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PubMedDate not supplied

The effect on fecundity of pill acceptance during postpartum amenorrhea in rural Bangladesh.

The length of the interval from last live birth to the subsequent pregnancy was studied for 121 contraceptive pill acceptors who were in postpartum amenorrhea at the time of acceptance and 121 matched nonacceptors in a prospective study in Matlab, Bangladesh. Half of the pill acceptors discontinued use within seven months, and as a group the pill acceptors had a significantly shorter interval to the next pregnancy than the matched nonacceptors. These findings suggest that unless continuation rates can be improved, it is better not to encourage women in rural Bangladesh to start the contraceptive pill during postpartum amenorrhea.

Adult↗
PubMed1981

Late complications of sterilization according to method.

By using a patient questionnaire, we checked the effects of two tubal sterilization procedures (high-frequency [HF] and endocoagulation techniques) in relation to late complications. In the years following high-frequency sterilization, 23 women (8.9%) had hysterectomies; in the endocoagulation group only 9 patients (2.3%) underwent hysterectomy. Patients sterilized by the unipolar high-frequency technique required one to three curettages in 7.8% of cases, whereas only 2.1% of the endocoagulation group required this procedure. Seventy-nine patients in the high-frequency group (30.9%) exhibited menstrual disorders as compared to only 45 (11.7%) in the other group. The combination of menstrual irregularities and menopausal complaints was found in 7.4% of the HF group, while only 2.8% of the endocoagulation group experienced these problems. Menopausal complaints only, without menstrual disorders, occurred in 4.7% and 3.9% of the women, respectively. Eighty-five percent of 330 patients sterilized by the Semm endocoagulation technique had no menstrual complaints or menopausal symptoms; in the HF group this was the case for 160 women (62%). Our results demonstrate that late postoperative complications arise less often in patients sterilized by endocoagulation.

Adult↗
PubMed1995

Nutritional therapy for pregnant women with a metabolic disorder.

Nutritional therapy is essential for a normal reproductive outcome in phenylketonuric women. In homocystinuria, fetal outcome is good in women whose disorder is responsive to vitamin B6 therapy and is poor in women whose disorder is unresponsive to therapy. Pregnancy in galactosemia is rare because of the almost universal ovarian dysfunction present in female patients with this disorder. Transplantation of the fertilized ovum is a promising possibility for these women. In women with MSUD, there has been only one case of pregnancy reported to date.

Adolescent↗
PubMed1993

[Effect of various levels of hypothermic ischemia on ATPase activity of the functional element of the myocardium].

Activity of ATPase in functional element of myocardium (its qualitative and quantitative aspects) has been researched in normal tissue and in one with various levels of hypothermic ischemia (28-30 degrees C and 10-12 degrees C) by methods of electron microscopic histochemistry on dogs. It has been found that hypothermia of myocardium (10-12 degrees C) optimally prevents ischemic disorders of energetic processes. Reproduction activity of ATPase during reperfusion of myocardium after that hypothermia maintains contractile function of heart in proper high level.

Adenosine Triphosphatases↗
PubMed1993

[Eugenics and public health: legal sterilization of mentally ill in the Vaud canton (Switzerland)].

In 1928 the canton of Vaud (Switzerland) voted a bill which legalized eugenics sterilization. The sterilization of the mentally ill was a public-health measure among others. It fitted in a wide variety of policies whose aims were to increase the physical and psychical well-being of the population. Vaud eugenics was progressive, reformist and non-partisan. This paper examines the intellectual, social and political conditions of the 1928 bill.

Eugenics↗
PubMed1976

[Forensic psychiatric aspects of sterilization].

