions in the four blood vessels investigated. In situ hybridization revealed the expression of 5-HT(1B) receptor mRNA in the smooth muscle as well as endothelial cells of the blood vessels, whereas the mRNA for the 5-HT(1D) receptor was only very weakly expressed. These results show that the 5-HT(1B) receptor is primarily involved in sumatriptan-induced contractions of human cranial as well as peripheral blood vessels.
PROBLEM: The majority of women with recurrent miscarriage have no discernible cause but it has been postulated that immunologic aberrations may be the cause in most of such cases. Also, it has been stressed that deliberate modification of the maternal host defense system can improve the chances of success. We tested the hypothesis that it is possible to potentiate maternal immune functions so as to improve reproductive performance by replacing several embryos into the uterus, thus favoring the recognition of fetal antigens. METHOD OF STUDY: A total of 57 couples with three or more (mean 5.52; range 3-12) consecutive first-trimester spontaneous clinical abortions of unknown etiology were treated with in vitro fertilization (IVF) and embryo transfer for a total of 84 cycles. Patients underwent IVF after combined gonadotropin-releasing hormone agonist/gonadotropin treatment for ovarian stimulation, and up to four embryos were replaced into the uterus. RESULTS: There were 32 pregnancies (three of them after frozen-thawed embryo transfers) and 26 (81%) of them were viable gestations. Overall, patients had a previous obstetric history of 315 pregnancy losses and 15 live-born babies. Thus, the probability of having a live baby before treatment was 4.54% (95% CI, 2.78-7.36) a figure significantly lower (P < 0.0001) than that observed under IVF treatment (81%; 95% CI, 64.53-91.01). None of selected variables potentially related with the outcome of pregnancy after IVF and embryo transfer in recurrent aborters (including pre-implantation genetic diagnosis) was found to be associated with miscarriage. CONCLUSIONS: This study shows that replacement of several embryos after IVF is a useful treatment in the prevention of unexplained recurrent spontaneous abortion thus providing further evidence for immunologically modifiable pregnancy loss.
OBJECTIVE: To determine the therapeutic efficacy and safety of a nitric oxide (NO) isosorbide dinitrate donor to induce cervical ripening of women with missed abortions before surgical evacuation of the uterus. DESIGN: A prospective, randomised, double-blind controlled trial. SETTING: Tertiary referral maternity teaching hospital. Population Sixty women with missed abortions and no cervical dilation. METHODS: Women requesting surgical evacuation of the uterus were randomly selected to receive endocervical 80 mg/1.5 mL isosorbide dinitrate gel solution (n= 30) or 400 mug/1.5 mL misoprostol gel solution (n= 30) every 3 hours to a maximum of four doses or until reaching cervical ripening. Vital signs and symptoms were recorded at baseline and then every 3 hours until finishing therapy. Adverse events, such as headache, abdominal pain, pelvic pain, backache, nausea and vomiting, were evaluated. MAIN OUTCOME MEASURES: Probability of reaching cervical ripening >8 mm Hegar dilator; evaluated at 3, 6, 9 and 12 hours after application of isosorbide dinitrate or misoprostol. RESULTS: The probabilities of induction of cervical ripening by isosorbide dinitrate and misoprostol after four repeated doses at 3-hour intervals were significantly different (P<0.001). Efficacy of therapy after 12 hours was 97% for the isosorbide dinitrate group and 70% for the misoprostol group. Systolic and diastolic blood pressures were lower after administration of isosorbide dinitrate than prostaglandin analogues. The difference in the mean systolic and diastolic blood pressure between treatment groups was greatest at 3 hours, with a difference of 7.7 mmHg (P<0.001) and 5.9 mmHg (P<0.003), respectively. The most frequent side effect associated with isosorbide dinitrate administration was headache, which occurred in 18 out of 30 patients, compared with only 5 out of 30 women in the misoprostol group [relative risk (RR) 2.41, 95% confidence interval (CI) 1.45-4.03, P<0.001). Women treated with misoprostol reported mainly pelvic pain (RR 3.24, 95% CI 1.99-5.27, P<0.001). CONCLUSIONS: Intracervical administration of 80 mg isosorbide dinitrate in women with missed abortions appears to be effective for cervical ripening prior to surgical evacuation of the uterus. Differences in the incidence of non-serious adverse events are not likely to be clinically significant.
