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PubMed1999

Abortion: behaviour of adolescents in two districts in Kenya.

BACKGROUND: In Kenya the reported high rates of unwanted pregnancies (more than 90%), among adolescents have subsequently resulted in unsafely induced abortions with the associated high morbidity and mortality rates. OBJECTIVE: To evaluate the adolescents' behaviour regarding induced abortion. DESIGN: A cross-sectional, prospective study done from July 1995 to June 1996. SETTING: Schools and health facilities in Kiambu and Nairobi districts in Kenya. PARTICIPANTS: Interviews were conducted among adolescents aged 10-19 years in schools at the two districts and selected using a multi-stage random sampling procedure, as well as adolescent girls at two hospitals and two clinics in the immediate post-abortion period. MAIN OUTCOME MEASURES: The number of adolescents health programmes, aimed at reducing the dangers of unsafely induced abortion, which are designed and subsequently implemented. DATA COLLECTION: Demographic and health data, as well as data on behaviour regarding induced abortion were collected using a self-administered questionnaire. RESULTS: The study sample comprised 1820 adolescents. These were 1048 school girls (SG), 580 school boys (SB) and 192 post-abortion (PA). Many adolescents were aware of abortion dangers, with the awareness being significantly lower among the SB whose girlfriends (GF) had aborted than those whose GF had not (p < 0.01). The practice of abortion was reported among 3.4% SG, 9.3% SBs' GF and 100% PA. Direct and indirect costs of abortion were heavy on the girls. Knowledge of the abortion dangers had no influence on the choice of the abortionist. Abortion encounter positively influenced approval by the adolescents, of abortion for pregnant school girls (p < 0.01). CONCLUSION: Despite the costs and awareness of abortion dangers by adolescents, they will take risks.

Abortion, Illegal↗
PubMed2000

Antibiotics for incomplete abortion.

OBJECTIVES: The value of routine antibiotics before surgical evacuation of the uterus in women incomplete abortion is controversial. In some health centres antibiotic prophylaxis is advised in others antibiotics are only prescribed when there is signs of infection. The objective of this review is to evaluate the effectiveness of routine antibiotic prophylaxis to women with incomplete abortion. SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register, MEDLINE and Popline. Date of last search: January 1999. SELECTION CRITERIA: Randomised trials comparing a policy of routine antibiotic prophylaxis with no routine prophylaxis were eligible for inclusion. DATA COLLECTION AND ANALYSIS: Data extraction was conducted by two reviewers independently. Trial quality was assessed. MAIN RESULTS: One study involving 140 women was included. A second well-conducted trial was excluded because of high losses to follow-up. No differences were detected in postabortal infection rates with routine prophylaxis or control. However, compliance with antibiotic treatment was also low. REVIEWER'S CONCLUSIONS: There is not enough evidence to evaluate a policy of routine antibiotic prophylaxis to women with incomplete abortion.

Abortion, Incomplete↗
PubMed1996

Trisomy 15 mosaic derived from trisomic conceptus: report of a case and a review.

We report on a fetus with 47,XX,+15 chromosome abnormality detected on chorionic villus sampling (CVS). The pregnancy was terminated at 15.5 weeks of gestation and chromosome analysis done on amniocytes and fetal tissues showed a karyotype 46,XX/47,XX,+15. Autopsy showed multiple abnormalities. Short-arm polymorphisms of the three number 15 chromosomes were highly informative in the delineation of parental origin and the stage of meiotic error. Using fluorescent in situ hybridization (FISH) with D15Z1 and a chromosome 15 painting probe, in addition to DA/DAPI and G-banding, we were able to show that the trisomic conceptus was derived through maternal meiosis I error. The trisomic state was then partially corrected by the loss of one of the two maternal 15s resulting in mosaicism without uniparental disomy (UPD). Striking differences in the proportion of trisomic cells in kidneys, blood, intestine, and skin, and lower proportions of trisomic cells in transformed and frozen than in fresh tissues, illustrate the continuing cell selection in this fetus in favour of the normal cell line. Trisomy 15 conceptions are usually aborted spontaneously in the first trimester of pregnancy. The longer survival of this fetus is most probably the result of a chromosome 15 loss from the trisomic zygote. To the best of our knowledge, the presence of this lethal trisomy has been reported in only five live-born infants, and in five fetuses including the present case, it was detected prenatally and the pregnancies were terminated.

Adult↗
PubMed1988

Pregnancy outcome associated with natural family planning (NFP): scientific basis and experimental design for an international cohort study.