How great the risk is that important and long-lasting psychic disturbances persist after sterilization cannot be forecast with certainty, even today. Increased susceptibility to abnormal psychic reactions and developments after sterilization is to be contemplated with certain personalities with overconscientious, asthenic or depressive traits. It is usually a matter of internal conflict situations at the level of self-esteem which, however, depend not only on the initial personality, but to a large extent are repeatedly reactualized through the behavior and reaction of the persons in the environment, so that finally mental developments arise which reach into the abnormal. This risk must be included in the calculation when making the indication and requires particular attention, because the legal effectiveness of the consent to sterilization is also dependent on the completeness of the advice on the consequences of this surgical operation.

Female↗
PubMed1998

Targeted induction of collagenase and stromelysin by relaxin in unprimed and beta-estradiol-primed diarthrodial joint fibrocartilaginous cells but not in synoviocytes.

Temporomandibular joint (TMJ)-related diseases have a high female-to-male predilection and, unlike similar diseases of other joints, occur primarily during reproductive years. Although a role of female reproductive hormones has been proposed in the etiopathogenesis of these diseases, no direct evidence exists to link female reproductive hormones to TMJ disorders or to define the mechanisms by which these hormones may predispose to TMJ disease. Because relaxin, a 6-kd polypeptide hormone, alters the matrix composition of pubic symphyseal fibrocartilage and has been implicated in systemic joint hypermobility, synovial joints--particularly those with a large component of fibrocartilaginous tissues such as the TMJ--are potential but unproved target sites for its matrix-remodeling activity. The purpose of these studies was to determine the effects of relaxin on the expression of tissue-degrading enzymes, matrix metalloproteinases (MMPs), and their inhibitors, tissue inhibitors of metalloproteinases (TIMPs), in unprimed and beta-estradiol-primed TMJ disc fibrocartilaginous cells. Early-passage disc fibrocartilaginous cells were exposed to increasing concentrations of relaxin, and the cell-conditioned medium or mRNA was assayed for MMPs and TIMPs. Relaxin produced a dose-dependent induction of collagenase-1 (MMP-1) and stromelysin-1 (MMP-3), but minimal modulation of TIMP-1 and TIMP-2 expression in the fibrocartilaginous cells. Priming of these cells with beta-estradiol potentiated their MMP-inductive response to relaxin such that the maximal expression of collagenase-1 and stromelysin-1 occurred at 10- to 100-fold lower concentrations of relaxin in estrogen-primed than in unprimed cells. By contrast, beta-estradiol alone caused a dose-dependent decrease in these MMPs. Finally, relaxin's induction of collagenase-1 and stromelysin-1 was specific to the fibrocartilaginous cells, because in both unprimed and estrogen-primed synoviocytes, relaxin produced a dose-dependent decrease in these MMPs. These findings implicate relaxin alone, or in combination with beta-estradiol, in the degradative remodeling of the fibrocartilaginous disc and suggest a mechanism by which relaxin may predispose women to TMJ disease.

Animals↗
PubMed2002

Diagnosis and treatment of premenstrual dysphoric disorder.

From 2 to 10 percent of women of reproductive age have severe distress and dysfunction caused by premenstrual dysphoric disorder, a severe form of premenstrual syndrome. Current research implicates mechanisms of serotonin as relevant to etiology and treatment. Patients with mild to moderate symptoms of premenstrual syndrome may benefit from nonpharmacologic interventions such as education about the disorder, lifestyle changes, and nutritional adjustments. However, patients with premenstrual dysphoric disorder and those who fail to respond to more conservative measures may also require pharmacologic management, typically beginning with a selective serotonin reuptake inhibitor. This drug class seems to reduce emotional, cognitive-behavioral, and physical symptoms, and improve psychosocial functioning. Serotoninergic antidepressants such as fluoxetine, citalopram, sertraline, and clomipramine are effective when used intermittently during the luteal phase of the menstrual cycle. Treatment strategies specific to the luteal phase may reduce cost, long-term side effects, and risk of discontinuation syndrome. Patients who do not respond to a serotoninergic antidepressant may be treated with another selective serotonin reuptake inhibitor. Low-dose alprazolam, administered intermittently during the luteal phase, may be considered as a second-line treatment. A therapeutic trial with a gonadotropin-releasing hormone agonist or danazol may be considered when other treatments are ineffective. However, the risk of serious side effects and the cost of these medications limit their use to short periods.