Recurrent miscarriage is a pathological condition induced by maternal and embryonic causes. This paper describes a prospective study to determine the real incidence of aneuploidy for autosomes 13, 16, 18, 21, 22, and gonosomes in preimplantation human embryos obtained from patients with recurrent pregnancy loss after ovarian stimulation in an IVF-ET programme. Our results indicate that aneuploidy for the chromosomes analysed are abnormally higher in embryos obtained after IVF from recurrent abortion patients (58%) compared to non-recurrent abortion patients undergoing IVF. Furthermore, monosomies are six times more frequent than trisomies (47:8) in preimplantation embryos from recurrent abortion patients. Based on the present study, preimplantation genetic diagnosis (PGD) of embryos obtained from patients with recurrent miscarriage could prove advantageous in diagnosing abnormal embryos and selecting normal embryos for transfer.
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The impact of cesarean section on subsequent fertility and abortions was studied by comparing cohorts of women from two populations with unequal rates of cesarean section. After excluding women with strong confounding factors, all primiparae having had a cesarean section in 1973 and 1976 and matched controls were identified from the Swedish Birth Registry. The subsequent births in the next five and eight years were sought from the same registry and subsequent spontaneous abortions from the Hospital Inpatient Discharge Registry. There were fewer second children, subsequent children and twin deliveries in the cesarean section groups than in the control groups. The ratio of spontaneous abortions to births was somewhat higher in the cesarean section groups, but the difference was not statistically significant. Regardless of the different rates of cesarean section in the two populations, the 1973 and 1976 cohorts were similar. Apparently the findings were due not only to selection in the first cesarean section but possibly also to the operation itself.
BACKGROUND AND OBJECTIVES: Conventional cytogenetic studies have revealed more number of females in spontaneous abortion and it has been assumed that a large proportion of those were resulted from maternal contamination and overgrowth of maternal decidua in long term culture. In this study we have attempted to overcome difficulties of conventional cytogenetics by using meticulous tissue dissection and molecular methods onto uncultured chorionic villous tissue thus bypassing long term culture to find out true sex ratio and frequency as well as type of common aneuploidy in early missed abortions. METHODS: Early missed abortion products (n=58) were collected from recurrent aborter in and around Lucknow, India, over a period of three years. All the cases were selected on the basis of ultrasonography diagnosis. Chorionic villous tissue was cleaned from maternal tissue and processed for conventional as well as molecular cytogenetic analysis. RESULTS: Conventional cytogenetics was successful in 15, of which 12 were females and 3 males. There were 3 cases of chromosomal abnormality, including one false. Interphase FISH with X, Y, 1, 9, 12, 16, 18 and 13/21 probes was carried out in all 58 cases. There were 43 females and 15 males. Four cases of chromosomal abnormality were detected by interphase FISH (6.9%). Comparative genomic hybridization was successful in 8 cases (6 females and 2 males). There was no aneuploidy; however, suspected gain and losses were seen in 4 cases. INTERPRETATION AND CONCLUSION: Our results suggested skewing of sex ratio (M : F, 1 : 2.9 ) and low aneuploidy rate, indicating that in early missed abortion from recurrent spontaneous abortion female outnumbers male. The various possibilities with literature support are presented that may serve as a template for future work.
Forty-seven antenatal patients with clinical diagnosis of cervical incompetence were subjected to a structured scoring system before insertion of McDonald Stitch. All other possible causes of midtrimester abortion were ruled out and the patients followed up to the end of their pregnancies. Significantly there were fewer preterm deliveries in the high score group (P less than 0.01) and no abortions. The mean cerclage-delivery interval was shown to rise with increasing scores. Significantly better fetal salvage ratio was also seen in the high score group (P less than 0.05). The scoring system shows promise as a selective and prognostic tool and is recommended for trial on a wider scale.
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