Although natural family planning (NFP) is a form of contraception without ostensible maternal risks (other than pregnancy), potential fetal risks could exist if aging gametes are involved in inadvertent fertilization. In the following report, we first review animal studies firmly establishing that aging sperm and aging oocytes (delayed fertilization) cause chromosomal abnormalities in mammals and other species. We next review human studies associating decreased coital frequency with trisomy and studies of NFP populations that generally show no increased frequency of anomalous offspring or spontaneous abortions. Our rationale for initiating an international cohort study is presented, along with the experimental design selected. Preliminary findings indicate that the experimental design chosen will indeed provide information allowing NFP safety to be assessed definitively.

Aging↗
PubMed2002

Post-traumatic Headache.

Headache is the most common symptom after closed head injury, persisting for more than 2 months in 60% of patients. Rarely does headache occur in isolation. Cervical pain is a frequent accompaniment. Post-traumatic headache is often one of several symptoms of the postconcussive syndrome, and therefore may be accompanied by additional cognitive, behavioral, and somatic problems. Acute post-traumatic headaches may begin at the time of injury and continue for up to 2 months post-injury. Although onset proximate to the time of injury is most common, any new headache type occurring within this period of time is referred to as an acute post-traumatic headache. If such headaches persist beyond the first two months post-injury, they are subsequently referred to as chronic post-traumatic headaches. Over time, post-traumatic headaches may take on a pattern of daily occurrence. If aggressive treatment is initiated early, posttraumatic headache is less likely to become a permanent problem. Once "windup" of post-traumatic headaches occurs, the cycle of ongoing headaches is more difficult to interrupt. The mechanism of post-traumatic headache is poorly understood. Trauma-induced headaches are usually heterogeneous in nature, often including both tension-type pain and intermittent migraine-like attacks. Rebound-headaches may develop from overuse of analgesic medications, and the occurrence of such may complicate significantly the diagnosis of post-traumatic headache. Adequate treatment typically requires both "peripheral" and "central" measures. Understanding the general principles of treatment, especially appropriate use of preventive and abortive medications, will most usefully guide treatment. There is scant literature with which to direct treatment selection for post-traumatic headache. Consequently, treatments for post-traumatic headache are based on those prescribed for phenomenologically similar but etiologically distinct headache disorders. Delayed recovery from post-traumatic headache may be a result of inadequately aggressive or ineffective treatment, overuse of analgesic medications resulting in analgesia rebound phenomena, or comorbid psychiatric disorders (eg, post-traumatic stress disorder, insomnia, substance abuse, depression, or anxiety).

Journal Article↗
PubMed2006

The role of cervical cerclage in obstetric practice: can the patient who could benefit from this procedure be identified?

This editorial critically examines the definition of "cervical insufficiency." The definition, the clinical ascertainment, efforts to develop an objective method of diagnosis, as well as the nature of cervical disease leading to spontaneous mid-trimester spontaneous abortion and preterm delivery are reviewed. The value and limitations of cervical sonography as a risk assessment tool for spontaneous preterm delivery are appraised. The main focus is on the role of cervical cerclage to prevent an adverse pregnancy outcome. The value of assessing the presence or absence of endocervical inflammation in the outcome of cerclage placement is discussed.

Abortion, Spontaneous↗
PubMed1998

The antimigraine agent alniditan selectively constricts porcine carotid arteriovenous anastomoses via 5-HT1B/1D receptors.

In previous studies, we have shown that several 5-HT1B/1D receptor agonists, including sumatriptan, potently constrict porcine carotid arteriovenous anastomoses. This effect seems to be of high predictive value for antimigraine activity. In the present experiments, we studied the effects of a new non-indole 5-HT1B/1D receptor agonist, alniditan, on systemic and carotid haemodynamics in anaesthetised pigs. In control animals, no significant changes in either systemic or carotid haemodynamics were observed after four consecutive i.v. injections of physiological saline (0.5 ml each, every 20 min; n = 4). On the other hand, i.v. doses of alniditan (3, 10, 30 and 100 microg kg(-1) in 0.5 ml saline, every 20 min; n = 6) dose-dependently decreased total carotid conductance (maximum change: -31 +/- 6%) by a selective vasoconstrictor action on arteriovenous anastomoses (maximum change: -72 +/- 5%); the nutrient vascular bed dilated in response to alniditan (maximum change: +103 +/- 39%). The dose of alniditan that decreased arteriovenous anastomotic conductance by 50% was 24 +/- 8 microg kg(-1) (64 +/- 20 nmol kg(-1)). Alniditan produced a slight bradycardia (maximum change: -4 +/- 1%) and a more pronounced hypotensive effect (maximum change: -23 +/- 5%). In six animals pre-treated with the potent and selective 5-HT1B/1D receptor antagonist, GR127935, the alniditan-induced changes in carotid haemodynamics were clearly antagonised, whereas the bradycardia and hypotension remained unaffected. These results suggest that alniditan selectively constricts porcine carotid arteriovenous anastomoses mainly via 5-HT1B/1D receptors and should be able to abort migraine headaches. The latter has indeed been confirmed in initial clinical studies in man.