Algorithms↗
PubMed1999

Eating disorders and gynecology: knowledge and attitudes among clinicians.

BACKGROUND: Eating disorders are common, responsive to treatment and affect women at a peak age of reproductive function, often presenting via gynecological and obstetric sequelae. The author wished to examine gynecologists' knowledge and attitudes towards them. METHOD: Following a pilot study, a questionnaire concerning eating disorders was designed covering aspects of diagnosis, characteristic gynecological manifestations, treatment, and attitudes. All gynecologists and obstetricians with more than 1 year of experience from four teaching hospitals in Australia and the United Kingdom were sent the anonymous, confidential postal questionnaire. One hundred and fifteen doctors replied, with a response rate of 86%. RESULTS: Only 20% of respondents were confident of diagnosing eating disorders. Various diagnostic misconceptions were revealed; for example, 42% overestimated weight loss in anorexia nervosa by 20% or more, and 28% wrongly believed that a sense of strict dietary control' was a feature of bulimia nervosa. Clinicians had least knowledge of bulimia nervosa, underestimating its treatment response. Surprisingly, the greatest deficits in knowledge were of endocrinology and gynecological sequelae. For example, 79% underestimated amenorrhea in anorexia nervosa by 25%, and 85% wrongly believed that regular menses was characteristic of bulimia nervosa at normal weight. Consultants demonstrated significantly more knowledge than junior grades. Thirty-one percent of respondents held pejorative attitudes to eating disorders, which over-represented men (p=0.045) who were also more likely than women to see bulimia nervosa as untreatable (p=0.01). CONCLUSION: The author suggests that these deficits might be addressed by development of simpler screening questionnaires for non-specialists, and elucidation of the interface between eating disorders and reproductive physiology.

Australia↗
PubMed1990

Family planning for the mentally disordered and retarded.

Increasing perception of healthy reproductive functioning and conception prevention has been accompanied by greater recognition of the needs for emotional and sexual fulfillment of individuals with mental disorder or retardation. Although family planning services have burgeoned in the United States and many other countries and the special concerns of mentally disordered and retarded persons have been well documented, organized efforts to include counseling on fertility regulation in mental health and in training programs have, with few exceptions, been sparse. Recent trends are discussed in terms of reported experience from the United States and Denmark. It is recommended that women of childbearing age in psychiatric facilities be given an opportunity to participate in programs offering screening for and treatment of gynecological conditions, as well as family planning counseling, before going on home leave or discharge. Such counseling should be adapted to a woman's emotional functioning, consider possible contraindications of specific contraceptive methods, and, to the extent possible, involve the partner. Ethical aspects need to be considered to avoid even the appearance of coercion. Similar opportunities should be provided for retarded persons seeking to achieve a satisfying sexual life. Surgical contraception and abortion are discussed within the context of patient rights, competence, and the desirability of avoiding unintended conceptions and reducing unwanted births that may engender further stress and psychosocial difficulties for the woman, the child, and society. The experience of former patients might well be useful in restructuring current service programs and priorities.

Family Planning Services↗
PubMed1993

Psychologic distress during menopause: associations across the reproductive life cycle.