Analgesics↗
PubMed1998

An evaluation of the Bio-Rad Variant Haemoglobin Testing System for the detection of haemoglobinopathies.

The Bio-Rad Variant Haemoglobin Testing System is an automated analyser which uses the principle of cation exchange high performance liquid chromatography. This evaluation was undertaken to examine the effectiveness of the instrument as a screening mechanism to assist in the diagnosis of haemoglobinopathies. The ability to quantify haemoglobins A2 and F and to 'flag' other haemoglobin variants was tested. Within-batch precision was excellent and between-batch precision was good. Linearity and sensitivity compared favourably with the manufacturer's published ranges. The level of carry-over for haemoglobins F, S and A was less than 0.25%. The mean carry-over for haemoglobin A2 was 2.08%. This higher figure reflected the smaller absolute difference between the high and low samples for this parameter. The instrument never failed to indicate the presence of an abnormal haemoglobin in 271 selected samples. The instrument was reliable throughout the evaluation and at no time was a run aborted.

Cations↗
PubMed1989

Adverse pregnancy outcomes in relation to water contamination, Santa Clara County, California, 1980-1981.

An epidemiologic study was conducted to investigate a suspected cluster of adverse outcomes of pregnancies conceived in 1980-1981 among women who resided in a census tract in Santa Clara County, California that was thought to be exposed to drinking water from a well contaminated by an organic solvent, trichloroethane. A comparison census tract that received water from a different source was selected on the basis of demographic comparability. The cluster was confirmed; the odds ratio for spontaneous abortion was 2.3 (95% confidence interval (Cl) 1.3-4.2) after adjustment by multiple logistic regression for maternal risk factors, including maternal age, alcohol consumption, smoking, and prior fetal loss. The relative risk for congenital malformations was 3.1 (95% Cl 1.1-10.4). Because of the lack of precise information on the timing and extent of contamination, the pattern of spontaneous abortion rates throughout the study period cannot be used to either support or refute a causal inference.

Abnormalities, Drug-Induced↗
PubMed1990

Excess of HLA parental sharing in families with Turner patients.

In utero selection processes are probably related to mother-father compatibility as has been reported in abortion-prone couples and in Down syndrome studies. In order to analyse this phenomenon, we investigated families with chromosomal imbalance (Turner syndrome). We chose this model because previous data indicated a high frequency of HLA-A31 and B38 in Turner patients and in their mothers. We report high HLA antigen sharing in Turner families and great histocompatibility between mother and affected daughter, not related to abortion histories. The proportion of HLA-A homozygous cases among Turner children was higher than expected. The level of lymphocytotoxic antibodies against fetus in mothers of Turner patients was comparable to that of mothers of families with normal fertility and probably favoured these pregnancies.

Abortion, Habitual↗
PubMed1995

Ventricular tachycardias with left bundle branch block morphology.

The differential diagnosis of VTs with LBBB morphology includes several well-defined syndromes. Although the majority of cases are attributable to acquired structural heart disease, including ischemia, prior infarction, or dilated cardiomyopathy, consideration of specific right ventricular processes is essential to proper evaluation and treatment. The approach to older patients or those with evidence for heart disease should begin with an evaluation for coronary artery disease and an assessment of biventricular function. Careful evaluation for bundle branch reentry should be performed during electrophysiological study, especially when there is underlying conduction system disease. Younger patients, those without overt heart disease, or those with isolated right ventricular disease, should receive a complete noninvasive evaluation of right and left ventricular size and function. An abnormal SAECG or identification of intracardiac late potentials suggest right ventricular dysplasia or cardiomyopathy, whereas responsiveness to adenosine and absence of detectable heart disease support the diagnosis of idiopathic right VT. Newer techniques, including MRI, show promise in identifying subtle right ventricular disease not otherwise detectable even in the setting of presumed idiopathic right VT. Following surgical repair of selected congenital heart defects, particularly tetralogy of Fallot, symptoms of recurrent palpitations, near syncope, syncope, or aborted sudden death may be attributable to recurrent VT, and diagnostic electrophysiological study should be considered for these patients. Finally, SVTs with LBBB morphology, particularly cases associated with right-sided or septal accessory pathways, should always be considered in this differential diagnosis.

Bundle of His↗
PubMed1979

Gray-scale ultrasound in 204 proved gynecologic masses: accuracy and specific diagnostic criteria.

Gray-scale ultrasound results are evaluated in 182 women with 204 histologically proved gynecologic masses. Ultrasound provided information leading to the correct diagnosis in 56% of cases, contributory data in 23%, and nonspecific information in 14%. Errors occurred in 6%. A specific histologic diagnosis was possible in selected patients with simple ovarian cysts, cystadenomas, cystadenocarcinomas, dermoids, uterine fibroids, ectopic and molar pregnancies, missed abortions, and endometriosis. A characteristic but nondiagnostic ultrasound pattern was associated with carcinoma of the uterus, recurrent carcinoma of the ovary, and pelvic abscesses. A nonspecific pattern was common in tubo-ovarian abscesses.

Abortion, Missed↗
PubMed1985

Hemopoiesis in mouse heterozygous for the W trait. Difference in postirradiation recovery related to the defect in formation of transient endogenous spleen colonies.

The hemopoietic regeneration following midlethal irradiation in Wv/+ mice had similarly biphasic kinetics as in their hematologically normal +/+ littermates. The first abortive phase of regeneration was either severely reduced (formation of transient endogenous spleen colonies, reticulocyte count, granulocyte count) or absent (spleen and femur cellularity, platelet count, PCV) in Wv/+ mice, when compared to +/+ mice. The second phase leading to permanent recovery of hemopoiesis was in Wv/+ mice delayed in time. Moreover, although to a lesser extent the values of spleen and femur cellularity, PCV and platelet count were decreased in Wv/+ mice. Postirradiation bleeding, which stimulated particularly the 1st phase of regeneration both in Wv/+ and +/+ mice did not lead to the minimization of differences between above two genotypes. It is suggested that the observed differences in the abortive regeneration between Wv/+ and +/+ mice are primarily dependent on the presence in Wv/+ mice of selective defect of transient endogenous colony forming units (TE-CFUs). Moreover, it is possible that the differences in the second phase of regeneration leading to permanent recovery are secondarily dependent on the TE-CFUs defect, as most probably the TE-CFU is the step in stem cell differentiation to mature cells.

Animals↗
PubMed1980

Microsurgical technique in the management of tubal ectopic pregnancy.

Microsurgical techniques employing fine instruments and suture, microelectrocautery and continuous lavage, and careful handling of tissue have been applied to a variety of gynecologic procedures in which the microscope itself is not warranted. The thesis underlying this practice is straightforward: if successful outcome in chronic tubal disease is enhanced by these procedures, then they may have a beneficial role in acute tubal disease. To test this premise, in the past 2 years nine patients with tubal ectopic pregnancies have been managed by microsurgical techniques at Yale-New Haven Hospital. Five of the ectopic pregnancies were unruptured and four were ruptured. The products of conception were removed either by meticulous debridement or linear antimesenteric salpingostomy in association with the microsurgical methods noted above. Tubal healing was by secondary intention. All patients were treated with prophylactic antibiotics and intra-abdominal low molecular weight dextran. Four months postoperatively, all tubes operated upon were patent by salpingography. Subsequently, three of the five women with unruptured pregnancies and two of the four with ruptured pregnancies achieved intrauterine pregnancies. However, one has spontaneously aborted. According to these preliminary results, microsurgical techniques may be beneficially applied in the treatment of selected cases of ectopic pregnancy.

Adult↗
PubMed1993

Recent advances in migraine management.

Migraine periodically disables millions of Americans and thus has a significant economic impact on society. Successful treatment of migraine requires that the physician understand the pathophysiology underlying migraine and educate the migraineur in the management of this chronic pain syndrome. Recent advances in the receptor biochemistry of serotonin have given important insight into the mechanisms of migraine pain and treatment. An understanding of these mechanisms has resulted in treatment strategies that address the mechanism of headache control rather than just symptom control. Advances in pharmacologic therapy include a newly developed highly selective serotonin agonist called sumatriptan, which appears to be a promising addition to the armamentarium of abortive migraine treatments. Further data correlating the role of daily analgesics and ergotamines in transforming episodic migraine into chronic daily headache represent another significant advance in migraine management. Clinical trials of sumatriptan are reviewed, and the role of daily analgesic and ergotamine use is discussed in relation to advances in migraine pathophysiology and available demographic data on migraine.

Analgesics↗
PubMed1981

Spontaneous abortion over time: comparing occurrence in two cohorts of women a generation apart.