OBJECTIVE: To determine if women with high psychologic distress attending a menopause clinic report more previous psychiatric disorders (especially depression), or psychologic distress associated with oral contraceptive use and reproductive cycle events than women with low psychologic distress attending the clinic. METHOD: Consecutive women attending a university hospital menopause clinic were administered the Brief Symptom Inventory (BSI). Women with high psychologic distress (who met case severity on the BSI general severity index) were compared to a similar number of the lowest scoring clinic women on their reports of previous psychiatric diagnoses and treatment, and depression or distress related to oral contraceptive use, the premenstrual period, or associated with pregnancy. RESULTS: The forty-four women with high psychologic distress were significantly more likely than the forty-two menopause clinic patients with low psychologic distress to report a past psychiatric diagnosis (usually depression) (p = 0.001), requiring anti-depressant treatment (p = 0.002), oral contraceptive dysphoria (p = 0.004), dysphoric premenstrual syndrome (p = 0.000), postnatal blues (p = 0.02) and postpartum depression (p = 0.004). CONCLUSIONS: Although the halo effect of current distress or retrospective reporting may have biased these results, the similarity of ratings in the two groups on physical symptoms in menopause and psychologic symptoms during pregnancy makes this less likely. These findings corroborate other recent studies showing that women who suffer from affective disorders following one reproductive event are more vulnerable to recurrences associated with others. Clinicians should inquire about possible relationships between previous depression or psychologic distress and reproductive cycle events as it may help predict women who are vulnerable to affective disorders and psychological distress at these critical times.

Adolescent↗
PubMed1997

Autoimmunity and reproduction.

OBJECTIVE: To review the association between autoimmunity and reproductive failure. DESIGN: A MEDLINE search done from 1965 to 1996. More than 300 original and review articles were evaluated, from which the most relevant were selected. RESULT(S): Autoimmune processes now are accepted widely as one of the possible mechanisms of many human diseases. The presence of autoimmune disorders has been associated repeatedly with reproductive failure. On the other hand, reproductive failure may be the first manifestation of autoimmune disorders. CONCLUSION(S): When abnormal autoantibody levels are present in women with reproductive failure, the reproductive failure alone should be considered as one of the possible clinical expressions of autoimmune disorders. Two relevant questions of whether these patients should be treated for autoimmunity remain unsolved. A prospective, placebo-controlled trial is necessary to evaluate the importance of any treatment.

Abortion, Habitual↗
PubMed2006

Obesity and assisted reproductive technology outcomes.

Obesity is a rising health problem in Western societies. It has been related to increased morbidity and mortality rates due to several pathologies. In the field of gynaecology and reproduction, obesity is associated with menstrual disorders, hirsutism, infertility, miscarriage and obstetric complications. It is known to impair human reproduction through different mechanisms such as insulin resistance, hyperandrogenism and elevated leptin levels. Weight management and dietary intervention can reverse this situation and improve reproductive function. Obesity can also impair the outcome of assisted reproductive technologies. The lower probability of a healthy live birth described in obese women seems to be the result of a combination of lower implantation and pregnancy rates, higher preclinical and clinical miscarriage rates and increased complications during pregnancy for both mother and fetus. Studies performed in infertile women undergoing assisted reproduction technologies indicate that the ovary plays a leading, but not exclusive, role in the fertility prognosis of these patients. The endocrine and metabolic environment may affect oocyte quality and, therefore, embryo development, implantation and pregnancy outcome. The endometrium seems to play a subtle role in the more negative reproductive outcome of obese women, according to recent studies based on the ovum donation model.

Endometrium↗
PubMed1999

The future of newborn screening belongs to obstetricians.

Newborn screening has been a mainstay of genetic testing for several decades. Molecular biological techniques, pervasive in genetics and in medicine, are shifting the focus of such testing from enzymology to molecular diagnosis. Concomitant developments in the isolation of fetal cells from maternal blood enable molecular analysis to be performed not just postnatally, but in fact as early as the late first trimester. Potential advantages of first trimester prenatal diagnosis of those disorders currently performed postnatally include more reproductive options for couples, and, in selected cases, the fact that certain genetic disorders can be treated much earlier in development, thereby potentially ameliorating the sequelae of these disorders. Thus, the future of newborn screening will belong as much to the obstetrician as to the pediatrician, if not more so.

Female↗
PubMed2005

Reproductive steroids in context.

The effects of reproductive steroids on the brain are highly context-dependent, a concept necessary to understand disorders of mood related to the reproductive endocrine system.

Affect↗