A prospective study of menstrual cycles and reproductive outcomes has been in progress since 1935. Data from this study are used to describe the risk of spontaneous abortion in two time periods 26 years apart. Out of the total of 3889 women who have enrolled in this study, two cohorts of women are selected for analysis: cohort one consists of 2070 university students who entered the study in 1935-1944, and cohort two consists of 1375 students a generation later, 1961-1970. Cohort one has contributed 2408 pregnancies, and cohort two, 1493 pregnancies. Overall spontaneous abortion risk for the two cohorts is 16.9% and 13.1%, respectively. However age-specific risks of spontaneous abortion do not differ for the two groups, nor is there a difference in the gestational duration of spontaneously aborted pregnancies.

Abortion, Spontaneous↗
PubMed2000

[Prevalence and distribution of congenital cardiopathy at birth and in pregnancy termination: impact of prenatal diagnosis in 4 years of experience].

OBJECTIVE: To evaluate in two time intervals the potential impact of prenatal diagnosis on prevalence and spectrum of CHD at birth and in aborted fetuses. PATIENTS AND METHODS: At the University Hospital of Bari, south-east Italy, in the period between January 1st 1996 and December 31st 1999 a retrospective study was performed of all newborns and termination of pregnancy (TOP) beyond 18 weeks' gestation with postnatally diagnosed CHD. An antenatal fetal ultrasonic evaluation had been always performed between 18-22 weeks' gestation. The prevalence, distribution and detection rate of CHD at birth and in TOP were assessed and compared between two different periods of time (96-97 vs 98-99) to verify an eventual improvement in the prenatal diagnosis due to the learning curve and to new technologies. RESULTS: Prevalence of severe CHD in livebirths and aborted fetuses showed no significant changes between the two study periods (respectively 4.6@1000 vs 5.4@1000, at birth; 10% vs 11%, in TOP) and the same was observed as for as distribution of CHD. Maternal or fetal risk factors were found in 23% of cases of CHD at birth and in 74% of cases of CHD in aborted fetuses. The antenatal detection rate of CHD did not change between the two study periods in newborns (25% vs 27%, NS) while in aborted fetuses it was higher and showed a significant longitudinal improvement (53% vs 85%, p < 0.05), which was more evident if only selected cases were considered (56% vs 93%, p < 0.03). DISCUSSION: Our data show that gain in experience in fetal echocardiography has increased the prenatal diagnostic accuracy for congenital cardiac malformations only in selected cases, evaluated by more expert operators. In conclusion the impact of antenatal routine screening for congenital heart disease appears still relatively small.

Abortion, Induced↗
PubMedDate not supplied

Expectant, medical, or surgical treatment of spontaneous abortion in first trimester of pregnancy? A pooled quantitative literature evaluation.

BACKGROUND: Spontaneous abortion is a common problem in everyday clinical practice, accounting for 15 to 20 percent of all recognized pregnancies. The traditional treatment of this problem has been surgical, emptying the uterus by dilatation and curettage (D&C). Recent therapeutic and laboratory advances call surgical therapy into question for many patients. It is believed that this pooled quantitative literature evaluation is the first with the goal to clarify the roles of expectant, medical, and surgical treatment of this common problem. METHODS: The literature review was focused on published studies in the English language of outcomes of therapy for spontaneous abortion in the first trimester. We looked for both observational and randomized controlled trials. A successful outcome of treatment required that three criteria be met: vaginal bleeding stopped by 3 weeks, products of conception fully expelled by 2 weeks, and absence of complications. Pooled weighted average success estimates and standard errors were determined for each study; 95 percent confidence intervals were calculated for each form of treatment. Sensitivity analysis compared randomized controlled trials with observational studies for both expectant and surgical treatment. RESULTS: Of the 31 studies retrieved, 18 met inclusion criteria, including 9 involving expectant treatment (545 pooled patients), 3 for medical treatment (prostaglandin or antiprogesterone agents) (198 pooled patients), and 10 for surgical treatment (D&C) (1408 pooled patients). Successful outcomes were found in 92.5 percent of patients receiving expectant treatment, in 93.6 percent of those undergoing D&C, and in 51.5 percent of patients receiving medical treatment. CONCLUSIONS: Expectant management of spontaneous abortion in the first trimester is safe and effective for many afebrile patients whose blood pressure and heart rate are stable and who have no excess bleeding or unacceptable pain. Transvaginal sonographic studies might be useful in patient selection, and serial chorionic gonadotropin monitoring should be considered while observing the initial course of expectant treatment. Currently there is insufficient evidence to support medical therapy of spontaneous abortion, and further research is needed to clarify the more limited role of surgical treatment.

Abortion, Spontaneous↗